|
REMOVE BLADDER STONE 52317
|
Professional
|
Both
|
$4,944.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
3014992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$293.51 |
| Max. Negotiated Rate |
$4,884.67 |
| Rate for Payer: Aetna Commercial |
$4,884.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,421.91
|
| Rate for Payer: Aetna Managed Medicare |
$293.51
|
| Rate for Payer: Anthem Medicare Advantage |
$293.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$293.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$293.51
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$4,884.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$373.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.51
|
| Rate for Payer: Health EOS Commercial |
$4,679.00
|
| Rate for Payer: HFN Commercial |
$4,884.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,198.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$293.51
|
| Rate for Payer: Multiplan Commercial |
$4,113.41
|
| Rate for Payer: NAPHCARE Commercial |
$440.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,884.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,262.37
|
| Rate for Payer: Quartz Commercial |
$2,930.80
|
| Rate for Payer: Quartz Medicare Advantage |
$293.51
|
| Rate for Payer: The Alliance Commercial |
$1,247.41
|
| Rate for Payer: United Healthcare Medicaid |
$373.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.51
|
| Rate for Payer: WEA Trust Commercial |
$2,827.97
|
| Rate for Payer: WPS Commercial |
$1,320.79
|
|
|
REMOVE BONE FIXATION DEVICE 20694
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
3013712
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$315.37 |
| Max. Negotiated Rate |
$1,419.16 |
| Rate for Payer: Aetna Commercial |
$1,166.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,056.29
|
| Rate for Payer: Aetna Managed Medicare |
$315.37
|
| Rate for Payer: Anthem Medicare Advantage |
$315.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$315.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$315.37
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cigna Commercial |
$1,166.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.37
|
| Rate for Payer: Health EOS Commercial |
$1,117.70
|
| Rate for Payer: HFN Commercial |
$1,166.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,174.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,174.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$315.37
|
| Rate for Payer: Multiplan Commercial |
$982.59
|
| Rate for Payer: NAPHCARE Commercial |
$473.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.83
|
| Rate for Payer: Quartz Beloit One Network |
$540.43
|
| Rate for Payer: Quartz Commercial |
$700.10
|
| Rate for Payer: Quartz Medicare Advantage |
$315.37
|
| Rate for Payer: The Alliance Commercial |
$1,340.32
|
| Rate for Payer: United Healthcare Medicaid |
$368.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.37
|
| Rate for Payer: WEA Trust Commercial |
$675.53
|
| Rate for Payer: WPS Commercial |
$1,419.16
|
|
|
Remove Drug Implant Device 1198222
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 11982 22
|
| Hospital Charge Code |
4253428
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$524.63 |
| Rate for Payer: Aetna Commercial |
$524.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$524.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.34
|
| Rate for Payer: Health EOS Commercial |
$502.54
|
| Rate for Payer: HFN Commercial |
$524.63
|
| 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: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$524.63
|
| Rate for Payer: Quartz Beloit One Network |
$242.99
|
| Rate for Payer: Quartz Commercial |
$314.78
|
| Rate for Payer: The Alliance Commercial |
$276.12
|
| Rate for Payer: United Healthcare Medicaid |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
REMOVE EAR CANAL LESION(S) 69145
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 69145
|
| Hospital Charge Code |
3015263
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.85 |
| Max. Negotiated Rate |
$1,040.88 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$231.31
|
| Rate for Payer: Anthem Medicare Advantage |
$231.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.31
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.31
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$892.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$892.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.31
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$346.96
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: Quartz Medicare Advantage |
$231.31
|
| Rate for Payer: The Alliance Commercial |
$983.05
|
| Rate for Payer: United Healthcare Medicaid |
$157.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.31
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$1,040.88
|
|
|
REMOVE EYELID FOREIGN BODY 67938
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
3015251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.30 |
| Max. Negotiated Rate |
$710.37 |
| Rate for Payer: Aetna Commercial |
$710.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$100.45
|
| Rate for Payer: Anthem Medicare Advantage |
$100.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.45
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$710.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.45
|
| Rate for Payer: Health EOS Commercial |
$680.46
|
| Rate for Payer: HFN Commercial |
$710.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$410.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.45
