|
Radiation Tx Simple
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
3040394
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$107.38 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Aetna Managed Medicare |
$107.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.29
|
| Rate for Payer: Anthem Medicare Advantage |
$107.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.38
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$107.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$107.38
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$107.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$107.38
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: NAPHCARE Commercial |
$161.07
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$686.82
|
| Rate for Payer: Quartz Medicare Advantage |
$107.38
|
| Rate for Payer: The Alliance Commercial |
$429.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.38
|
| Rate for Payer: United Healthcare PPO |
$792.48
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: Wellcare Medicare |
$107.38
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
Radiation Tx Simple
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
3040394
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$517.75 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$633.98
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (e.g., tenosynovitis, fungus, TBC, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
Radical resection of tumor (e.g., sarcoma), soft tissue of abdominal wall; 5 cm or greater
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 22905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,056.89 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
|
|
Radical resection of tumor (e.g., sarcoma), soft tissue of back or flank; 5 cm or greater
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 21936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,056.89 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
|
|
Radical resection of tumor (e.g., sarcoma), soft tissue of face or scalp; 2 cm or greater
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 21016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,056.89 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
|
|
RADIOFREQUENCY ABLATION, NERVES INNERVATING THE SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED TOMOGRAPHY)
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 64625
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
RADIOFREQUENCY VEIN ABLATION
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
4494794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
RADIOFREQUENCY VEIN ABLATION
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
4494794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
Radiographic Guidance
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2944295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$3,297.94 |
| Rate for Payer: Aetna Commercial |
$3,297.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,297.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,735.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$3,159.08
|
| Rate for Payer: HFN Commercial |
$3,297.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$3,297.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.47
|
| Rate for Payer: Quartz Commercial |
$1,978.77
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
Radiographic Guidance
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2944295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$972.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,256.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,735.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,666.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,942.72
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,603.64
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,082.91
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,256.49
|
| Rate for Payer: Quartz Medicare Advantage |
$2,082.91
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
Radiographic Guidance
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
2944295
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,701.04 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,082.91
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES
|
Facility
|
OP
|
$44.09
|
|
|
Service Code
|
EAPG 00474
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$44.09 |
| Rate for Payer: Anthem Medicaid |
$42.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$42.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.39
|
| Rate for Payer: Dean Health Medicaid |
$42.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42.39
|
| Rate for Payer: Managed Health Services Medicaid |
$44.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$42.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$42.39
|
| Rate for Payer: United Healthcare Medicaid |
$42.39
|
|
|
RADIOSURGERY
|
Facility
|
OP
|
$1,124.19
|
|
|
Service Code
|
EAPG 00346
|
| Min. Negotiated Rate |
$1,080.95 |
| Max. Negotiated Rate |
$1,124.19 |
| Rate for Payer: Anthem Medicaid |
$1,080.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,080.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,080.95
|
| Rate for Payer: Dean Health Medicaid |
$1,080.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,080.95
|
| Rate for Payer: Managed Health Services Medicaid |
$1,124.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,080.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,080.95
|
| Rate for Payer: United Healthcare Medicaid |
$1,080.95
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$10,346.61
|
|
|
Service Code
|
APR-DRG 6921
|
| Min. Negotiated Rate |
$9,190.50 |
| Max. Negotiated Rate |
$10,346.61 |
| Rate for Payer: Anthem Medicaid |
$9,907.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,907.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,907.45
|
| Rate for Payer: Dean Health Medicaid |
$9,907.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$10,346.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,907.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,907.45
|
| Rate for Payer: United Healthcare Medicaid |
$9,907.45
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$15,782.96
|
|
|
Service Code
|
APR-DRG 6922
|
| Min. Negotiated Rate |
$14,019.41 |
| Max. Negotiated Rate |
$15,782.96 |
| Rate for Payer: Anthem Medicaid |
$15,113.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,113.05
|
| Rate for Payer: Dean Health Medicaid |
$15,113.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,019.41
|
| Rate for Payer: Managed Health Services Medicaid |
$15,782.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,113.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,113.05
|
| Rate for Payer: United Healthcare Medicaid |
$15,113.05
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$28,584.69
|
|
|
Service Code
|
APR-DRG 6924
|
| Min. Negotiated Rate |
$25,390.71 |
| Max. Negotiated Rate |
$28,584.69 |
| Rate for Payer: Anthem Medicaid |
$27,371.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,371.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,371.42
|
| Rate for Payer: Dean Health Medicaid |
