|
REMOVAL OF TOE LESIONS 28092
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
3014197
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,560.05 |
| Rate for Payer: Aetna Commercial |
$1,560.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.26
|
| Rate for Payer: Aetna Managed Medicare |
$256.47
|
| Rate for Payer: Anthem Medicare Advantage |
$256.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.47
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,560.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.47
|
| Rate for Payer: Health EOS Commercial |
$1,494.37
|
| Rate for Payer: HFN Commercial |
$1,560.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$943.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$943.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.47
|
| Rate for Payer: Multiplan Commercial |
$1,313.73
|
| Rate for Payer: NAPHCARE Commercial |
$384.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.05
|
| Rate for Payer: Quartz Beloit One Network |
$722.55
|
| Rate for Payer: Quartz Commercial |
$936.03
|
| Rate for Payer: Quartz Medicare Advantage |
$256.47
|
| Rate for Payer: The Alliance Commercial |
$1,090.02
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.47
|
| Rate for Payer: WEA Trust Commercial |
$903.19
|
| Rate for Payer: WPS Commercial |
$1,154.13
|
|
|
REMOVAL OF TOE LESIONS 28108
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
3014199
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$269.84 |
| Max. Negotiated Rate |
$1,827.80 |
| Rate for Payer: Aetna Commercial |
$1,827.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Aetna Managed Medicare |
$269.84
|
| Rate for Payer: Anthem Medicare Advantage |
$269.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$269.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$269.84
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$1,827.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.84
|
| Rate for Payer: Health EOS Commercial |
$1,750.84
|
| Rate for Payer: HFN Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,009.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,009.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$269.84
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$404.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.80
|
| Rate for Payer: Quartz Beloit One Network |
$846.56
|
| Rate for Payer: Quartz Commercial |
$1,096.68
|
| Rate for Payer: Quartz Medicare Advantage |
$269.84
|
| Rate for Payer: The Alliance Commercial |
$1,146.81
|
| Rate for Payer: United Healthcare Medicaid |
$282.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$269.84
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,214.27
|
|
|
REMOVAL OF TOTAL OR NEAR TOTAL NON-INFECTED MESH OR OTHER PROSTHESIS AT THE TIME OF INITIAL OR RECURRENT ANTERIOR ABDOMINAL HERNIA REPAIR OR PARASTOMAL HERNIA REPAIR, ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$669.01
|
|
|
Service Code
|
CPT 49623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.01 |
| Max. Negotiated Rate |
$669.01 |
| Rate for Payer: The Alliance Commercial |
$669.01
|
|
|
Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Periphe
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
1190868
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.49 |
| Max. Negotiated Rate |
$1,056.17 |
| Rate for Payer: Aetna Commercial |
$1,056.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$164.49
|
| Rate for Payer: Anthem Medicare Advantage |
$164.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.49
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,056.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.49
|
| Rate for Payer: Health EOS Commercial |
$1,011.70
|
| Rate for Payer: HFN Commercial |
$1,056.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$648.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.49
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$246.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.17
|
| Rate for Payer: Quartz Beloit One Network |
$489.17
|
| Rate for Payer: Quartz Commercial |
$633.70
|
| Rate for Payer: Quartz Medicare Advantage |
$164.49
|
| Rate for Payer: The Alliance Commercial |
$699.07
|
| Rate for Payer: United Healthcare Medicaid |
$254.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.49
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$740.19
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$6,626.51
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,656.63 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| 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 |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
|
|
Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
1190869
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$682.71 |
| Rate for Payer: Aetna Commercial |
$682.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$120.13
|
| Rate for Payer: Anthem Medicare Advantage |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.13
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$682.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.13
|
| Rate for Payer: Health EOS Commercial |
$653.96
|
| Rate for Payer: HFN Commercial |
$682.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.13
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.71
|
| Rate for Payer: Quartz Beloit One Network |
$316.20
|
| Rate for Payer: Quartz Commercial |
$409.62
|
| Rate for Payer: Quartz Medicare Advantage |
$120.13
|
| Rate for Payer: The Alliance Commercial |
$510.55
|
| Rate for Payer: United Healthcare Medicaid |
$157.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.13
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$540.59
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$660.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| 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 |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
|
|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REMOVAL OF URETHRA GLAND 53270
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
CPT 53270
|
