|
REMOVAL OF SALIVARY STONE 42330
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
3014630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.62 |
| Max. Negotiated Rate |
$548.07 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.20
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$548.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$548.07
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: The Alliance Commercial |
$286.00
|
| Rate for Payer: United Healthcare Medicaid |
$103.62
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
Removal of Salivary Stone 42335
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
CPT 42335
|
| Hospital Charge Code |
3190217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$864.57 |
| Rate for Payer: Aetna Commercial |
$771.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.32
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$771.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$487.20
|
| Rate for Payer: Health EOS Commercial |
$738.92
|
| Rate for Payer: HFN Commercial |
$771.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$864.57
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: Preferred Network Access Commercial |
$771.40
|
| Rate for Payer: Quartz Beloit One Network |
$357.28
|
| Rate for Payer: Quartz Commercial |
$462.84
|
| Rate for Payer: The Alliance Commercial |
$406.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$446.60
|
| Rate for Payer: WPS Commercial |
$601.45
|
|
|
REMOVAL OF SESAMOID BONE 28315
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
CPT 28315
|
| Hospital Charge Code |
3014243
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.15 |
| Max. Negotiated Rate |
$1,394.60 |
| Rate for Payer: Aetna Commercial |
$1,394.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.48
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,394.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$880.80
|
| Rate for Payer: Health EOS Commercial |
$1,335.88
|
| Rate for Payer: HFN Commercial |
$1,394.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,103.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,103.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.60
|
| Rate for Payer: Quartz Beloit One Network |
$645.92
|
| Rate for Payer: Quartz Commercial |
$836.76
|
| Rate for Payer: The Alliance Commercial |
$734.00
|
| Rate for Payer: United Healthcare Medicaid |
$202.15
|
| Rate for Payer: WEA Trust Commercial |
$807.40
|
| Rate for Payer: WPS Commercial |
$1,087.35
|
|
|
REMOVAL OF SHOULDER LESION 23075
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
CPT 23075
|
| Hospital Charge Code |
3013763
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$1,083.64 |
| Rate for Payer: Aetna Commercial |
$1,056.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.32
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$1,056.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.20
|
| Rate for Payer: Health EOS Commercial |
$1,011.92
|
| Rate for Payer: HFN Commercial |
$1,056.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,083.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,083.64
|
| Rate for Payer: Multiplan Commercial |
$889.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.40
|
| Rate for Payer: Quartz Beloit One Network |
$489.28
|
| Rate for Payer: Quartz Commercial |
$633.84
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: United Healthcare Medicaid |
$120.38
|
| Rate for Payer: WEA Trust Commercial |
$611.60
|
| Rate for Payer: WPS Commercial |
$823.66
|
|
|
Removal Of Skin Tags 15 Or Less 11200
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
1188861
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.71 |
| Max. Negotiated Rate |
$251.65 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.64
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.40
|
| Rate for Payer: Health EOS Commercial |
$158.34
|
| Rate for Payer: HFN Commercial |
$165.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.65
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$165.30
|
| Rate for Payer: Quartz Beloit One Network |
$76.56
|
| Rate for Payer: Quartz Commercial |
$99.18
|
| Rate for Payer: The Alliance Commercial |
$87.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.71
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: WPS Commercial |
$128.88
|
|
|
Removal Of Skin Tags ea add'l 10 - 11201
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
1188862
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.00
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: HFN Commercial |
$71.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.57
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$71.25
|
| Rate for Payer: Quartz Beloit One Network |
$33.00
|
| Rate for Payer: Quartz Commercial |
$42.75
|
| Rate for Payer: The Alliance Commercial |
$37.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| 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 |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
|
|
REMOVAL OF SUPPORT IMPLANT 20670
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
3013708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$621.30 |
| Rate for Payer: Aetna Commercial |
$621.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$562.44
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$621.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.40
|
| Rate for Payer: Health EOS Commercial |
$595.14
|
| Rate for Payer: HFN Commercial |
$621.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$484.42
|
| Rate for Payer: Multiplan Commercial |
$523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$621.30
|
| Rate for Payer: Quartz Beloit One Network |
$287.76
|
| Rate for Payer: Quartz Commercial |
$372.78
|
| Rate for Payer: The Alliance Commercial |
$327.00
|
| Rate for Payer: United Healthcare Medicaid |
$53.15
|
| Rate for Payer: WEA Trust Commercial |
$359.70
|
| Rate for Payer: WPS Commercial |
$484.42
|
|
|
REMOVAL OF SUPPORT IMPLANT 20680
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
3013709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.09 |
| Max. Negotiated Rate |
$2,277.15 |
| Rate for Payer: Aetna Commercial |
