|
Removal Of Impacted Cerumen With Hearing Test
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
1152806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$26.34
|
| Rate for Payer: Anthem Medicare Advantage |
$26.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.34
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.34
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.34
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$39.51
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$26.34
|
| Rate for Payer: The Alliance Commercial |
$72.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.34
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$46.10
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 20680
|
|
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
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
REMOVAL OF INTRANASAL LESION 30117
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
3014353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$1,647.83 |
| Rate for Payer: Aetna Commercial |
$927.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Aetna Managed Medicare |
$366.18
|
| Rate for Payer: Anthem Medicare Advantage |
$366.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$366.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$366.18
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$927.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.18
|
| Rate for Payer: Health EOS Commercial |
$888.67
|
| Rate for Payer: HFN Commercial |
$927.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,169.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,169.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$366.18
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: NAPHCARE Commercial |
$549.28
|
| Rate for Payer: Preferred Network Access Commercial |
$927.73
|
| Rate for Payer: Quartz Beloit One Network |
$429.69
|
| Rate for Payer: Quartz Commercial |
$556.64
|
| Rate for Payer: Quartz Medicare Advantage |
$366.18
|
| Rate for Payer: The Alliance Commercial |
$1,556.28
|
| Rate for Payer: United Healthcare Medicaid |
$27.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.18
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$1,647.83
|
|
|
Removal Of Intrauterine Device
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
1188879
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$371.49 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$54.64
|
| Rate for Payer: Anthem Medicare Advantage |
$54.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.64
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$371.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.64
|
| Rate for Payer: Health EOS Commercial |
$355.85
|
| Rate for Payer: HFN Commercial |
$371.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$81.96
|
| Rate for Payer: Preferred Network Access Commercial |
$371.49
|
| Rate for Payer: Quartz Beloit One Network |
$172.06
|
| Rate for Payer: Quartz Commercial |
$222.89
|
| Rate for Payer: Quartz Medicare Advantage |
$54.64
|
| Rate for Payer: The Alliance Commercial |
$232.23
|
| Rate for Payer: United Healthcare Medicaid |
$111.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.64
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$245.89
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.69 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
|
|
REMOVAL OF LARYNX LESION 31578
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
CPT 31578
|
| Hospital Charge Code |
3014392
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$2,159.77 |
| Rate for Payer: Aetna Commercial |
$2,159.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.16
|
| Rate for Payer: Aetna Managed Medicare |
$124.11
|
| Rate for Payer: Anthem Medicare Advantage |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.11
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,159.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.11
|
| Rate for Payer: Health EOS Commercial |
$2,068.83
|
| Rate for Payer: HFN Commercial |
$2,159.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.11
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: NAPHCARE Commercial |
$186.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,000.31
|
| Rate for Payer: Quartz Commercial |
$1,295.86
|
| Rate for Payer: Quartz Medicare Advantage |
$124.11
|
| Rate for Payer: The Alliance Commercial |
$527.48
|
| Rate for Payer: United Healthcare Medicaid |
$327.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.11
|
| Rate for Payer: WEA Trust Commercial |
$1,250.39
|
| Rate for Payer: WPS Commercial |
$558.51
|
|
|
Removal of Nail Bed 11750
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
3241482
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.93 |
| Max. Negotiated Rate |
$842.76 |
| Rate for Payer: Aetna Commercial |
$842.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.92
|
| Rate for Payer: Aetna Managed Medicare |
$92.93
|
| Rate for Payer: Anthem Medicare Advantage |
$92.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.93
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$842.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.93
|
| Rate for Payer: Health EOS Commercial |
$807.28
|
| Rate for Payer: HFN Commercial |
