|
REMOVAL OF ANAL FISTULA 46285
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
CPT 46285
|
| Hospital Charge Code |
3014839
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,576.05 |
| Rate for Payer: Aetna Commercial |
$1,576.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,426.74
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna Commercial |
$1,576.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$995.40
|
| Rate for Payer: Health EOS Commercial |
$1,509.69
|
| Rate for Payer: HFN Commercial |
$1,576.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,406.60
|
| Rate for Payer: Multiplan Commercial |
$1,327.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,576.05
|
| Rate for Payer: Quartz Beloit One Network |
$729.96
|
| Rate for Payer: Quartz Commercial |
$945.63
|
| Rate for Payer: The Alliance Commercial |
$829.50
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$912.45
|
| Rate for Payer: WPS Commercial |
$1,228.82
|
|
|
Removal of Anal Fistula 4699946270
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
5424643
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$851.20 |
| Rate for Payer: Aetna Commercial |
$851.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$851.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$448.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.60
|
| Rate for Payer: Health EOS Commercial |
$815.36
|
| Rate for Payer: HFN Commercial |
$851.20
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: Preferred Network Access Commercial |
$851.20
|
| Rate for Payer: Quartz Beloit One Network |
$394.24
|
| Rate for Payer: Quartz Commercial |
$510.72
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
REMOVAL OF ANAL TAG 46220
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
3014828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.35 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna Commercial |
$415.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$415.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$397.67
|
| Rate for Payer: HFN Commercial |
$415.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.95
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: Preferred Network Access Commercial |
$415.15
|
| Rate for Payer: Quartz Beloit One Network |
$192.28
|
| Rate for Payer: Quartz Commercial |
$249.09
|
| Rate for Payer: The Alliance Commercial |
$218.50
|
| Rate for Payer: United Healthcare Medicaid |
$174.35
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
REMOVAL OF ARM FOREIGN BODY 24201
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
3013818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$1,212.20 |
| Rate for Payer: Aetna Commercial |
$1,212.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.36
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,212.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.60
|
| Rate for Payer: Health EOS Commercial |
$1,161.16
|
| Rate for Payer: HFN Commercial |
$1,212.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,203.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,203.62
|
| Rate for Payer: Multiplan Commercial |
$1,020.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.20
|
| Rate for Payer: Quartz Beloit One Network |
$561.44
|
| Rate for Payer: Quartz Commercial |
$727.32
|
| Rate for Payer: The Alliance Commercial |
$638.00
|
| Rate for Payer: United Healthcare Medicaid |
$93.40
|
| Rate for Payer: WEA Trust Commercial |
$701.80
|
| Rate for Payer: WPS Commercial |
$945.13
|
|
|
REMOVAL OF BONE FOR GRAFT 20900
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
3013713
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$198.25 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Aetna Commercial |
$914.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$914.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.80
|
| Rate for Payer: Health EOS Commercial |
$876.33
|
| Rate for Payer: HFN Commercial |
$914.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$602.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$602.75
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Preferred Network Access Commercial |
$914.85
|
| Rate for Payer: Quartz Beloit One Network |
$423.72
|
| Rate for Payer: Quartz Commercial |
$548.91
|
| Rate for Payer: The Alliance Commercial |
$481.50
|
| Rate for Payer: United Healthcare Medicaid |
$198.25
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
REMOVAL OF BREAST LESION 19120
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
3013679
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$1,599.80 |
| Rate for Payer: Aetna Commercial |
$1,599.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,599.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$305.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.40
|
| Rate for Payer: Health EOS Commercial |
$1,532.44
|
| Rate for Payer: HFN Commercial |
$1,599.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,357.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,357.25
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.80
|
| Rate for Payer: Quartz Beloit One Network |
$740.96
|
| Rate for Payer: Quartz Commercial |
$959.88
|
| Rate for Payer: The Alliance Commercial |
$842.00
|
| Rate for Payer: United Healthcare Medicaid |
$305.92
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
Removal of Breast Lesion 1912050
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
