|
Removal of Foreign Body: Conjunctival Imbedded
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
1188894
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Aetna Commercial |
$378.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.28
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$378.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.80
|
| Rate for Payer: Health EOS Commercial |
$362.18
|
| Rate for Payer: HFN Commercial |
$378.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.15
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: Preferred Network Access Commercial |
$378.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.12
|
| Rate for Payer: Quartz Commercial |
$226.86
|
| Rate for Payer: The Alliance Commercial |
$199.00
|
| Rate for Payer: United Healthcare Medicaid |
$47.59
|
| Rate for Payer: WEA Trust Commercial |
$218.90
|
| Rate for Payer: WPS Commercial |
$294.80
|
|
|
Removal of Foreign Body: Cornea
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
1188892
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.18 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Aetna Commercial |
$387.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.88
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$387.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.80
|
| Rate for Payer: Health EOS Commercial |
$371.28
|
| Rate for Payer: HFN Commercial |
$387.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.58
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Preferred Network Access Commercial |
$387.60
|
| Rate for Payer: Quartz Beloit One Network |
$179.52
|
| Rate for Payer: Quartz Commercial |
$232.56
|
| Rate for Payer: The Alliance Commercial |
$204.00
|
| Rate for Payer: United Healthcare Medicaid |
$47.18
|
| Rate for Payer: WEA Trust Commercial |
$224.40
|
| Rate for Payer: WPS Commercial |
$302.21
|
|
|
Removal of Foreign Body: External Eye Superficial
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
1188893
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.54 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.58
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$240.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.80
|
| Rate for Payer: Health EOS Commercial |
$230.23
|
| Rate for Payer: HFN Commercial |
$240.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.95
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Preferred Network Access Commercial |
$240.35
|
| Rate for Payer: Quartz Beloit One Network |
$111.32
|
| Rate for Payer: Quartz Commercial |
$144.21
|
| Rate for Payer: The Alliance Commercial |
$126.50
|
| Rate for Payer: United Healthcare Medicaid |
$34.54
|
| Rate for Payer: WEA Trust Commercial |
$139.15
|
| Rate for Payer: WPS Commercial |
$187.40
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
|
Facility
|
OP
|
$7,795.33
|
|
|
Service Code
|
CPT 28193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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 |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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 |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
Removal of Foreign Body from External Auditory Canal
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
1152799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.71 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna Commercial |
$379.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$379.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.40
|
| Rate for Payer: Health EOS Commercial |
$363.09
|
| Rate for Payer: HFN Commercial |
$379.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.71
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.05
|
| Rate for Payer: Quartz Beloit One Network |
$175.56
|
| Rate for Payer: Quartz Commercial |
$227.43
|
| Rate for Payer: The Alliance Commercial |
$199.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.71
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
Removal of foreign body from external auditory canal 6920050
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 69200 50
|
| Hospital Charge Code |
5313690
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.48 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna Commercial |
$609.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$609.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$385.20
|
| Rate for Payer: Health EOS Commercial |
$584.22
|
| Rate for Payer: HFN Commercial |
$609.90
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Preferred Network Access Commercial |
$609.90
|
| Rate for Payer: Quartz Beloit One Network |
$282.48
|
| Rate for Payer: Quartz Commercial |
$365.94
|
| Rate for Payer: The Alliance Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
Removal of foreign body in muscle or tendon; simple
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
1190879
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$493.32 |
| Rate for Payer: Aetna Commercial |
$482.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$482.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.80
|
| Rate for Payer: Health EOS Commercial |
$462.28
|
| Rate for Payer: HFN Commercial |
$482.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$493.32
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.60
|
| Rate for Payer: Quartz Beloit One Network |
$223.52
|
| Rate for Payer: Quartz Commercial |
$289.56
|
| Rate for Payer: The Alliance Commercial |
$254.00
|
| Rate for Payer: United Healthcare Medicaid |
$62.28
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
|
Removal of Foreign Body; Intranasal
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
1152803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.54 |
| Max. Negotiated Rate |
$406.59 |
| Rate for Payer: Aetna Commercial |
$373.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$373.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.80
|
| Rate for Payer: Health EOS Commercial |
$357.63
|
| Rate for Payer: HFN Commercial |
$373.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.59
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$373.35
|
| Rate for Payer: Quartz Beloit One Network |
$172.92
|
| Rate for Payer: Quartz Commercial |
$224.01
|
| Rate for Payer: The Alliance Commercial |
$196.50
|
| Rate for Payer: United Healthcare Medicaid |
$63.54
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
REMOVAL OF HEEL BONE 28118
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
CPT 28118
|
