|
Removal of Anal Fistula 4699946270
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
5424643
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$885.25 |
| Rate for Payer: Aetna Commercial |
$885.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$885.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$465.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.10
|
| Rate for Payer: Health EOS Commercial |
$847.97
|
| Rate for Payer: HFN Commercial |
$885.25
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$885.25
|
| Rate for Payer: Quartz Beloit One Network |
$410.01
|
| Rate for Payer: Quartz Commercial |
$531.15
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
REMOVAL OF ANAL TAG 46220
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
3014828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$516.95 |
| Rate for Payer: Aetna Commercial |
$431.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$114.88
|
| Rate for Payer: Anthem Medicare Advantage |
$114.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.88
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$431.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.88
|
| Rate for Payer: Health EOS Commercial |
$413.58
|
| Rate for Payer: HFN Commercial |
$431.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$415.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.88
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$172.32
|
| Rate for Payer: Preferred Network Access Commercial |
$431.76
|
| Rate for Payer: Quartz Beloit One Network |
$199.97
|
| Rate for Payer: Quartz Commercial |
$259.05
|
| Rate for Payer: Quartz Medicare Advantage |
$114.88
|
| Rate for Payer: The Alliance Commercial |
$488.23
|
| Rate for Payer: United Healthcare Medicaid |
$181.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.88
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$516.95
|
|
|
REMOVAL OF ARM FOREIGN BODY 24201
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
CPT 24201
|
| Hospital Charge Code |
3013818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.14 |
| Max. Negotiated Rate |
$1,689.06 |
| Rate for Payer: Aetna Commercial |
$1,260.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,141.25
|
| Rate for Payer: Aetna Managed Medicare |
$375.35
|
| Rate for Payer: Anthem Medicare Advantage |
$375.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$375.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$375.35
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cash Price |
$382.80
|
| Rate for Payer: Cigna Commercial |
$1,260.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.35
|
| Rate for Payer: Health EOS Commercial |
$1,207.61
|
| Rate for Payer: HFN Commercial |
$1,260.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,251.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,251.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$375.35
|
| Rate for Payer: Multiplan Commercial |
$1,061.63
|
| Rate for Payer: NAPHCARE Commercial |
$563.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.69
|
| Rate for Payer: Quartz Beloit One Network |
$583.90
|
| Rate for Payer: Quartz Commercial |
$756.41
|
| Rate for Payer: Quartz Medicare Advantage |
$375.35
|
| Rate for Payer: The Alliance Commercial |
$1,595.22
|
| Rate for Payer: United Healthcare Medicaid |
$97.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.35
|
| Rate for Payer: WEA Trust Commercial |
$729.87
|
| Rate for Payer: WPS Commercial |
$1,689.06
|
|
|
REMOVAL OF BONE FOR GRAFT 20900
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
CPT 20900
|
| Hospital Charge Code |
3013713
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$153.50 |
| Max. Negotiated Rate |
$951.44 |
| Rate for Payer: Aetna Commercial |
$951.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$153.50
|
| Rate for Payer: Anthem Medicare Advantage |
$153.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.50
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$951.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.50
|
| Rate for Payer: Health EOS Commercial |
$911.38
|
| Rate for Payer: HFN Commercial |
$951.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$626.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$626.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.50
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$951.44
|
| Rate for Payer: Quartz Beloit One Network |
$440.67
|
| Rate for Payer: Quartz Commercial |
$570.87
|
| Rate for Payer: Quartz Medicare Advantage |
$153.50
|
| Rate for Payer: The Alliance Commercial |
$652.39
|
| Rate for Payer: United Healthcare Medicaid |
$206.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$690.77
|
|
|
REMOVAL OF BREAST LESION 19120
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
3013679
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$1,719.01 |
| Rate for Payer: Aetna Commercial |
$1,663.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Aetna Managed Medicare |
$382.00
|
| Rate for Payer: Anthem Medicare Advantage |
$382.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$382.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$382.00
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,663.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.00
|
| Rate for Payer: Health EOS Commercial |
$1,593.74
|
| Rate for Payer: HFN Commercial |
$1,663.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,411.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$382.00
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: NAPHCARE Commercial |
$573.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.79
|
| Rate for Payer: Quartz Beloit One Network |
$770.60
|
| Rate for Payer: Quartz Commercial |
$998.28
|
| Rate for Payer: Quartz Medicare Advantage |
$382.00
|
| Rate for Payer: The Alliance Commercial |
$1,623.51
|
| Rate for Payer: United Healthcare Medicaid |