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$150.68
|
| Rate for Payer: Preferred Network Access Commercial |
$710.37
|
| Rate for Payer: Quartz Beloit One Network |
$329.01
|
| Rate for Payer: Quartz Commercial |
$426.22
|
| Rate for Payer: Quartz Medicare Advantage |
$100.45
|
| Rate for Payer: The Alliance Commercial |
$426.93
|
| Rate for Payer: United Healthcare Medicaid |
$67.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.45
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$452.04
|
|
|
REMOVE EYELID LINING LESION 68110
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
CPT 68110
|
| Hospital Charge Code |
3015253
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.88 |
| Max. Negotiated Rate |
$858.57 |
| Rate for Payer: Aetna Commercial |
$858.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$777.23
|
| Rate for Payer: Aetna Managed Medicare |
$127.88
|
| Rate for Payer: Anthem Medicare Advantage |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.88
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$858.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$822.42
|
| Rate for Payer: HFN Commercial |
$858.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$517.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$723.01
|
| Rate for Payer: NAPHCARE Commercial |
$191.82
|
| Rate for Payer: Preferred Network Access Commercial |
$858.57
|
| Rate for Payer: Quartz Beloit One Network |
$397.65
|
| Rate for Payer: Quartz Commercial |
$515.14
|
| Rate for Payer: Quartz Medicare Advantage |
$127.88
|
| Rate for Payer: The Alliance Commercial |
$543.48
|
| Rate for Payer: United Healthcare Medicaid |
$94.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.88
|
| Rate for Payer: WEA Trust Commercial |
$497.07
|
| Rate for Payer: WPS Commercial |
$575.45
|
|
|
REMOVE FOREIGN BODY FROM EYE 65220
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
3015219
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.58 |
| Max. Negotiated Rate |
$362.60 |
| Rate for Payer: Aetna Commercial |
$362.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$36.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.58
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$362.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.58
|
| Rate for Payer: Health EOS Commercial |
$347.33
|
| Rate for Payer: HFN Commercial |
$362.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.58
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$54.87
|
| Rate for Payer: Preferred Network Access Commercial |
$362.60
|
| Rate for Payer: Quartz Beloit One Network |
$167.94
|
| Rate for Payer: Quartz Commercial |
$217.56
|
| Rate for Payer: Quartz Medicare Advantage |
$36.58
|
| Rate for Payer: The Alliance Commercial |
$155.45
|
| Rate for Payer: United Healthcare Medicaid |
$47.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.58
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$164.60
|
|
|
REMOVE HIP FOREIGN BODY 27086
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 27086
|
| Hospital Charge Code |
3014012
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$721.89 |
| Rate for Payer: Aetna Commercial |
$564.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$160.42
|
| Rate for Payer: Anthem Medicare Advantage |
$160.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$160.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$160.42
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$564.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.42
|
| Rate for Payer: Health EOS Commercial |
$540.39
|
| Rate for Payer: HFN Commercial |
$564.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$581.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$160.42
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$240.63
|
| Rate for Payer: Preferred Network Access Commercial |
$564.15
|
| Rate for Payer: Quartz Beloit One Network |
$261.29
|
| Rate for Payer: Quartz Commercial |
$338.49
|
| Rate for Payer: Quartz Medicare Advantage |
$160.42
|
| Rate for Payer: The Alliance Commercial |
$681.78
|
| Rate for Payer: United Healthcare Medicaid |
$40.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.42
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$721.89
|
|
|
Remove Impacted Cerumen using Irrigation/lavage 69209
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5034612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$211.43 |
| Rate for Payer: Aetna Commercial |
$211.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$16.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.74
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$211.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.74
|
| Rate for Payer: Health EOS Commercial |
$202.53
|
| Rate for Payer: HFN Commercial |
$211.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$211.43
|
| Rate for Payer: Quartz Beloit One Network |
$97.93
|
| Rate for Payer: Quartz Commercial |
$126.86
|
| Rate for Payer: Quartz Medicare Advantage |
$16.74
|
| Rate for Payer: The Alliance Commercial |
$71.16
|
| Rate for Payer: United Healthcare Medicaid |
$10.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.74
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$75.35
|
|
|
Remove Impacted Cerumen w/instrumentation 69210
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
1188959
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$128.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Aetna Managed Medicare |
$26.24
|
