|
Remicade 10 mg Charge
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
2958931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$204.05
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
Remicade 10 mg Charge
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
2958931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$32.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.94
|
| Rate for Payer: Anthem Medicare Advantage |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.74
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.74
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.74
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$49.11
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$221.05
|
| Rate for Payer: Quartz Medicare Advantage |
$32.74
|
| Rate for Payer: The Alliance Commercial |
$130.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.74
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: Wellcare Medicare |
$32.74
|
| Rate for Payer: WPS Commercial |
$82.34
|
|
|
Remicade 10 mg Charge
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
2958931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.94
|
| Rate for Payer: Aetna Commercial |
$323.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$32.74
|
| Rate for Payer: Anthem Medicare Advantage |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.74
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$323.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.72
|
| Rate for Payer: Health EOS Commercial |
$309.47
|
| Rate for Payer: HFN Commercial |
$323.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.74
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$49.11
|
| Rate for Payer: Preferred Network Access Commercial |
$323.08
|
| Rate for Payer: Quartz Beloit One Network |
$149.64
|
| Rate for Payer: Quartz Commercial |
$193.85
|
| Rate for Payer: Quartz Medicare Advantage |
$32.74
|
| Rate for Payer: The Alliance Commercial |
$90.03
|
| Rate for Payer: United Healthcare Medicaid |
$33.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.74
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$82.34
|
|
|
Rem Impacted Cerumen Irrigation/LVG Unilat 69209
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4598872
|
|
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
|
|
|
REM INTERROG DEV EVAL ICPMS <30 D PHYS/QHP
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
6182854
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$378.89 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$267.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$197.68
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$267.70
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
REM INTERROG DEV EVAL ICPMS <30 D PHYS/QHP
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 93297
|
| Hospital Charge Code |
6182854
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$378.89 |
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$247.10
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
Rem or Insert Suprapubic Cath
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3005559
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
Rem or Insert Suprapubic Cath
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3005559
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$423.54
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
REMOTE CONTROL IRRIGATION IRD200
|
Facility
|
OP
|
$1,358.00
|
|
| Hospital Charge Code |
3884889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.45 |
| Max. Negotiated Rate |
$1,299.33 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.60
|
| Rate for Payer: Aetna Managed Medicare |
$395.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$918.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$706.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$677.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.53
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,299.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$790.36
|
| Rate for Payer: Health EOS Commercial |
$1,256.96
|
| Rate for Payer: HFN Commercial |
$1,299.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.24
|
| Rate for Payer: Multiplan Commercial |
$1,129.86
|
| Rate for Payer: NAPHCARE Commercial |
$847.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.33
|
| Rate for Payer: Quartz Beloit One Network |
$692.04
|
| Rate for Payer: Quartz Commercial |
$918.01
|
| Rate for Payer: Quartz Medicare Advantage |
$847.39
|
| Rate for Payer: The Alliance Commercial |
$706.16
|
| Rate for Payer: WEA Trust Commercial |
$776.78
|
| Rate for Payer: WPS Commercial |
$1,046.07
|
|
|
REMOTE CONTROL IRRIGATION IRD200
|
Facility
|
IP
|
$1,358.00
|
|
| Hospital Charge Code |
3884889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$692.04 |
| Max. Negotiated Rate |
$1,299.33 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.53
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,299.33
|
| Rate for Payer: Health EOS Commercial |
$1,256.96
|
| Rate for Payer: HFN Commercial |
$1,299.33
|
| Rate for Payer: Multiplan Commercial |
$1,129.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.33
|
| Rate for Payer: Quartz Beloit One Network |
$692.04
|
| Rate for Payer: Quartz Commercial |
$847.39
|
| Rate for Payer: WEA Trust Commercial |
$776.78
|
| Rate for Payer: WPS Commercial |
$1,046.07
|
|
|
Remote Pacer Interogation
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052489
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$265.82
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
Remote Pacer Interogation
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052489