$318.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$382.00
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,719.01
|
|
|
Removal of Breast Lesion 1912050
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
CPT 19120 50
|
| Hospital Charge Code |
4217287
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$3,328.57 |
| Rate for Payer: Aetna Commercial |
$3,328.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,328.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.26
|
| Rate for Payer: Health EOS Commercial |
$3,188.42
|
| Rate for Payer: HFN Commercial |
$3,328.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,411.54
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.65
|
| Rate for Payer: Quartz Commercial |
$1,997.14
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: United Healthcare Medicaid |
$318.16
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
REMOVAL OF BREAST TISSUE 19300
|
Professional
|
Both
|
$2,552.00
|
|
|
Service Code
|
CPT 19300
|
| Hospital Charge Code |
3013683
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$404.53 |
| Max. Negotiated Rate |
$2,521.38 |
| Rate for Payer: Aetna Commercial |
$2,521.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,282.51
|
| Rate for Payer: Aetna Managed Medicare |
$404.53
|
| Rate for Payer: Anthem Medicare Advantage |
$404.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$404.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$404.53
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cigna Commercial |
$2,521.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.53
|
| Rate for Payer: Health EOS Commercial |
$2,415.21
|
| Rate for Payer: HFN Commercial |
$2,521.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,463.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,463.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$404.53
|
| Rate for Payer: Multiplan Commercial |
$2,123.26
|
| Rate for Payer: NAPHCARE Commercial |
$606.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,521.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.80
|
| Rate for Payer: Quartz Commercial |
$1,512.83
|
| Rate for Payer: Quartz Medicare Advantage |
$404.53
|
| Rate for Payer: The Alliance Commercial |
$1,719.25
|
| Rate for Payer: United Healthcare Medicaid |
$405.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.53
|
| Rate for Payer: WEA Trust Commercial |
$1,459.74
|
| Rate for Payer: WPS Commercial |
$1,820.38
|
|
|
Removal of Breast Tissue 1930050
|
Professional
|
Both
|
$5,105.00
|
|
|
Service Code
|
CPT 19300 50
|
| Hospital Charge Code |
5250610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$5,043.74 |
| Rate for Payer: Aetna Commercial |
$5,043.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,565.91
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cash Price |
$1,531.50
|
| Rate for Payer: Cigna Commercial |
$5,043.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,185.52
|
| Rate for Payer: Health EOS Commercial |
$4,831.37
|
| Rate for Payer: HFN Commercial |
$5,043.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,463.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,463.82
|
| Rate for Payer: Multiplan Commercial |
$4,247.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,043.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.05
|
| Rate for Payer: Quartz Commercial |
$3,026.24
|
| Rate for Payer: The Alliance Commercial |
$2,654.60
|
| Rate for Payer: United Healthcare Medicaid |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,920.06
|
| Rate for Payer: WPS Commercial |
$3,932.38
|
|
|
Removal of Cast 29700
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
2572819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.11 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$129.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$28.74
|
| Rate for Payer: Anthem Medicare Advantage |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.74
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$129.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.74
|
| Rate for Payer: Health EOS Commercial |
$123.98
|
| Rate for Payer: HFN Commercial |
$129.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.74
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$43.10
|
| Rate for Payer: Preferred Network Access Commercial |
$129.43
|
| Rate for Payer: Quartz Beloit One Network |
$59.95
|
| Rate for Payer: Quartz Commercial |
$77.66
|
| Rate for Payer: Quartz Medicare Advantage |
$28.74
|
| Rate for Payer: The Alliance Commercial |
$122.12
|
| Rate for Payer: United Healthcare Medicaid |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$129.31
|
|
|
REMOVAL OF CONTRACEPTIVE CAP 11976
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
3013580
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.63 |
| Max. Negotiated Rate |
$625.40 |
| Rate for Payer: Aetna Commercial |
$625.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.63
|
| Rate for Payer: Anthem Medicare Advantage |
$75.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.63
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cash Price |
$189.90
|
| Rate for Payer: Cigna Commercial |
$625.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.63
|
| Rate for Payer: Health EOS Commercial |
$599.07
|
| Rate for Payer: HFN Commercial |
$625.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.63
|
| Rate for Payer: Multiplan Commercial |
$526.66
|
| Rate for Payer: NAPHCARE Commercial |
$113.44
|
| Rate for Payer: Preferred Network Access Commercial |
$625.40
|
| Rate for Payer: Quartz Beloit One Network |
$289.66
|
| Rate for Payer: Quartz Commercial |
$375.24
|
| Rate for Payer: Quartz Medicare Advantage |
$75.63
|
| Rate for Payer: The Alliance Commercial |
$321.42
|
| Rate for Payer: United Healthcare Medicaid |
$128.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.63