$842.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.93
|
| Rate for Payer: Multiplan Commercial |
$709.70
|
| Rate for Payer: NAPHCARE Commercial |
$139.40
|
| Rate for Payer: Preferred Network Access Commercial |
$842.76
|
| Rate for Payer: Quartz Beloit One Network |
$390.33
|
| Rate for Payer: Quartz Commercial |
$505.66
|
| Rate for Payer: Quartz Medicare Advantage |
$92.93
|
| Rate for Payer: The Alliance Commercial |
$394.97
|
| Rate for Payer: United Healthcare Medicaid |
$113.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.93
|
| Rate for Payer: WEA Trust Commercial |
$487.92
|
| Rate for Payer: WPS Commercial |
$418.20
|
|
|
Removal Of Non-Biodegradable Drug Delivery Implant 11982
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
1188881
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$388.28 |
| Rate for Payer: Aetna Commercial |
$388.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$59.61
|
| Rate for Payer: Anthem Medicare Advantage |
$59.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.61
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$388.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.61
|
| Rate for Payer: Health EOS Commercial |
$371.94
|
| Rate for Payer: HFN Commercial |
$388.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.61
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$89.42
|
| Rate for Payer: Preferred Network Access Commercial |
$388.28
|
| Rate for Payer: Quartz Beloit One Network |
$179.84
|
| Rate for Payer: Quartz Commercial |
$232.97
|
| Rate for Payer: Quartz Medicare Advantage |
$59.61
|
| Rate for Payer: The Alliance Commercial |
$253.35
|
| Rate for Payer: United Healthcare Medicaid |
$112.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.61
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$268.26
|
|
|
REMOVAL OF NOSE POLYP(S) 30110
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
3014351
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Aetna Commercial |
$790.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$116.67
|
| Rate for Payer: Anthem Medicare Advantage |
$116.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.67
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$790.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.67
|
| Rate for Payer: Health EOS Commercial |
$757.12
|
| Rate for Payer: HFN Commercial |
$790.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$451.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.67
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.00
|
| Rate for Payer: Preferred Network Access Commercial |
$790.40
|
| Rate for Payer: Quartz Beloit One Network |
$366.08
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: Quartz Medicare Advantage |
$116.67
|
| Rate for Payer: The Alliance Commercial |
$495.84
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.67
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$525.00
|
|
|
REMOVAL OF PILONIDAL LESION 11770
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
3013576
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.37 |
| Max. Negotiated Rate |
$766.68 |
| Rate for Payer: Aetna Commercial |
$718.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$650.23
|
| Rate for Payer: Aetna Managed Medicare |
$170.37
|
| Rate for Payer: Anthem Medicare Advantage |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.37
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$718.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.37
|
| Rate for Payer: Health EOS Commercial |
$688.03
|
| Rate for Payer: HFN Commercial |
$718.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$633.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$633.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.37
|
| Rate for Payer: Multiplan Commercial |
$604.86
|
| Rate for Payer: NAPHCARE Commercial |
$255.56
|
| Rate for Payer: Preferred Network Access Commercial |
$718.28
|
| Rate for Payer: Quartz Beloit One Network |
$332.68
|
| Rate for Payer: Quartz Commercial |
$430.97
|
| Rate for Payer: Quartz Medicare Advantage |
$170.37
|
| Rate for Payer: The Alliance Commercial |
$724.08
|
| Rate for Payer: United Healthcare Medicaid |
$222.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.37
|
| Rate for Payer: WEA Trust Commercial |
$415.84
|
| Rate for Payer: WPS Commercial |
$766.68
|
|
|
REMOVAL OF PILONIDAL LESION 11771
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
3013577
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.64 |
| Max. Negotiated Rate |
$2,543.11 |
| Rate for Payer: Aetna Commercial |
$2,543.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,302.19
|
| Rate for Payer: Aetna Managed Medicare |
$416.64
|
| Rate for Payer: Anthem Medicare Advantage |
$416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$416.64
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna Commercial |
$2,543.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$458.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.64
|
| Rate for Payer: Health EOS Commercial |
$2,436.03
|
| Rate for Payer: HFN Commercial |
$2,543.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,515.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$416.64
|
| Rate for Payer: Multiplan Commercial |
$2,141.57
|
| Rate for Payer: NAPHCARE Commercial |