CPT 19120 50
|
| Hospital Charge Code |
4217287
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$3,200.55 |
| Rate for Payer: Aetna Commercial |
$3,200.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,897.34
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,200.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$305.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,021.40
|
| Rate for Payer: Health EOS Commercial |
$3,065.79
|
| Rate for Payer: HFN Commercial |
$3,200.55
|
| Rate for Payer: Multiplan Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,200.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,482.36
|
| Rate for Payer: Quartz Commercial |
$1,920.33
|
| Rate for Payer: The Alliance Commercial |
$1,684.50
|
| Rate for Payer: United Healthcare Medicaid |
$305.92
|
| Rate for Payer: WEA Trust Commercial |
$1,852.95
|
| Rate for Payer: WPS Commercial |
$2,495.42
|
|
|
REMOVAL OF BREAST TISSUE 19300
|
Professional
|
Both
|
$2,552.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
3013683
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$389.42 |
| Max. Negotiated Rate |
$2,424.40 |
| Rate for Payer: Aetna Commercial |
$2,424.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,194.72
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cigna Commercial |
$2,424.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,531.20
|
| Rate for Payer: Health EOS Commercial |
$2,322.32
|
| Rate for Payer: HFN Commercial |
$2,424.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,407.52
|
| Rate for Payer: Multiplan Commercial |
$2,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,424.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.88
|
| Rate for Payer: Quartz Commercial |
$1,454.64
|
| Rate for Payer: The Alliance Commercial |
$1,276.00
|
| Rate for Payer: United Healthcare Medicaid |
$389.42
|
| Rate for Payer: WEA Trust Commercial |
$1,403.60
|
| Rate for Payer: WPS Commercial |
$1,890.27
|
|
|
Removal of Breast Tissue 1930050
|
Professional
|
Both
|
$5,105.00
|
|
|
Service Code
|
CPT 19300 50
|
| Hospital Charge Code |
5250610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$389.42 |
| Max. Negotiated Rate |
$4,849.75 |
| Rate for Payer: Aetna Commercial |
$4,849.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,390.30
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cigna Commercial |
$4,849.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.00
|
| Rate for Payer: Health EOS Commercial |
$4,645.55
|
| Rate for Payer: HFN Commercial |
$4,849.75
|
| Rate for Payer: Multiplan Commercial |
$4,084.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,849.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.20
|
| Rate for Payer: Quartz Commercial |
$2,909.85
|
| Rate for Payer: The Alliance Commercial |
$2,552.50
|
| Rate for Payer: United Healthcare Medicaid |
$389.42
|
| Rate for Payer: WEA Trust Commercial |
$2,807.75
|
| Rate for Payer: WPS Commercial |
$3,781.27
|
|
|
Removal of Cast 29700
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
2572819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna Commercial |
$124.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$124.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.60
|
| Rate for Payer: Health EOS Commercial |
$119.21
|
| Rate for Payer: HFN Commercial |
$124.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.65
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Preferred Network Access Commercial |
$124.45
|
| Rate for Payer: Quartz Beloit One Network |
$57.64
|
| Rate for Payer: Quartz Commercial |
$74.67
|
| Rate for Payer: The Alliance Commercial |
$65.50
|
| Rate for Payer: United Healthcare Medicaid |
$22.22
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
REMOVAL OF CONTRACEPTIVE CAP 11976
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
3013580
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$601.35 |
| Rate for Payer: Aetna Commercial |
$601.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.38
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$601.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.80
|
| Rate for Payer: Health EOS Commercial |
$576.03
|
| Rate for Payer: HFN Commercial |
$601.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.99
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Preferred Network Access Commercial |
$601.35
|
| Rate for Payer: Quartz Beloit One Network |
$278.52
|
| Rate for Payer: Quartz Commercial |
$360.81
|
| Rate for Payer: The Alliance Commercial |
$316.50
|
| Rate for Payer: United Healthcare Medicaid |
$95.52
|
| Rate for Payer: WEA Trust Commercial |
$348.15
|
| Rate for Payer: WPS Commercial |
$468.86
|
|
|
Removal of Devitalized Tissue from Wound(s)
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
1188991
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$281.38 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.60
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: HFN Commercial |
$157.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.38
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: The Alliance Commercial |
$83.00
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE 40804
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
6209970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$446.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.00
|
| Rate for Payer: Health EOS Commercial |