| Hospital Charge Code |
3014204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,735.65 |
| Rate for Payer: Aetna Commercial |
$1,735.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.22
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,735.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,096.20
|
| Rate for Payer: Health EOS Commercial |
$1,662.57
|
| Rate for Payer: HFN Commercial |
$1,735.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,406.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,406.56
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,735.65
|
| Rate for Payer: Quartz Beloit One Network |
$803.88
|
| Rate for Payer: Quartz Commercial |
$1,041.39
|
| Rate for Payer: The Alliance Commercial |
$913.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,004.85
|
| Rate for Payer: WPS Commercial |
$1,353.26
|
|
|
Removal of Heel Bone 2811822
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
CPT 28118 22
|
| Hospital Charge Code |
4592949
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$881.32 |
| Max. Negotiated Rate |
$1,902.85 |
| Rate for Payer: Aetna Commercial |
$1,902.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,722.58
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,902.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,001.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,201.80
|
| Rate for Payer: Health EOS Commercial |
$1,822.73
|
| Rate for Payer: HFN Commercial |
$1,902.85
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,902.85
|
| Rate for Payer: Quartz Beloit One Network |
$881.32
|
| Rate for Payer: Quartz Commercial |
$1,141.71
|
| Rate for Payer: The Alliance Commercial |
$1,001.50
|
| Rate for Payer: WEA Trust Commercial |
$1,101.65
|
| Rate for Payer: WPS Commercial |
$1,483.62
|
|
|
REMOVAL OF HEEL SPUR 28119
|
Professional
|
Both
|
$2,078.00
|
|
|
Service Code
|
CPT 28119
|
| Hospital Charge Code |
3014205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,974.10 |
| Rate for Payer: Aetna Commercial |
$1,974.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,787.08
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$1,974.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,246.80
|
| Rate for Payer: Health EOS Commercial |
$1,890.98
|
| Rate for Payer: HFN Commercial |
$1,974.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,220.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,220.85
|
| Rate for Payer: Multiplan Commercial |
$1,662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,974.10
|
| Rate for Payer: Quartz Beloit One Network |
$914.32
|
| Rate for Payer: Quartz Commercial |
$1,184.46
|
| Rate for Payer: The Alliance Commercial |
$1,039.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,142.90
|
| Rate for Payer: WPS Commercial |
$1,539.17
|
|
|
Removal Of Impacted Cerumen With Hearing Test
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS G0268
|
| Hospital Charge Code |
1152806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.00
|
| Rate for Payer: Health EOS Commercial |
$159.25
|
| Rate for Payer: HFN Commercial |
$166.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.75
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$166.25
|
| Rate for Payer: Quartz Beloit One Network |
$77.00
|
| Rate for Payer: Quartz Commercial |
$99.75
|
| Rate for Payer: The Alliance Commercial |
$87.50
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$11,234.20
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.55 |
| Max. Negotiated Rate |
$11,234.20 |
| Rate for Payer: Aetna Managed Medicare |
$2,808.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,808.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,808.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,808.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,447.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,808.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,808.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,808.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,808.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.55
|
| Rate for Payer: The Alliance Commercial |
$11,234.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,808.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$2,808.55
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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 |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
REMOVAL OF INTRANASAL LESION 30117
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
3014353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$1,124.55 |
| Rate for Payer: Aetna Commercial |
$892.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$892.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.40
|
| Rate for Payer: Health EOS Commercial |
$854.49
|
| Rate for Payer: HFN Commercial |
$892.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,124.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,124.55
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$892.05
|
| Rate for Payer: Quartz Beloit One Network |
$413.16
|
| Rate for Payer: Quartz Commercial |
$535.23
|
| Rate for Payer: The Alliance Commercial |
$469.50
|
| Rate for Payer: United Healthcare Medicaid |
$26.18
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
Removal Of Intrauterine Device
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
1188879
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$357.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.60
|
| Rate for Payer: Health EOS Commercial |
$342.16
|
| Rate for Payer: HFN Commercial |
$357.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.59
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$357.20
|
| Rate for Payer: Quartz Beloit One Network |
$165.44
|
| Rate for Payer: Quartz Commercial |
$214.32
|
| Rate for Payer: The Alliance Commercial |
$188.00
|
| Rate for Payer: United Healthcare Medicaid |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.09 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$317.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$317.09
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Quartz Medicare Advantage |
$317.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.09
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
|
|
REMOVAL OF LARYNX LESION 31578
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
CPT 31578
|
| Hospital Charge Code |
3014392
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$315.34 |
| Max. Negotiated Rate |
$2,076.70 |