| Rate for Payer: Anthem Medicare Advantage |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.24
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$128.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.24
|
| Rate for Payer: Health EOS Commercial |
$123.03
|
| Rate for Payer: HFN Commercial |
$128.44
|
| 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 |
$26.24
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: NAPHCARE Commercial |
$39.36
|
| Rate for Payer: Preferred Network Access Commercial |
$128.44
|
| Rate for Payer: Quartz Beloit One Network |
$59.49
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$26.24
|
| Rate for Payer: The Alliance Commercial |
$111.52
|
| Rate for Payer: United Healthcare Medicaid |
$14.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.24
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$118.08
|
|
|
Remove Impacted Ear Wax 69210
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
3713511
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$128.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Aetna Managed Medicare |
$26.24
|
| Rate for Payer: Anthem Medicare Advantage |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.24
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$128.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.24
|
| Rate for Payer: Health EOS Commercial |
$123.03
|
| Rate for Payer: HFN Commercial |
$128.44
|
| 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 |
$26.24
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: NAPHCARE Commercial |
$39.36
|
| Rate for Payer: Preferred Network Access Commercial |
$128.44
|
| Rate for Payer: Quartz Beloit One Network |
$59.49
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$26.24
|
| Rate for Payer: The Alliance Commercial |
$111.52
|
| Rate for Payer: United Healthcare Medicaid |
$14.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.24
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$118.08
|
|
|
Remove Impacted Ear Wax 6921050
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
CPT 69210 50
|
| Hospital Charge Code |
3245542
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$256.88 |
| Rate for Payer: Aetna Commercial |
$256.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$256.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.24
|
| Rate for Payer: Health EOS Commercial |
$246.06
|
| Rate for Payer: HFN Commercial |
$256.88
|
| 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: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$256.88
|
| Rate for Payer: Quartz Beloit One Network |
$118.98
|
| Rate for Payer: Quartz Commercial |
$154.13
|
| Rate for Payer: The Alliance Commercial |
$135.20
|
| Rate for Payer: United Healthcare Medicaid |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
REMOVE/INSERT DRUG IMPLANT 11983
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
3013582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.55 |
| Max. Negotiated Rate |
$492.02 |
| Rate for Payer: Aetna Commercial |
$492.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.41
|
| Rate for Payer: Aetna Managed Medicare |
$83.55
|
| Rate for Payer: Anthem Medicare Advantage |
$83.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.55
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$492.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$397.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.55
|
| Rate for Payer: Health EOS Commercial |
$471.31
|
| Rate for Payer: HFN Commercial |
$492.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$354.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.55
|
| Rate for Payer: Multiplan Commercial |
$414.34
|
| Rate for Payer: NAPHCARE Commercial |
$125.33
|
| Rate for Payer: Preferred Network Access Commercial |
$492.02
|
| Rate for Payer: Quartz Beloit One Network |
$227.88
|
| Rate for Payer: Quartz Commercial |
$295.21
|
| Rate for Payer: Quartz Medicare Advantage |
$83.55
|
| Rate for Payer: The Alliance Commercial |
$355.10
|
| Rate for Payer: United Healthcare Medicaid |
$397.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.55
|
| Rate for Payer: WEA Trust Commercial |
$284.86
|
| Rate for Payer: WPS Commercial |
$375.99
|
|
|
Remove/Insert Drug Implant 1198322
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
CPT 11983 22
|
| Hospital Charge Code |
4500624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$273.64 |
| Max. Negotiated Rate |
$590.82 |
| Rate for Payer: Aetna Commercial |
$590.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$590.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$397.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.15
|
| Rate for Payer: Health EOS Commercial |
$565.95
|
| Rate for Payer: HFN Commercial |
$590.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$354.57
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$590.82
|
| Rate for Payer: Quartz Beloit One Network |
$273.64
|
| Rate for Payer: Quartz Commercial |
$354.49
|
| Rate for Payer: The Alliance Commercial |
$310.96
|
| Rate for Payer: United Healthcare Medicaid |
$397.28
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
Remove Intrauterine Device 5830122
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 58301 22
|
| Hospital Charge Code |
4253625
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.28 |
| Max. Negotiated Rate |
$443.61 |
| Rate for Payer: Aetna Commercial |
$443.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$443.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.18
|
| Rate for Payer: Health EOS Commercial |
$424.93
|
| Rate for Payer: HFN Commercial |