$624.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,543.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,177.86
|
| Rate for Payer: Quartz Commercial |
$1,525.87
|
| Rate for Payer: Quartz Medicare Advantage |
$416.64
|
| Rate for Payer: The Alliance Commercial |
$1,770.74
|
| Rate for Payer: United Healthcare Medicaid |
$458.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.64
|
| Rate for Payer: WEA Trust Commercial |
$1,472.33
|
| Rate for Payer: WPS Commercial |
$1,874.90
|
|
|
REMOVAL OF PILONIDAL LESION 11772
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
3013578
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$440.73 |
| Max. Negotiated Rate |
$2,445.58 |
| Rate for Payer: Aetna Commercial |
$1,714.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,551.78
|
| Rate for Payer: Aetna Managed Medicare |
$543.46
|
| Rate for Payer: Anthem Medicare Advantage |
$543.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.46
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cigna Commercial |
$1,714.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.46
|
| Rate for Payer: Health EOS Commercial |
$1,642.00
|
| Rate for Payer: HFN Commercial |
$1,714.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,006.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,006.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$543.46
|
| Rate for Payer: Multiplan Commercial |
$1,443.52
|
| Rate for Payer: NAPHCARE Commercial |
$815.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.18
|
| Rate for Payer: Quartz Beloit One Network |
$793.94
|
| Rate for Payer: Quartz Commercial |
$1,028.51
|
| Rate for Payer: Quartz Medicare Advantage |
$543.46
|
| Rate for Payer: The Alliance Commercial |
$2,309.72
|
| Rate for Payer: United Healthcare Medicaid |
$440.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$543.46
|
| Rate for Payer: WEA Trust Commercial |
$992.42
|
| Rate for Payer: WPS Commercial |
$2,445.58
|
|
|
REMOVAL OF SALIVARY STONE 42330
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
3014630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$654.78 |
| Rate for Payer: Aetna Commercial |
$565.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Aetna Managed Medicare |
$145.51
|
| Rate for Payer: Anthem Medicare Advantage |
$145.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$145.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$145.51
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$565.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.51
|
| Rate for Payer: Health EOS Commercial |
$541.34
|
| Rate for Payer: HFN Commercial |
$565.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$145.51
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: NAPHCARE Commercial |
$218.26
|
| Rate for Payer: Preferred Network Access Commercial |
$565.14
|
| Rate for Payer: Quartz Beloit One Network |
$261.75
|
| Rate for Payer: Quartz Commercial |
$339.08
|
| Rate for Payer: Quartz Medicare Advantage |
$145.51
|
| Rate for Payer: The Alliance Commercial |
$618.40
|
| Rate for Payer: United Healthcare Medicaid |
$107.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.51
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
Removal of Salivary Stone 42335
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
CPT 42335
|
| Hospital Charge Code |
3190217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,046.73 |
| Rate for Payer: Aetna Commercial |
$802.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$726.25
|
| Rate for Payer: Aetna Managed Medicare |
$232.61
|
| Rate for Payer: Anthem Medicare Advantage |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$232.61
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$802.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.61
|
| Rate for Payer: Health EOS Commercial |
$768.48
|
| Rate for Payer: HFN Commercial |
$802.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$899.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$899.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$232.61
|
| Rate for Payer: Multiplan Commercial |
$675.58
|
| Rate for Payer: NAPHCARE Commercial |
$348.91
|
| Rate for Payer: Preferred Network Access Commercial |
$802.26
|
| Rate for Payer: Quartz Beloit One Network |
$371.57
|
| Rate for Payer: Quartz Commercial |
$481.35
|
| Rate for Payer: Quartz Medicare Advantage |
$232.61
|
| Rate for Payer: The Alliance Commercial |
$988.58
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.61
|
| Rate for Payer: WEA Trust Commercial |
$464.46
|
| Rate for Payer: WPS Commercial |
$1,046.73
|
|
|
REMOVAL OF SESAMOID BONE 28315
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
3014243
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$1,450.38 |
| Rate for Payer: Aetna Commercial |
$1,450.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$304.74
|
| Rate for Payer: Anthem Medicare Advantage |
$304.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$304.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$304.74
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,450.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.74
|
| Rate for Payer: Health EOS Commercial |
$1,389.32
|
| Rate for Payer: HFN Commercial |