| Hospital Charge Code |
3015013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$1,647.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,490.96
|
| Rate for Payer: Aetna Managed Medicare |
$164.15
|
| Rate for Payer: Anthem Medicare Advantage |
$164.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.15
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cigna Commercial |
$1,647.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.15
|
| Rate for Payer: Health EOS Commercial |
$1,577.65
|
| Rate for Payer: HFN Commercial |
$1,647.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.15
|
| Rate for Payer: Multiplan Commercial |
$1,386.94
|
| Rate for Payer: NAPHCARE Commercial |
$246.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.00
|
| Rate for Payer: Quartz Beloit One Network |
$762.82
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: Quartz Medicare Advantage |
$164.15
|
| Rate for Payer: The Alliance Commercial |
$697.65
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.15
|
| Rate for Payer: WEA Trust Commercial |
$953.52
|
| Rate for Payer: WPS Commercial |
$738.69
|
|
|
REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES
|
Facility
|
OP
|
$1,623.46
|
|
|
Service Code
|
EAPG 00087
|
| Min. Negotiated Rate |
$1,561.02 |
| Max. Negotiated Rate |
$1,623.46 |
| Rate for Payer: Anthem Medicaid |
$1,561.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,561.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,561.02
|
| Rate for Payer: Dean Health Medicaid |
$1,561.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,561.02
|
| Rate for Payer: Managed Health Services Medicaid |
$1,623.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,561.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,561.02
|
| Rate for Payer: United Healthcare Medicaid |
$1,561.02
|
|
|
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 57287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| 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 |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
REMOVAL/REVISION OF CAST 29705
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
3014307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$174.33 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$38.74
|
| Rate for Payer: Anthem Medicare Advantage |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.74
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.74
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.74
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$58.11
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$38.74
|
| Rate for Payer: The Alliance Commercial |
$164.65
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.74
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$174.33
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA 15853
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
6219984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$58.87 |
| Rate for Payer: Aetna Commercial |
$25.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$25.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$24.61
|
| Rate for Payer: HFN Commercial |
$25.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$25.69
|
| Rate for Payer: Quartz Beloit One Network |
$11.90
|
| Rate for Payer: Quartz Commercial |
$15.41
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$55.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$58.87
|
|
|
REMOVAL, SWEAT GLAND LESION 11450
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
CPT 11450
|
| Hospital Charge Code |
3013551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.24 |
| Max. Negotiated Rate |
$1,433.59 |
| Rate for Payer: Aetna Commercial |
$1,433.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,297.77
|
| Rate for Payer: Aetna Managed Medicare |
$242.24
|
| Rate for Payer: Anthem Medicare Advantage |
$242.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.24
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna Commercial |
$1,433.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.24
|
| Rate for Payer: Health EOS Commercial |
$1,373.23
|
| Rate for Payer: HFN Commercial |
$1,433.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$882.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$882.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.24
|
| Rate for Payer: Multiplan Commercial |
$1,207.23
|
| Rate for Payer: NAPHCARE Commercial |
$363.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.59
|
| Rate for Payer: Quartz Beloit One Network |
$663.98
|
| Rate for Payer: Quartz Commercial |
$860.15
|
| Rate for Payer: Quartz Medicare Advantage |
$242.24
|
| Rate for Payer: The Alliance Commercial |
$1,029.51
|
| Rate for Payer: United Healthcare Medicaid |
$298.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.24
|
| Rate for Payer: WEA Trust Commercial |
$829.97
|
| Rate for Payer: WPS Commercial |
$1,090.07
|
|
|
REMOVAL, SWEAT GLAND LESION 11462
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
3013552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$1,651.94 |
| Rate for Payer: Aetna Commercial |
$1,651.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.44
|
| Rate for Payer: Aetna Managed Medicare |
$231.75
|
| Rate for Payer: Anthem Medicare Advantage |
$231.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.75
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$1,651.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.75
|
| Rate for Payer: Health EOS Commercial |
$1,582.38
|
| Rate for Payer: HFN Commercial |
$1,651.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$839.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$839.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$1,391.10
|
| Rate for Payer: NAPHCARE Commercial |
$347.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,651.94
|
| Rate for Payer: Quartz Beloit One Network |
$765.11
|
| Rate for Payer: Quartz Commercial |
$991.16
|
| Rate for Payer: Quartz Medicare Advantage |
$231.75
|
| Rate for Payer: The Alliance Commercial |
$984.95
|
| Rate for Payer: United Healthcare Medicaid |