$443.61
|
| 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: Multiplan Commercial |
$373.57
|
| Rate for Payer: Preferred Network Access Commercial |
$443.61
|
| Rate for Payer: Quartz Beloit One Network |
$205.46
|
| Rate for Payer: Quartz Commercial |
$266.17
|
| Rate for Payer: The Alliance Commercial |
$233.48
|
| Rate for Payer: United Healthcare Medicaid |
$111.28
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
REMOVE LESION, BACK OR FLANK 21930
|
Professional
|
Both
|
$2,363.00
|
|
|
Service Code
|
CPT 21930
|
| Hospital Charge Code |
3013747
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.96 |
| Max. Negotiated Rate |
$2,334.64 |
| Rate for Payer: Aetna Commercial |
$2,334.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,113.47
|
| Rate for Payer: Aetna Managed Medicare |
$332.96
|
| Rate for Payer: Anthem Medicare Advantage |
$332.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$332.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$332.96
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cash Price |
$708.90
|
| Rate for Payer: Cigna Commercial |
$2,334.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.96
|
| Rate for Payer: Health EOS Commercial |
$2,236.34
|
| Rate for Payer: HFN Commercial |
$2,334.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,246.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,246.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$332.96
|
| Rate for Payer: Multiplan Commercial |
$1,966.02
|
| Rate for Payer: NAPHCARE Commercial |
$499.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,081.31
|
| Rate for Payer: Quartz Commercial |
$1,400.79
|
| Rate for Payer: Quartz Medicare Advantage |
$332.96
|
| Rate for Payer: The Alliance Commercial |
$1,415.06
|
| Rate for Payer: United Healthcare Medicaid |
$405.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.96
|
| Rate for Payer: WEA Trust Commercial |
$1,351.64
|
| Rate for Payer: WPS Commercial |
$1,498.30
|
|
|
REMOVE LESION, BACK OR FLANK 3cm Or GREATER 21931
|
Professional
|
Both
|
$3,719.00
|
|
|
Service Code
|
CPT 21931
|
| Hospital Charge Code |
3013748
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$393.28 |
| Max. Negotiated Rate |
$3,674.37 |
| Rate for Payer: Aetna Commercial |
$3,674.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Aetna Managed Medicare |
$424.23
|
| Rate for Payer: Anthem Medicare Advantage |
$424.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$424.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$424.23
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,674.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$393.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.23
|
| Rate for Payer: Health EOS Commercial |
$3,519.66
|
| Rate for Payer: HFN Commercial |
$3,674.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$424.23
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: NAPHCARE Commercial |
$636.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,674.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.81
|
| Rate for Payer: Quartz Commercial |
$2,204.62
|
| Rate for Payer: Quartz Medicare Advantage |
$424.23
|
| Rate for Payer: The Alliance Commercial |
$1,802.96
|
| Rate for Payer: United Healthcare Medicaid |
$393.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$424.23
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$1,909.02
|
|
|
REMOVE LESION, NECK/CHEST 21555
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 21555
|
| Hospital Charge Code |
3013739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.09 |
| Max. Negotiated Rate |
$1,276.33 |
| Rate for Payer: Aetna Commercial |
$1,015.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.44
|
| Rate for Payer: Aetna Managed Medicare |
$283.63
|
| Rate for Payer: Anthem Medicare Advantage |
$283.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$283.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$283.63
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$1,015.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.63
|
| Rate for Payer: Health EOS Commercial |
$972.90
|
| Rate for Payer: HFN Commercial |
$1,015.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,050.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$283.63
|
| Rate for Payer: Multiplan Commercial |
$855.30
|
| Rate for Payer: NAPHCARE Commercial |
$425.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.66
|
| Rate for Payer: Quartz Beloit One Network |
$470.41
|
| Rate for Payer: Quartz Commercial |
$609.40
|
| Rate for Payer: Quartz Medicare Advantage |
$283.63
|
| Rate for Payer: The Alliance Commercial |
$1,205.42
|
| Rate for Payer: United Healthcare Medicaid |
$87.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.63
|
| Rate for Payer: WEA Trust Commercial |
$588.02
|
| Rate for Payer: WPS Commercial |
$1,276.33
|
|
|
REMOVE LOWER LEG LESION 27618
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
3014114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$1,283.35 |
| Rate for Payer: Aetna Commercial |
$1,179.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,067.91
|
| Rate for Payer: Aetna Managed Medicare |
$285.19
|
| Rate for Payer: Anthem Medicare Advantage |
$285.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$285.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$285.19
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cigna Commercial |
$1,179.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.19
|
| Rate for Payer: Health EOS Commercial |
$1,130.00
|
| Rate for Payer: HFN Commercial |