$1,450.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,147.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,147.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$304.74
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$457.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.38
|
| Rate for Payer: Quartz Beloit One Network |
$671.76
|
| Rate for Payer: Quartz Commercial |
$870.23
|
| Rate for Payer: Quartz Medicare Advantage |
$304.74
|
| Rate for Payer: The Alliance Commercial |
$1,295.15
|
| Rate for Payer: United Healthcare Medicaid |
$210.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.74
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,371.33
|
|
|
REMOVAL OF SHOULDER LESION 23075
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
CPT 23075
|
| Hospital Charge Code |
3013763
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$1,374.05 |
| Rate for Payer: Aetna Commercial |
$1,098.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$994.57
|
| Rate for Payer: Aetna Managed Medicare |
$305.34
|
| Rate for Payer: Anthem Medicare Advantage |
$305.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$305.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$305.34
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$1,098.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.34
|
| Rate for Payer: Health EOS Commercial |
$1,052.40
|
| Rate for Payer: HFN Commercial |
$1,098.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,126.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,126.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$305.34
|
| Rate for Payer: Multiplan Commercial |
$925.18
|
| Rate for Payer: NAPHCARE Commercial |
$458.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,098.66
|
| Rate for Payer: Quartz Beloit One Network |
$508.85
|
| Rate for Payer: Quartz Commercial |
$659.19
|
| Rate for Payer: Quartz Medicare Advantage |
$305.34
|
| Rate for Payer: The Alliance Commercial |
$1,297.71
|
| Rate for Payer: United Healthcare Medicaid |
$125.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.34
|
| Rate for Payer: WEA Trust Commercial |
$636.06
|
| Rate for Payer: WPS Commercial |
$1,374.05
|
|
|
Removal Of Skin Tags 15 Or Less 11200
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
1188861
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$307.10 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$68.24
|
| Rate for Payer: Anthem Medicare Advantage |
$68.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.24
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.24
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.24
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$102.37
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$68.24
|
| Rate for Payer: The Alliance Commercial |
$290.04
|
| Rate for Payer: United Healthcare Medicaid |
$41.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.24
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$307.10
|
|
|
Removal Of Skin Tags ea add'l 10 - 11201
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
1188862
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.71
|
| Rate for Payer: Anthem Medicare Advantage |
$12.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.71
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.71
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.06
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.71
|
| Rate for Payer: The Alliance Commercial |
$54.01
|
| Rate for Payer: United Healthcare Medicaid |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.71
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
|
|
REMOVAL OF SUPPORT IMPLANT 20670
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
3013708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$646.15 |
| Rate for Payer: Aetna Commercial |
$646.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.94
|
| Rate for Payer: Aetna Managed Medicare |
$135.89
|
| Rate for Payer: Anthem Medicare Advantage |
$135.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.89
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$646.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.89
|
| Rate for Payer: Health EOS Commercial |
$618.95
|
| Rate for Payer: HFN Commercial |
$646.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.89
|
| Rate for Payer: Multiplan Commercial |
$544.13
|
| Rate for Payer: NAPHCARE Commercial |
$203.83
|
| Rate for Payer: Preferred Network Access Commercial |
$646.15
|
| Rate for Payer: Quartz Beloit One Network |
$299.27
|
| Rate for Payer: Quartz Commercial |
$387.69
|
| Rate for Payer: Quartz Medicare Advantage |
$135.89
|
| Rate for Payer: The Alliance Commercial |
$577.52
|
| Rate for Payer: United Healthcare Medicaid |
$55.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.89
|
| Rate for Payer: WEA Trust Commercial |
$374.09
|
| Rate for Payer: WPS Commercial |
$611.49
|
|
|
REMOVAL OF SUPPORT IMPLANT 20680
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
3013709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$238.25 |
| Max. Negotiated Rate |
$2,368.24 |
| Rate for Payer: Aetna Commercial |
$2,368.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,143.88
|
| Rate for Payer: Aetna Managed Medicare |
$377.55
|
| Rate for Payer: Anthem Medicare Advantage |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.55