$427.70
|
| Rate for Payer: HFN Commercial |
$446.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$384.88
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Preferred Network Access Commercial |
$446.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.80
|
| Rate for Payer: Quartz Commercial |
$267.90
|
| Rate for Payer: The Alliance Commercial |
$235.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
REMOVAL OF EYE LESION 65420
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
CPT 65420
|
| Hospital Charge Code |
3015222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$347.68 |
| Max. Negotiated Rate |
$1,507.65 |
| Rate for Payer: Aetna Commercial |
$1,507.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,364.82
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cigna Commercial |
$1,507.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$952.20
|
| Rate for Payer: Health EOS Commercial |
$1,444.17
|
| Rate for Payer: HFN Commercial |
$1,507.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,274.26
|
| Rate for Payer: Multiplan Commercial |
$1,269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,507.65
|
| Rate for Payer: Quartz Beloit One Network |
$698.28
|
| Rate for Payer: Quartz Commercial |
$904.59
|
| Rate for Payer: The Alliance Commercial |
$793.50
|
| Rate for Payer: United Healthcare Medicaid |
$347.68
|
| Rate for Payer: WEA Trust Commercial |
$872.85
|
| Rate for Payer: WPS Commercial |
$1,175.49
|
|
|
Removal Of Fecal Impaction Or Foreign Body
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
1190852
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.14 |
| Max. Negotiated Rate |
$1,268.25 |
| Rate for Payer: Aetna Commercial |
$1,268.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,148.10
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna Commercial |
$1,268.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$801.00
|
| Rate for Payer: Health EOS Commercial |
$1,214.85
|
| Rate for Payer: HFN Commercial |
$1,268.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$1,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.25
|
| Rate for Payer: Quartz Beloit One Network |
$587.40
|
| Rate for Payer: Quartz Commercial |
$760.95
|
| Rate for Payer: The Alliance Commercial |
$667.50
|
| Rate for Payer: United Healthcare Medicaid |
$128.14
|
| Rate for Payer: WEA Trust Commercial |
$734.25
|
| Rate for Payer: WPS Commercial |
$988.83
|
|
|
Removal of Fecal Impaction Or Foreign Body 45999-45915
|
Professional
|
Both
|
$1,334.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
6173584
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.14 |
| Max. Negotiated Rate |
$1,267.30 |
| Rate for Payer: Aetna Commercial |
$1,267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.24
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,267.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.40
|
| Rate for Payer: Health EOS Commercial |
$1,213.94
|
| Rate for Payer: HFN Commercial |
$1,267.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.30
|
| Rate for Payer: Quartz Beloit One Network |
$586.96
|
| Rate for Payer: Quartz Commercial |
$760.38
|
| Rate for Payer: The Alliance Commercial |
$667.00
|
| Rate for Payer: United Healthcare Medicaid |
$128.14
|
| Rate for Payer: WEA Trust Commercial |
$733.70
|
| Rate for Payer: WPS Commercial |
$988.09
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$4,665.56
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,166.39 |
| Max. Negotiated Rate |
$4,665.56 |
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28190
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3014213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.60
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| Rate for Payer: HFN Commercial |
$589.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$449.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$449.79
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$589.95
|
| Rate for Payer: Quartz Beloit One Network |
$273.24
|
| Rate for Payer: Quartz Commercial |
$353.97
|
| Rate for Payer: The Alliance Commercial |
$310.50
|
| Rate for Payer: United Healthcare Medicaid |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28192
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
3014214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.81 |
| Max. Negotiated Rate |
$1,053.03 |
| Rate for Payer: Aetna Commercial |
$462.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.82
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$462.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.20
|
| Rate for Payer: Health EOS Commercial |
$443.17
|
| Rate for Payer: HFN Commercial |
$462.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,053.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,053.03
|
| Rate for Payer: Multiplan Commercial |
$389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$462.65
|
| Rate for Payer: Quartz Beloit One Network |
$214.28
|
| Rate for Payer: Quartz Commercial |
$277.59
|
| Rate for Payer: The Alliance Commercial |
$243.50
|
| Rate for Payer: United Healthcare Medicaid |
$186.81
|
| Rate for Payer: WEA Trust Commercial |
$267.85
|
| Rate for Payer: WPS Commercial |
$360.72
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28193
|
Professional
|
Both
|
$1,746.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
3014215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$1,658.70 |