$1,179.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,050.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$285.19
|
| Rate for Payer: Multiplan Commercial |
$993.41
|
| Rate for Payer: NAPHCARE Commercial |
$427.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.67
|
| Rate for Payer: Quartz Beloit One Network |
$546.37
|
| Rate for Payer: Quartz Commercial |
$707.80
|
| Rate for Payer: Quartz Medicare Advantage |
$285.19
|
| Rate for Payer: The Alliance Commercial |
$1,212.05
|
| Rate for Payer: United Healthcare Medicaid |
$217.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.19
|
| Rate for Payer: WEA Trust Commercial |
$682.97
|
| Rate for Payer: WPS Commercial |
$1,283.35
|
|
|
REMOVE MESH FROM ABD WALL, UNL 2299911008
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
CPT 22999
|
| Hospital Charge Code |
6171942
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$559.64 |
| Max. Negotiated Rate |
$1,208.32 |
| Rate for Payer: Aetna Commercial |
$1,208.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,093.85
|
| Rate for Payer: Cash Price |
$366.90
|
| Rate for Payer: Cash Price |
$366.90
|
| Rate for Payer: Cigna Commercial |
$1,208.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$635.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$763.15
|
| Rate for Payer: Health EOS Commercial |
$1,157.45
|
| Rate for Payer: HFN Commercial |
$1,208.32
|
| Rate for Payer: Multiplan Commercial |
$1,017.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,208.32
|
| Rate for Payer: Quartz Beloit One Network |
$559.64
|
| Rate for Payer: Quartz Commercial |
$724.99
|
| Rate for Payer: The Alliance Commercial |
$635.96
|
| Rate for Payer: WEA Trust Commercial |
$699.56
|
| Rate for Payer: WPS Commercial |
$942.08
|
|
|
REMOVER ANASTOCLIP UNIVERSAL CLIP DISP 4001-00
|
Facility
|
IP
|
$1,731.00
|
|
| Hospital Charge Code |
5298749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$882.12 |
| Max. Negotiated Rate |
$1,656.22 |
| Rate for Payer: Aetna Commercial |
$1,620.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$954.13
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,656.22
|
| Rate for Payer: Health EOS Commercial |
$1,602.21
|
| Rate for Payer: HFN Commercial |
$1,656.22
|
| Rate for Payer: Multiplan Commercial |
$1,440.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,656.22
|
| Rate for Payer: Quartz Beloit One Network |
$882.12
|
| Rate for Payer: Quartz Commercial |
$1,080.14
|
| Rate for Payer: WEA Trust Commercial |
$990.13
|
| Rate for Payer: WPS Commercial |
$1,333.39
|
|
|
REMOVER ANASTOCLIP UNIVERSAL CLIP DISP 4001-00
|
Facility
|
OP
|
$1,731.00
|
|
| Hospital Charge Code |
5298749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$504.07 |
| Max. Negotiated Rate |
$1,656.22 |
| Rate for Payer: Aetna Commercial |
$1,620.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.21
|
| Rate for Payer: Aetna Managed Medicare |
$504.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,170.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$900.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$864.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$954.13
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,656.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,007.44
|
| Rate for Payer: Health EOS Commercial |
$1,602.21
|
| Rate for Payer: HFN Commercial |
$1,656.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,350.18
|
| Rate for Payer: Multiplan Commercial |
$1,440.19
|
| Rate for Payer: NAPHCARE Commercial |
$1,080.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,656.22
|
| Rate for Payer: Quartz Beloit One Network |
$882.12
|
| Rate for Payer: Quartz Commercial |
$1,170.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,080.14
|
| Rate for Payer: The Alliance Commercial |
$900.12
|
| Rate for Payer: WEA Trust Commercial |
$990.13
|
| Rate for Payer: WPS Commercial |
$1,333.39
|
|
|
REMOVER CONTACT LENS DMU ULTRA
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2969598
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
REMOVER CONTACT LENS DMU ULTRA
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2969598
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
REMOVE RENAL TUBE W/FLUORO 50389
|
Professional
|
Both
|
$4,294.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
3014928
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.44 |
| Max. Negotiated Rate |
$4,242.47 |
| Rate for Payer: Aetna Commercial |
$4,242.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,840.55
|
| Rate for Payer: Aetna Managed Medicare |
$44.44
|
| Rate for Payer: Anthem Medicare Advantage |
$44.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.44
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$4,242.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.44
|
| Rate for Payer: Health EOS Commercial |
$4,063.84
|
| Rate for Payer: HFN Commercial |
$4,242.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.44
|
| Rate for Payer: Multiplan Commercial |
$3,572.61
|
| Rate for Payer: NAPHCARE Commercial |
$66.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,242.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.93
|
| Rate for Payer: Quartz Commercial |
$2,545.48
|
| Rate for Payer: Quartz Medicare Advantage |
$44.44
|
| Rate for Payer: The Alliance Commercial |
$188.87
|
| Rate for Payer: United Healthcare Medicaid |
$440.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.44
|
| Rate for Payer: WEA Trust Commercial |
$2,456.17
|
| Rate for Payer: WPS Commercial |
$199.98
|
|