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,368.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.55
|
| Rate for Payer: Health EOS Commercial |
$2,268.52
|
| Rate for Payer: HFN Commercial |
$2,368.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,448.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,448.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.55
|
| Rate for Payer: Multiplan Commercial |
$1,994.30
|
| Rate for Payer: NAPHCARE Commercial |
$566.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,368.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.87
|
| Rate for Payer: Quartz Commercial |
$1,420.94
|
| Rate for Payer: Quartz Medicare Advantage |
$377.55
|
| Rate for Payer: The Alliance Commercial |
$1,604.59
|
| Rate for Payer: United Healthcare Medicaid |
$238.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.55
|
| Rate for Payer: WEA Trust Commercial |
$1,371.08
|
| Rate for Payer: WPS Commercial |
$1,698.98
|
|
|
REMOVAL OF TENDON LESION 27630
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
CPT 27630
|
| Hospital Charge Code |
3014116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.34 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Aetna Commercial |
$1,330.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.76
|
| Rate for Payer: Aetna Managed Medicare |
$336.20
|
| Rate for Payer: Anthem Medicare Advantage |
$336.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.20
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,330.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$331.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.20
|
| Rate for Payer: Health EOS Commercial |
$1,274.80
|
| Rate for Payer: HFN Commercial |
$1,330.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,257.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,257.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.20
|
| Rate for Payer: Multiplan Commercial |
$1,120.70
|
| Rate for Payer: NAPHCARE Commercial |
$504.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,330.84
|
| Rate for Payer: Quartz Beloit One Network |
$616.39
|
| Rate for Payer: Quartz Commercial |
$798.50
|
| Rate for Payer: Quartz Medicare Advantage |
$336.20
|
| Rate for Payer: The Alliance Commercial |
$1,428.85
|
| Rate for Payer: United Healthcare Medicaid |
$331.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.20
|
| Rate for Payer: WEA Trust Commercial |
$770.48
|
| Rate for Payer: WPS Commercial |
$1,512.90
|
|
|
REMOVAL OF THIGH LESION 27327
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
3014048
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.67 |
| Max. Negotiated Rate |
$1,322.15 |
| Rate for Payer: Aetna Commercial |
$1,053.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.43
|
| Rate for Payer: Aetna Managed Medicare |
$293.81
|
| Rate for Payer: Anthem Medicare Advantage |
$293.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$293.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$293.81
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$1,053.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.81
|
| Rate for Payer: Health EOS Commercial |
$1,008.86
|
| Rate for Payer: HFN Commercial |
$1,053.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,074.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,074.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$293.81
|
| Rate for Payer: Multiplan Commercial |
$886.91
|
| Rate for Payer: NAPHCARE Commercial |
$440.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.21
|
| Rate for Payer: Quartz Beloit One Network |
$487.80
|
| Rate for Payer: Quartz Commercial |
$631.92
|
| Rate for Payer: Quartz Medicare Advantage |
$293.81
|
| Rate for Payer: The Alliance Commercial |
$1,248.69
|
| Rate for Payer: United Healthcare Medicaid |
$32.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.81
|
| Rate for Payer: WEA Trust Commercial |
$609.75
|
| Rate for Payer: WPS Commercial |
$1,322.15
|
|
|
REMOVAL OF TOE 28150
|
Professional
|
Both
|
$1,797.00
|
|
|
Service Code
|
CPT 28150
|
| Hospital Charge Code |
3014210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,775.44 |
| Rate for Payer: Aetna Commercial |
$1,775.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,607.24
|
| Rate for Payer: Aetna Managed Medicare |
$260.86
|
| Rate for Payer: Anthem Medicare Advantage |
$260.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.86
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cigna Commercial |
$1,775.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.86
|
| Rate for Payer: Health EOS Commercial |
$1,700.68
|
| Rate for Payer: HFN Commercial |
$1,775.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$977.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.86
|
| Rate for Payer: Multiplan Commercial |
$1,495.10
|
| Rate for Payer: NAPHCARE Commercial |
$391.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,775.44
|
| Rate for Payer: Quartz Beloit One Network |
$822.31
|
| Rate for Payer: Quartz Commercial |
$1,065.26
|
| Rate for Payer: Quartz Medicare Advantage |
$260.86
|
| Rate for Payer: The Alliance Commercial |
$1,108.67
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.86
|
| Rate for Payer: WEA Trust Commercial |
$1,027.88
|
| Rate for Payer: WPS Commercial |
$1,173.88
|
|