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.66
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$287.98
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$332.28
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE NEPHROURETERAL CATHETER (EG, EXTERNAL/INTERNAL STENT) REQUIRING FLUOROSCOPIC GUIDANCE, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 50387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| 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 |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
REMOVAL FOREIGN BODY, GUM 41805
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
CPT 41805
|
| Hospital Charge Code |
3014620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$848.86 |
| Rate for Payer: Aetna Commercial |
$305.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.37
|
| Rate for Payer: Aetna Managed Medicare |
$188.64
|
| Rate for Payer: Anthem Medicare Advantage |
$188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$188.64
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$305.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.64
|
| Rate for Payer: Health EOS Commercial |
$292.44
|
| Rate for Payer: HFN Commercial |
$305.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$725.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$725.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$188.64
|
| Rate for Payer: Multiplan Commercial |
$257.09
|
| Rate for Payer: NAPHCARE Commercial |
$282.95
|
| Rate for Payer: Preferred Network Access Commercial |
$305.29
|
| Rate for Payer: Quartz Beloit One Network |
$141.40
|
| Rate for Payer: Quartz Commercial |
$183.18
|
| Rate for Payer: Quartz Medicare Advantage |
$188.64
|
| Rate for Payer: The Alliance Commercial |
$801.70
|
| Rate for Payer: United Healthcare Medicaid |
$45.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.64
|
| Rate for Payer: WEA Trust Commercial |
$176.75
|
| Rate for Payer: WPS Commercial |
$848.86
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| 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 |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
REMOVAL HAND LESION SUBCUT 26115
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
3013940
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.30 |
| Max. Negotiated Rate |
$1,529.42 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,384.53
|
| Rate for Payer: Aetna Managed Medicare |
$308.83
|
| Rate for Payer: Anthem Medicare Advantage |
$308.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$308.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$308.83
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna Commercial |
$1,529.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.83
|
| Rate for Payer: Health EOS Commercial |
$1,465.03
|
| Rate for Payer: HFN Commercial |
$1,529.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,150.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,150.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$308.83
|
| Rate for Payer: Multiplan Commercial |
$1,287.94
|
| Rate for Payer: NAPHCARE Commercial |
$463.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,529.42
|
| Rate for Payer: Quartz Beloit One Network |
$708.36
|
| Rate for Payer: Quartz Commercial |
$917.65
|
| Rate for Payer: Quartz Medicare Advantage |
$308.83
|
| Rate for Payer: The Alliance Commercial |
$1,312.52
|
| Rate for Payer: United Healthcare Medicaid |
$114.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$308.83
|
| Rate for Payer: WEA Trust Commercial |
$885.46
|
| Rate for Payer: WPS Commercial |
$1,389.73
|
|
|
Removal impacted cerumen requiring instrumentation, unilateral
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| 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 |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
|
|
Removal LVAD-IMPELLA
|
Facility
|
IP
|
$17,436.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
5128680
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,885.39 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$10,880.06
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
Removal LVAD-IMPELLA
|
Facility
|
OP
|
$17,436.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
5128680
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$603.70 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,077.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,786.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,066.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,704.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,600.08
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: NAPHCARE Commercial |
$10,880.06
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$11,786.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,880.06
|
| Rate for Payer: The Alliance Commercial |
$603.70
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
Removal, non-biodegradable drug delivery implant
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$470.13 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$470.13
|
| 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 |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$470.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$470.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$470.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,748.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$470.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$470.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$470.13
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| Rate for Payer: Quartz Medicare Advantage |
$470.13
|
| Rate for Payer: The Alliance Commercial |