$2,277.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.42
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,277.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,438.20
|
| Rate for Payer: Health EOS Commercial |
$2,181.27
|
| Rate for Payer: HFN Commercial |
$2,277.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,393.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,393.22
|
| Rate for Payer: Multiplan Commercial |
$1,917.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.68
|
| Rate for Payer: Quartz Commercial |
$1,366.29
|
| Rate for Payer: The Alliance Commercial |
$1,198.50
|
| Rate for Payer: United Healthcare Medicaid |
$229.09
|
| Rate for Payer: WEA Trust Commercial |
$1,318.35
|
| Rate for Payer: WPS Commercial |
$1,775.46
|
|
|
REMOVAL OF TENDON LESION 27630
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
CPT 27630
|
| Hospital Charge Code |
3014116
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.60 |
| Max. Negotiated Rate |
$1,279.65 |
| Rate for Payer: Aetna Commercial |
$1,279.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,158.42
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,279.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$808.20
|
| Rate for Payer: Health EOS Commercial |
$1,225.77
|
| Rate for Payer: HFN Commercial |
$1,279.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,208.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,208.71
|
| Rate for Payer: Multiplan Commercial |
$1,077.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.65
|
| Rate for Payer: Quartz Beloit One Network |
$592.68
|
| Rate for Payer: Quartz Commercial |
$767.79
|
| Rate for Payer: The Alliance Commercial |
$673.50
|
| Rate for Payer: United Healthcare Medicaid |
$318.60
|
| Rate for Payer: WEA Trust Commercial |
$740.85
|
| Rate for Payer: WPS Commercial |
$997.72
|
|
|
REMOVAL OF THIGH LESION 27327
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
CPT 27327
|
| Hospital Charge Code |
3014048
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$1,032.84 |
| Rate for Payer: Aetna Commercial |
$1,012.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$1,012.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$639.60
|
| Rate for Payer: Health EOS Commercial |
$970.06
|
| Rate for Payer: HFN Commercial |
$1,012.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,032.84
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.70
|
| Rate for Payer: Quartz Beloit One Network |
$469.04
|
| Rate for Payer: Quartz Commercial |
$607.62
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.41
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.59
|
|
|
REMOVAL OF TOE 28150
|
Professional
|
Both
|
$1,797.00
|
|
|
Service Code
|
CPT 28150
|
| Hospital Charge Code |
3014210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,707.15 |
| Rate for Payer: Aetna Commercial |
$1,707.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,545.42
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cigna Commercial |
$1,707.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.20
|
| Rate for Payer: Health EOS Commercial |
$1,635.27
|
| Rate for Payer: HFN Commercial |
$1,707.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$940.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$940.11
|
| Rate for Payer: Multiplan Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,707.15
|
| Rate for Payer: Quartz Beloit One Network |
$790.68
|
| Rate for Payer: Quartz Commercial |
$1,024.29
|
| Rate for Payer: The Alliance Commercial |
$898.50
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$988.35
|
| Rate for Payer: WPS Commercial |
$1,331.04
|
|
|
REMOVAL OF TOE LESIONS 28092
|
Professional
|
Both
|
$1,579.00
|
|
|
Service Code
|
CPT 28092
|
| Hospital Charge Code |
3014197
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,500.05 |
| Rate for Payer: Aetna Commercial |
$1,500.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.94
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,500.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$947.40
|
| Rate for Payer: Health EOS Commercial |
$1,436.89
|
| Rate for Payer: HFN Commercial |
$1,500.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$906.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$906.86
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,500.05
|
| Rate for Payer: Quartz Beloit One Network |
$694.76
|
| Rate for Payer: Quartz Commercial |
$900.03
|
| Rate for Payer: The Alliance Commercial |
$789.50
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$868.45
|
| Rate for Payer: WPS Commercial |
$1,169.57
|
|
|
REMOVAL OF TOE LESIONS 28108
|
Professional
|
Both
|
$1,850.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
3014199
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$1,757.50 |
| Rate for Payer: Aetna Commercial |
$1,757.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,591.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$1,757.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,110.00
|
| Rate for Payer: Health EOS Commercial |
$1,683.50
|
| Rate for Payer: HFN Commercial |
$1,757.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.86
|
| Rate for Payer: Multiplan Commercial |
$1,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,757.50
|
| Rate for Payer: Quartz Beloit One Network |
$814.00
|
| Rate for Payer: Quartz Commercial |
$1,054.50
|
| Rate for Payer: The Alliance Commercial |
$925.00
|
| Rate for Payer: United Healthcare Medicaid |
$271.17
|
| Rate for Payer: WEA Trust Commercial |
$1,017.50
|
| Rate for Payer: WPS Commercial |
$1,370.30
|
|
|
Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Periphe
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
1190868
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$245.15 |
| Max. Negotiated Rate |
$1,015.55 |
| Rate for Payer: Aetna Commercial |
$1,015.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,015.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.40
|
| Rate for Payer: Health EOS Commercial |
$972.79
|
| Rate for Payer: HFN Commercial |
$1,015.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.93
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.55
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$609.33
|