| Rate for Payer: Aetna Commercial |
$1,658.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,501.56
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$1,658.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,047.60
|
| Rate for Payer: Health EOS Commercial |
$1,588.86
|
| Rate for Payer: HFN Commercial |
$1,658.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,244.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,244.61
|
| Rate for Payer: Multiplan Commercial |
$1,396.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,658.70
|
| Rate for Payer: Quartz Beloit One Network |
$768.24
|
| Rate for Payer: Quartz Commercial |
$995.22
|
| Rate for Payer: The Alliance Commercial |
$873.00
|
| Rate for Payer: United Healthcare Medicaid |
$210.24
|
| Rate for Payer: WEA Trust Commercial |
$960.30
|
| Rate for Payer: WPS Commercial |
$1,293.26
|
|
|
REMOVAL OF FOOT LESION 28080
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
3014194
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$261.69 |
| Max. Negotiated Rate |
$1,352.80 |
| Rate for Payer: Aetna Commercial |
$1,352.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.64
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,352.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$854.40
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,352.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,258.13
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,352.80
|
| Rate for Payer: Quartz Beloit One Network |
$626.56
|
| Rate for Payer: Quartz Commercial |
$811.68
|
| Rate for Payer: The Alliance Commercial |
$712.00
|
| Rate for Payer: United Healthcare Medicaid |
$261.69
|
| Rate for Payer: WEA Trust Commercial |
$783.20
|
| Rate for Payer: WPS Commercial |
$1,054.76
|
|
|
Removal of Foot Lesion 2808050
|
Professional
|
Both
|
$2,844.00
|
|
|
Service Code
|
CPT 28080 50
|
| Hospital Charge Code |
3292170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,251.36 |
| Max. Negotiated Rate |
$2,701.80 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,701.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,422.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,706.40
|
| Rate for Payer: Health EOS Commercial |
$2,588.04
|
| Rate for Payer: HFN Commercial |
$2,701.80
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,251.36
|
| Rate for Payer: Quartz Commercial |
$1,621.08
|
| Rate for Payer: The Alliance Commercial |
$1,422.00
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
REMOVAL OF FOOT LESION 28090
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
3014196
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$359.49 |
| Max. Negotiated Rate |
$1,392.70 |
| Rate for Payer: Aetna Commercial |
$1,392.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,260.76
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,392.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$359.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.60
|
| Rate for Payer: Health EOS Commercial |
$1,334.06
|
| Rate for Payer: HFN Commercial |
$1,392.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,035.17
|
| Rate for Payer: Multiplan Commercial |
$1,172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.70
|
| Rate for Payer: Quartz Beloit One Network |
$645.04
|
| Rate for Payer: Quartz Commercial |
$835.62
|
| Rate for Payer: The Alliance Commercial |
$733.00
|
| Rate for Payer: United Healthcare Medicaid |
$359.49
|
| Rate for Payer: WEA Trust Commercial |
$806.30
|
| Rate for Payer: WPS Commercial |
$1,085.87
|
|
|
REMOVAL OF FOOT LESION 28104
|
Professional
|
Both
|
$2,130.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
3014198
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$2,023.50 |
| Rate for Payer: Aetna Commercial |
$2,023.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,831.80
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$2,023.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,278.00
|
| Rate for Payer: Health EOS Commercial |
$1,938.30
|
| Rate for Payer: HFN Commercial |
$2,023.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,192.26
|
| Rate for Payer: Multiplan Commercial |
$1,704.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.50
|
| Rate for Payer: Quartz Beloit One Network |
$937.20
|
| Rate for Payer: Quartz Commercial |
$1,214.10
|
| Rate for Payer: The Alliance Commercial |
$1,065.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,171.50
|
| Rate for Payer: WPS Commercial |
$1,577.69
|
|
|
REMOVAL OF FOREIGN BODY 27372
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
3014063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.99 |
| Max. Negotiated Rate |
$1,943.70 |
| Rate for Payer: Aetna Commercial |
$1,943.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,943.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,227.60
|
| Rate for Payer: Health EOS Commercial |
$1,861.86
|
| Rate for Payer: HFN Commercial |
$1,943.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,328.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,328.23
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,943.70
|
| Rate for Payer: Quartz Beloit One Network |
$900.24
|
| Rate for Payer: Quartz Commercial |
$1,166.22
|
| Rate for Payer: The Alliance Commercial |
$1,023.00
|
| Rate for Payer: United Healthcare Medicaid |
$156.99
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