$27,371.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,390.71
|
| Rate for Payer: Managed Health Services Medicaid |
$28,584.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,371.42
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,371.42
|
| Rate for Payer: United Healthcare Medicaid |
$27,371.42
|
|
|
RADIOTHERAPY
|
Facility
|
OP
|
$30.93
|
|
|
Service Code
|
EAPG 00802
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$30.93 |
| Rate for Payer: Anthem Medicaid |
$29.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$29.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.74
|
| Rate for Payer: Dean Health Medicaid |
$29.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29.74
|
| Rate for Payer: Managed Health Services Medicaid |
$30.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$29.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$29.74
|
| Rate for Payer: United Healthcare Medicaid |
$29.74
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$22,797.61
|
|
|
Service Code
|
APR-DRG 6923
|
| Min. Negotiated Rate |
$20,250.26 |
| Max. Negotiated Rate |
$22,797.61 |
| Rate for Payer: Anthem Medicaid |
$21,829.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,829.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,829.96
|
| Rate for Payer: Dean Health Medicaid |
$21,829.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,250.26
|
| Rate for Payer: Managed Health Services Medicaid |
$22,797.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,829.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,829.96
|
| Rate for Payer: United Healthcare Medicaid |
$21,829.96
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$74,748.96
|
|
|
Service Code
|
MSDRG 849
|
| Min. Negotiated Rate |
$21,256.66 |
| Max. Negotiated Rate |
$74,748.96 |
| Rate for Payer: Aetna Managed Medicare |
$21,256.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,119.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,314.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,051.57
|
| Rate for Payer: Anthem Medicare Advantage |
$21,256.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,256.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,256.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,256.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,791.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,256.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54,581.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,256.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,256.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,256.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,256.66
|
| Rate for Payer: NAPHCARE Commercial |
$31,885.00
|
| Rate for Payer: Quartz Medicare Advantage |
$21,256.66
|
| Rate for Payer: The Alliance Commercial |
$74,748.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,256.66
|
| Rate for Payer: United Healthcare PPO |
$42,492.47
|
| Rate for Payer: Wellcare Medicare |
$21,256.66
|
|
|
Radium 223 (Xofigo)
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
3790004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$620.77 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.36
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
|
|
Radium 223 (Xofigo)
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
3790004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Radium 223 (Xofigo)
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
HCPCS A9606
|
| Hospital Charge Code |
3790004
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$188.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Anthem Medicare Advantage |
$188.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$188.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$188.81
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$188.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$188.81
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$188.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$188.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$188.81
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$283.22
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$188.81
|
| Rate for Payer: The Alliance Commercial |
$755.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.81
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$188.81
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Rad Therapy Mgmt 5 Treatments 77427
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
CPT 77427
|
| Hospital Charge Code |
5258642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$193.72 |
| Max. Negotiated Rate |
$2,683.41 |
| Rate for Payer: Aetna Commercial |
$2,683.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,429.19
|
| Rate for Payer: Aetna Managed Medicare |
$193.72
|
| Rate for Payer: Anthem Medicare Advantage |
$193.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.72
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cash Price |
$814.80
|
| Rate for Payer: Cigna Commercial |
$2,683.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,412.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.72
|
| Rate for Payer: Health EOS Commercial |
$2,570.42
|
| Rate for Payer: HFN Commercial |
$2,683.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$668.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$668.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.72
|
| Rate for Payer: Multiplan Commercial |
$2,259.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,683.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.84
|
| Rate for Payer: Quartz Commercial |
$1,610.04
|
| Rate for Payer: Quartz Medicare Advantage |
$193.72
|
| Rate for Payer: The Alliance Commercial |
$736.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.72
|
| Rate for Payer: WEA Trust Commercial |
$1,553.55
|
| Rate for Payer: WPS Commercial |
$968.60
|
|
|
Rad Therapy Mgmt-Complete 77431
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
CPT 77431
|
| Hospital Charge Code |
5258643
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.56 |
| Max. Negotiated Rate |
$1,408.89 |
| Rate for Payer: Aetna Commercial |
$1,408.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.41
|
| Rate for Payer: Aetna Managed Medicare |
$105.56
|
| Rate for Payer: Anthem Medicare Advantage |
$105.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.56
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,408.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$741.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.56
|
| Rate for Payer: Health EOS Commercial |
$1,349.57
|
| Rate for Payer: HFN Commercial |
$1,408.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$374.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.56
|
| Rate for Payer: Multiplan Commercial |
$1,186.43
|
| Rate for Payer: NAPHCARE Commercial |
$158.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.89
|
| Rate for Payer: Quartz Beloit One Network |
$652.54
|
| Rate for Payer: Quartz Commercial |
$845.33
|
| Rate for Payer: Quartz Medicare Advantage |
$105.56
|
| Rate for Payer: The Alliance Commercial |
$401.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.56
|
| Rate for Payer: WEA Trust Commercial |
$815.67
|
| Rate for Payer: WPS Commercial |
$527.80
|
|