| Rate for Payer: The Alliance Commercial |
$534.50
|
| Rate for Payer: United Healthcare Medicaid |
$245.15
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$6,331.88
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,582.97 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| 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 |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
|
|
Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
1190869
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.51 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Aetna Commercial |
$656.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.26
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$656.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$414.60
|
| Rate for Payer: Health EOS Commercial |
$628.81
|
| Rate for Payer: HFN Commercial |
$656.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.63
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Preferred Network Access Commercial |
$656.45
|
| Rate for Payer: Quartz Beloit One Network |
$304.04
|
| Rate for Payer: Quartz Commercial |
$393.87
|
| Rate for Payer: The Alliance Commercial |
$345.50
|
| Rate for Payer: United Healthcare Medicaid |
$151.51
|
| Rate for Payer: WEA Trust Commercial |
$380.05
|
| Rate for Payer: WPS Commercial |
$511.82
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$620.92 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| 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 |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
|
|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$12,602.12
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| 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 |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
REMOVAL OF URETHRA GLAND 53270
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
CPT 53270
|
| Hospital Charge Code |
3015013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Aetna Commercial |
$1,583.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,433.62
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cigna Commercial |
$1,583.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,000.20
|
| Rate for Payer: Health EOS Commercial |
$1,516.97
|
| Rate for Payer: HFN Commercial |
$1,583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.87
|
| Rate for Payer: Multiplan Commercial |
$1,333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.65
|
| Rate for Payer: Quartz Beloit One Network |
$733.48
|
| Rate for Payer: Quartz Commercial |
$950.19
|
| Rate for Payer: The Alliance Commercial |
$833.50
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$916.85
|
| Rate for Payer: WPS Commercial |
$1,234.75
|
|
|
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 57287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| 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 |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
REMOVAL/REVISION OF CAST 29705
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
3014307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$150.55 |
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$109.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$104.65
|
| Rate for Payer: HFN Commercial |
$109.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.55
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Preferred Network Access Commercial |
$109.25
|
| Rate for Payer: Quartz Beloit One Network |
$50.60
|
| Rate for Payer: Quartz Commercial |
$65.55
|
| Rate for Payer: The Alliance Commercial |
$57.50
|
| Rate for Payer: United Healthcare Medicaid |
$24.91
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA 15853
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
6219984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.60
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| Rate for Payer: HFN Commercial |
$24.70
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| Rate for Payer: The Alliance Commercial |
$13.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.38
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
REMOVAL, SWEAT GLAND LESION 11450
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
CPT 11450
|
| Hospital Charge Code |
3013551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$287.34 |
| Max. Negotiated Rate |
$1,378.45 |
| Rate for Payer: Aetna Commercial |
$1,378.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,247.86
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna Commercial |
$1,378.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.60
|
| Rate for Payer: Health EOS Commercial |
$1,320.41
|
| Rate for Payer: HFN Commercial |
$1,378.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$848.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$848.33
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.45
|
| Rate for Payer: Quartz Beloit One Network |
$638.44
|
| Rate for Payer: Quartz Commercial |
$827.07
|
| Rate for Payer: The Alliance Commercial |
$725.50
|
| Rate for Payer: United Healthcare Medicaid |
$287.34
|
| Rate for Payer: WEA Trust Commercial |
$798.05
|
| Rate for Payer: WPS Commercial |
$1,074.76
|
|
|
REMOVAL, SWEAT GLAND LESION 11462
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
3013552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$1,588.40 |
| Rate for Payer: Aetna Commercial |
$1,588.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.92
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$1,588.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$485.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,003.20
|
| Rate for Payer: Health EOS Commercial |
$1,521.52
|
| Rate for Payer: HFN Commercial |
$1,588.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$807.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$807.06
|
| Rate for Payer: Multiplan Commercial |
$1,337.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,588.40
|
| Rate for Payer: Quartz Beloit One Network |
$735.68
|
| Rate for Payer: Quartz Commercial |
$953.04
|
| Rate for Payer: The Alliance Commercial |
$836.00
|
| Rate for Payer: United Healthcare Medicaid |
$485.14
|
| Rate for Payer: WEA Trust Commercial |
$919.60
|
| Rate for Payer: WPS Commercial |
$1,238.45
|
|