$504.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.75
|
| Rate for Payer: WEA Trust Commercial |
$956.38
|
| Rate for Payer: WPS Commercial |
$1,042.89
|
|
|
REMOVAL, SWEAT GLAND LESION 11470
|
Professional
|
Both
|
$2,113.00
|
|
|
Service Code
|
CPT 11470
|
| Hospital Charge Code |
3013553
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.35 |
| Max. Negotiated Rate |
$2,087.64 |
| Rate for Payer: Aetna Commercial |
$2,087.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Aetna Managed Medicare |
$267.35
|
| Rate for Payer: Anthem Medicare Advantage |
$267.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.35
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,087.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.35
|
| Rate for Payer: Health EOS Commercial |
$1,999.74
|
| Rate for Payer: HFN Commercial |
$2,087.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.35
|
| Rate for Payer: Multiplan Commercial |
$1,758.02
|
| Rate for Payer: NAPHCARE Commercial |
$401.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,087.64
|
| Rate for Payer: Quartz Beloit One Network |
$966.91
|
| Rate for Payer: Quartz Commercial |
$1,252.59
|
| Rate for Payer: Quartz Medicare Advantage |
$267.35
|
| Rate for Payer: The Alliance Commercial |
$1,136.25
|
| Rate for Payer: United Healthcare Medicaid |
$328.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.35
|
| Rate for Payer: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: WPS Commercial |
$1,203.09
|
|
|
REMOVAL, SWEAT GLAND LESION 11471
|
Professional
|
Both
|
$2,414.00
|
|
|
Service Code
|
CPT 11471
|
| Hospital Charge Code |
3013554
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$316.64 |
| Max. Negotiated Rate |
$2,385.03 |
| Rate for Payer: Aetna Commercial |
$2,385.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Aetna Managed Medicare |
$316.64
|
| Rate for Payer: Anthem Medicare Advantage |
$316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$316.64
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,385.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.64
|
| Rate for Payer: Health EOS Commercial |
$2,284.61
|
| Rate for Payer: HFN Commercial |
$2,385.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,195.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,195.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$316.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: NAPHCARE Commercial |
$474.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.65
|
| Rate for Payer: Quartz Commercial |
$1,431.02
|
| Rate for Payer: Quartz Medicare Advantage |
$316.64
|
| Rate for Payer: The Alliance Commercial |
$1,345.71
|
| Rate for Payer: United Healthcare Medicaid |
$352.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.64
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,424.87
|
|
|
Removal Tunneled CV Cath 36589
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
3935352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$682.71 |
| Rate for Payer: Aetna Commercial |
$682.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$120.13
|
| Rate for Payer: Anthem Medicare Advantage |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.13
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$682.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.13
|
| Rate for Payer: Health EOS Commercial |
$653.96
|
| Rate for Payer: HFN Commercial |
$682.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.13
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.71
|
| Rate for Payer: Quartz Beloit One Network |
$316.20
|
| Rate for Payer: Quartz Commercial |
$409.62
|
| Rate for Payer: Quartz Medicare Advantage |
$120.13
|
| Rate for Payer: The Alliance Commercial |
$510.55
|
| Rate for Payer: United Healthcare Medicaid |
$157.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.13
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$540.59
|
|
|
Removal Tunneled CV Cath 3658922
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
CPT 36589 22
|
| Hospital Charge Code |
5552206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.57 |
| Max. Negotiated Rate |
$816.09 |
| Rate for Payer: Aetna Commercial |
$816.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.77
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$816.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.42
|
| Rate for Payer: Health EOS Commercial |
$781.73
|
| Rate for Payer: HFN Commercial |
$816.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.94
|
| Rate for Payer: Multiplan Commercial |
$687.23
|
| Rate for Payer: Preferred Network Access Commercial |
$816.09
|
| Rate for Payer: Quartz Beloit One Network |
$377.98
|
| Rate for Payer: Quartz Commercial |
$489.65
|
| Rate for Payer: The Alliance Commercial |
$429.52
|
| Rate for Payer: United Healthcare Medicaid |
$157.57
|
| Rate for Payer: WEA Trust Commercial |
$472.47
|
| Rate for Payer: WPS Commercial |
$636.27
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| 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 |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
REMOVE ARM/ELBOW LESION 24075
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
3013807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$1,373.30 |
| Rate for Payer: Aetna Commercial |
$1,189.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.86
|
| Rate for Payer: Aetna Managed Medicare |
$305.18
|
| Rate for Payer: Anthem Medicare Advantage |
$305.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$305.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$305.18
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$1,189.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.18
|
| Rate for Payer: Health EOS Commercial |
$1,139.47
|
| Rate for Payer: HFN Commercial |
$1,189.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,132.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,132.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$305.18
|
| Rate for Payer: Multiplan Commercial |
$1,001.73
|
| Rate for Payer: NAPHCARE Commercial |