$1,880.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
|
|
REMOVAL OF ANAL FISSURE 46200
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
3014826
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.72 |
| Max. Negotiated Rate |
$1,520.91 |
| Rate for Payer: Aetna Commercial |
$1,397.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,264.68
|
| Rate for Payer: Aetna Managed Medicare |
$337.98
|
| Rate for Payer: Anthem Medicare Advantage |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$337.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$337.98
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$1,397.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.98
|
| Rate for Payer: Health EOS Commercial |
$1,338.21
|
| Rate for Payer: HFN Commercial |
$1,397.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,173.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$337.98
|
| Rate for Payer: Multiplan Commercial |
$1,176.45
|
| Rate for Payer: NAPHCARE Commercial |
$506.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.03
|
| Rate for Payer: Quartz Beloit One Network |
$647.05
|
| Rate for Payer: Quartz Commercial |
$838.22
|
| Rate for Payer: Quartz Medicare Advantage |
$337.98
|
| Rate for Payer: The Alliance Commercial |
$1,436.41
|
| Rate for Payer: United Healthcare Medicaid |
$217.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$337.98
|
| Rate for Payer: WEA Trust Commercial |
$808.81
|
| Rate for Payer: WPS Commercial |
$1,520.91
|
|
|
REMOVAL OF ANAL FISTULA 46270
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
CPT 46270
|
| Hospital Charge Code |
3014836
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,760.90 |
| Rate for Payer: Aetna Commercial |
$936.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.89
|
| Rate for Payer: Aetna Managed Medicare |
$391.31
|
| Rate for Payer: Anthem Medicare Advantage |
$391.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$391.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$391.31
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cigna Commercial |
$936.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.31
|
| Rate for Payer: Health EOS Commercial |
$897.19
|
| Rate for Payer: HFN Commercial |
$936.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,383.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,383.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$391.31
|
| Rate for Payer: Multiplan Commercial |
$788.74
|
| Rate for Payer: NAPHCARE Commercial |
$586.97
|
| Rate for Payer: Preferred Network Access Commercial |
$936.62
|
| Rate for Payer: Quartz Beloit One Network |
$433.80
|
| Rate for Payer: Quartz Commercial |
$561.97
|
| Rate for Payer: Quartz Medicare Advantage |
$391.31
|
| Rate for Payer: The Alliance Commercial |
$1,663.07
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$391.31
|
| Rate for Payer: WEA Trust Commercial |
$542.26
|
| Rate for Payer: WPS Commercial |
$1,760.90
|
|
|
REMOVAL OF ANAL FISTULA 46275
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
CPT 46275
|
| Hospital Charge Code |
3014837
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.21 |
| Max. Negotiated Rate |
$1,977.98 |
| Rate for Payer: Aetna Commercial |
$1,977.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,790.59
|
| Rate for Payer: Aetna Managed Medicare |
$409.21
|
| Rate for Payer: Anthem Medicare Advantage |
$409.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$409.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$409.21
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna Commercial |
$1,977.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$626.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.21
|
| Rate for Payer: Health EOS Commercial |
$1,894.69
|
| Rate for Payer: HFN Commercial |
$1,977.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$409.21
|
| Rate for Payer: Multiplan Commercial |
$1,665.66
|
| Rate for Payer: NAPHCARE Commercial |
$613.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,977.98
|
| Rate for Payer: Quartz Beloit One Network |
$916.12
|
| Rate for Payer: Quartz Commercial |
$1,186.79
|
| Rate for Payer: Quartz Medicare Advantage |
$409.21
|
| Rate for Payer: The Alliance Commercial |
$1,739.14
|
| Rate for Payer: United Healthcare Medicaid |
$626.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$409.21
|
| Rate for Payer: WEA Trust Commercial |
$1,145.14
|
| Rate for Payer: WPS Commercial |
$1,841.44
|
|
|
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 |
$156.69 |
| Max. Negotiated Rate |
$1,847.90 |
| Rate for Payer: Aetna Commercial |
$1,639.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.81
|
| Rate for Payer: Aetna Managed Medicare |
$410.64
|
| Rate for Payer: Anthem Medicare Advantage |
$410.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$410.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$410.64
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna Commercial |
$1,639.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.64
|
| Rate for Payer: Health EOS Commercial |
$1,570.08
|
| Rate for Payer: HFN Commercial |
$1,639.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$410.64
|
| Rate for Payer: Multiplan Commercial |
$1,380.29
|
| Rate for Payer: NAPHCARE Commercial |
$615.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,639.09
|
| Rate for Payer: Quartz Beloit One Network |
$759.16
|
| Rate for Payer: Quartz Commercial |
$983.46
|
| Rate for Payer: Quartz Medicare Advantage |
$410.64
|
| Rate for Payer: The Alliance Commercial |
$1,745.24
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$410.64
|
| Rate for Payer: WEA Trust Commercial |
$948.95
|
| Rate for Payer: WPS Commercial |
$1,847.90
|
|