| Rate for Payer: Aetna Commercial |
$2,076.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,879.96
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,076.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,311.60
|
| Rate for Payer: Health EOS Commercial |
$1,989.26
|
| Rate for Payer: HFN Commercial |
$2,076.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.86
|
| Rate for Payer: Multiplan Commercial |
$1,748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.70
|
| Rate for Payer: Quartz Beloit One Network |
$961.84
|
| Rate for Payer: Quartz Commercial |
$1,246.02
|
| Rate for Payer: The Alliance Commercial |
$1,093.00
|
| Rate for Payer: United Healthcare Medicaid |
$315.34
|
| Rate for Payer: WEA Trust Commercial |
$1,202.30
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
Removal of Nail Bed 11750
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
3241482
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$810.35 |
| Rate for Payer: Aetna Commercial |
$810.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.58
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$810.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$511.80
|
| Rate for Payer: Health EOS Commercial |
$776.23
|
| Rate for Payer: HFN Commercial |
$810.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.39
|
| Rate for Payer: Multiplan Commercial |
$682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$810.35
|
| Rate for Payer: Quartz Beloit One Network |
$375.32
|
| Rate for Payer: Quartz Commercial |
$486.21
|
| Rate for Payer: The Alliance Commercial |
$426.50
|
| Rate for Payer: United Healthcare Medicaid |
$109.27
|
| Rate for Payer: WEA Trust Commercial |
$469.15
|
| Rate for Payer: WPS Commercial |
$631.82
|
|
|
Removal Of Non-Biodegradable Drug Delivery Implant 11982
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
1188881
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.74 |
| Max. Negotiated Rate |
$373.35 |
| Rate for Payer: Aetna Commercial |
$373.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$337.98
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$373.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.80
|
| Rate for Payer: Health EOS Commercial |
$357.63
|
| Rate for Payer: HFN Commercial |
$373.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.95
|
| Rate for Payer: Multiplan Commercial |
$314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$373.35
|
| Rate for Payer: Quartz Beloit One Network |
$172.92
|
| Rate for Payer: Quartz Commercial |
$224.01
|
| Rate for Payer: The Alliance Commercial |
$196.50
|
| Rate for Payer: United Healthcare Medicaid |
$91.74
|
| Rate for Payer: WEA Trust Commercial |
$216.15
|
| Rate for Payer: WPS Commercial |
$291.10
|
|
|
REMOVAL OF NOSE POLYP(S) 30110
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
3014351
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$760.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$480.00
|
| Rate for Payer: Health EOS Commercial |
$728.00
|
| Rate for Payer: HFN Commercial |
$760.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$434.61
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: Preferred Network Access Commercial |
$760.00
|
| Rate for Payer: Quartz Beloit One Network |
$352.00
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: The Alliance Commercial |
$400.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
REMOVAL OF PILONIDAL LESION 11770
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
3013576
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$214.32 |
| Max. Negotiated Rate |
$690.65 |
| Rate for Payer: Aetna Commercial |
$690.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$625.22
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$690.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$436.20
|
| Rate for Payer: Health EOS Commercial |
$661.57
|
| Rate for Payer: HFN Commercial |
$690.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$609.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$609.07
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.65
|
| Rate for Payer: Quartz Beloit One Network |
$319.88
|
| Rate for Payer: Quartz Commercial |
$414.39
|
| Rate for Payer: The Alliance Commercial |
$363.50
|
| Rate for Payer: United Healthcare Medicaid |
$214.32
|
| Rate for Payer: WEA Trust Commercial |
$399.85
|
| Rate for Payer: WPS Commercial |
$538.49
|
|
|
REMOVAL OF PILONIDAL LESION 11771
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
3013577
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$440.51 |
| Max. Negotiated Rate |
$2,445.30 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,213.64
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna Commercial |
$2,445.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,544.40
|
| Rate for Payer: Health EOS Commercial |
$2,342.34
|
| Rate for Payer: HFN Commercial |
$2,445.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,456.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.80
|
| Rate for Payer: Multiplan Commercial |
$2,059.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,132.56
|
| Rate for Payer: Quartz Commercial |
$1,467.18
|
| Rate for Payer: The Alliance Commercial |
$1,287.00
|
| Rate for Payer: United Healthcare Medicaid |
$440.51
|
| Rate for Payer: WEA Trust Commercial |
$1,415.70
|
| Rate for Payer: WPS Commercial |
$1,906.56
|
|
|
REMOVAL OF PILONIDAL LESION 11772
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
3013578
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$423.78 |
| Max. Negotiated Rate |
$1,929.75 |
| Rate for Payer: Aetna Commercial |
$1,648.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.10
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cigna Commercial |
$1,648.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$423.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.00
|
| Rate for Payer: Health EOS Commercial |
$1,578.85
|
| Rate for Payer: HFN Commercial |
$1,648.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,929.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,929.75
|
| Rate for Payer: Multiplan Commercial |
$1,388.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.25
|
| Rate for Payer: Quartz Beloit One Network |
$763.40
|
| Rate for Payer: Quartz Commercial |
$988.95
|
| Rate for Payer: The Alliance Commercial |
$867.50
|
| Rate for Payer: United Healthcare Medicaid |
$423.78
|
| Rate for Payer: WEA Trust Commercial |
$954.25
|
| Rate for Payer: WPS Commercial |
$1,285.11
|
|