$457.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.55
|
| Rate for Payer: Quartz Beloit One Network |
$550.95
|
| Rate for Payer: Quartz Commercial |
$713.73
|
| Rate for Payer: Quartz Medicare Advantage |
$305.18
|
| Rate for Payer: The Alliance Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare Medicaid |
$81.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.18
|
| Rate for Payer: WEA Trust Commercial |
$688.69
|
| Rate for Payer: WPS Commercial |
$1,373.30
|
|
|
REMOVE BLADDER/REVISE TRACT 51590
|
Professional
|
Both
|
$10,627.00
|
|
|
Service Code
|
CPT 51590
|
| Hospital Charge Code |
3014971
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,650.82 |
| Max. Negotiated Rate |
$10,499.48 |
| Rate for Payer: Aetna Commercial |
$10,499.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,504.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,650.82
|
| Rate for Payer: Anthem Medicare Advantage |
$1,650.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,650.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,650.82
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cigna Commercial |
$10,499.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,193.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,650.82
|
| Rate for Payer: Health EOS Commercial |
$10,057.39
|
| Rate for Payer: HFN Commercial |
$10,499.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,696.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,696.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,650.82
|
| Rate for Payer: Multiplan Commercial |
$8,841.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,476.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,499.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,862.92
|
| Rate for Payer: Quartz Commercial |
$6,299.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,650.82
|
| Rate for Payer: The Alliance Commercial |
$7,016.00
|
| Rate for Payer: United Healthcare Medicaid |
$2,193.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,650.82
|
| Rate for Payer: WEA Trust Commercial |
$6,078.64
|
| Rate for Payer: WPS Commercial |
$7,428.70
|
|
|
REMOVE BLADDER/REVISE TRACT 51595
|
Professional
|
Both
|
$12,086.00
|
|
|
Service Code
|
CPT 51595
|
| Hospital Charge Code |
3014972
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,867.13 |
| Max. Negotiated Rate |
$11,940.97 |
| Rate for Payer: Aetna Commercial |
$11,940.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,809.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,867.13
|
| Rate for Payer: Anthem Medicare Advantage |
$1,867.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,867.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,867.13
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cigna Commercial |
$11,940.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,424.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,867.13
|
| Rate for Payer: Health EOS Commercial |
$11,438.19
|
| Rate for Payer: HFN Commercial |
$11,940.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,579.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,867.13
|
| Rate for Payer: Multiplan Commercial |
$10,055.55
|
| Rate for Payer: NAPHCARE Commercial |
$2,800.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,940.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,530.55
|
| Rate for Payer: Quartz Commercial |
$7,164.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,867.13
|
| Rate for Payer: The Alliance Commercial |
$7,935.31
|
| Rate for Payer: United Healthcare Medicaid |
$2,424.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,867.13
|
| Rate for Payer: WEA Trust Commercial |
$6,913.19
|
| Rate for Payer: WPS Commercial |
$8,402.10
|
|
|
REMOVE BLADDER/REVISE TRACT, EXT 5159022
|
Professional
|
Both
|
$12,752.00
|
|
|
Service Code
|
CPT 51590 22
|
| Hospital Charge Code |
6243936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,193.68 |
| Max. Negotiated Rate |
$12,598.98 |
| Rate for Payer: Aetna Commercial |
$12,598.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,405.39
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cigna Commercial |
$12,598.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,193.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,957.25
|
| Rate for Payer: Health EOS Commercial |
$12,068.49
|
| Rate for Payer: HFN Commercial |
$12,598.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,696.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,696.85
|
| Rate for Payer: Multiplan Commercial |
$10,609.66
|
| Rate for Payer: Preferred Network Access Commercial |
$12,598.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,835.32
|
| Rate for Payer: Quartz Commercial |
$7,559.39
|
| Rate for Payer: The Alliance Commercial |
$6,631.04
|
| Rate for Payer: United Healthcare Medicaid |
$2,193.68
|
| Rate for Payer: WEA Trust Commercial |
$7,294.14
|
| Rate for Payer: WPS Commercial |
$9,822.87
|
|
|
REMOVE BLADDER/REVISE TRACT, EXT 5159522
|
Professional
|
Both
|
$14,507.00
|
|
|
Service Code
|
CPT 51595 22
|
| Hospital Charge Code |
6243513
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,424.62 |
| Max. Negotiated Rate |
$14,332.92 |
| Rate for Payer: Aetna Commercial |
$14,332.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,975.06
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cigna Commercial |
$14,332.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,424.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,052.37
|
| Rate for Payer: Health EOS Commercial |
$13,729.42
|
| Rate for Payer: HFN Commercial |
$14,332.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,579.49
|
| Rate for Payer: Multiplan Commercial |
$12,069.82
|
| Rate for Payer: Preferred Network Access Commercial |
$14,332.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,638.40
|
| Rate for Payer: Quartz Commercial |
$8,599.75
|
| Rate for Payer: The Alliance Commercial |
$7,543.64
|
| Rate for Payer: United Healthcare Medicaid |
$2,424.62
|
| Rate for Payer: WEA Trust Commercial |
$8,298.00
|
| Rate for Payer: WPS Commercial |
$11,174.74
|
|