|
| Rate for Payer: WEA Trust Commercial |
$362.08
|
| Rate for Payer: WPS Commercial |
$340.33
|
|
|
Removal of Devitalized Tissue from Wound(s)
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
1188991
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.96 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$164.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.58
|
| Rate for Payer: Health EOS Commercial |
$157.10
|
| Rate for Payer: HFN Commercial |
$164.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.64
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$164.01
|
| Rate for Payer: Quartz Beloit One Network |
$75.96
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: The Alliance Commercial |
$86.32
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
REMOVAL OF DRUG-DELIVERY DEVICE(S), INTRA-ARTICULAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$396.70
|
|
|
Service Code
|
CPT 20705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$396.70 |
| Max. Negotiated Rate |
$396.70 |
| Rate for Payer: The Alliance Commercial |
$396.70
|
|
|
REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; SIMPLE 40804
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
6209970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$507.17 |
| Rate for Payer: Aetna Commercial |
$464.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$112.70
|
| Rate for Payer: Anthem Medicare Advantage |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.70
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$464.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.70
|
| Rate for Payer: Health EOS Commercial |
$444.81
|
| Rate for Payer: HFN Commercial |
$464.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$400.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.70
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$169.06
|
| Rate for Payer: Preferred Network Access Commercial |
$464.36
|
| Rate for Payer: Quartz Beloit One Network |
$215.07
|
| Rate for Payer: Quartz Commercial |
$278.62
|
| Rate for Payer: Quartz Medicare Advantage |
$112.70
|
| Rate for Payer: The Alliance Commercial |
$479.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.70
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$507.17
|
|
|
REMOVAL OF EYE LESION 65420
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
CPT 65420
|
| Hospital Charge Code |
3015222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.74 |
| Max. Negotiated Rate |
$1,567.96 |
| Rate for Payer: Aetna Commercial |
$1,567.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,419.41
|
| Rate for Payer: Aetna Managed Medicare |
$331.74
|
| Rate for Payer: Anthem Medicare Advantage |
$331.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331.74
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cash Price |
$476.10
|
| Rate for Payer: Cigna Commercial |
$1,567.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.74
|
| Rate for Payer: Health EOS Commercial |
$1,501.94
|
| Rate for Payer: HFN Commercial |
$1,567.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,325.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,325.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331.74
|
| Rate for Payer: Multiplan Commercial |
$1,320.38
|
| Rate for Payer: NAPHCARE Commercial |
$497.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,567.96
|
| Rate for Payer: Quartz Beloit One Network |
$726.21
|
| Rate for Payer: Quartz Commercial |
$940.77
|
| Rate for Payer: Quartz Medicare Advantage |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$1,409.89
|
| Rate for Payer: United Healthcare Medicaid |
$361.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331.74
|
| Rate for Payer: WEA Trust Commercial |
$907.76
|
| Rate for Payer: WPS Commercial |
$1,492.83
|
|
|
Removal Of Fecal Impaction Or Foreign Body
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
1190852
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$1,318.98 |
| Rate for Payer: Aetna Commercial |
$1,318.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.02
|
| Rate for Payer: Aetna Managed Medicare |
$221.49
|
| Rate for Payer: Anthem Medicare Advantage |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$221.49
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna Commercial |
$1,318.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.49
|
| Rate for Payer: Health EOS Commercial |
$1,263.44
|
| Rate for Payer: HFN Commercial |
$1,318.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$801.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$221.49
|
| Rate for Payer: Multiplan Commercial |
$1,110.72
|
| Rate for Payer: NAPHCARE Commercial |
$332.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,318.98
|
| Rate for Payer: Quartz Beloit One Network |
$610.90
|
| Rate for Payer: Quartz Commercial |
$791.39
|
| Rate for Payer: Quartz Medicare Advantage |
$221.49
|
| Rate for Payer: The Alliance Commercial |
$941.33
|
| Rate for Payer: United Healthcare Medicaid |
$133.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.49
|
| Rate for Payer: WEA Trust Commercial |
$763.62
|
| Rate for Payer: WPS Commercial |
$996.70
|
|
|
Removal of Fecal Impaction Or Foreign Body 45999-45915
|
Professional
|
Both
|
$1,334.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
6173584
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$1,317.99 |
| Rate for Payer: Aetna Commercial |
$1,317.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.13
|
| Rate for Payer: Aetna Managed Medicare |
$221.49
|
| Rate for Payer: Anthem Medicare Advantage |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$221.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$221.49
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,317.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.49
|
| Rate for Payer: Health EOS Commercial |
$1,262.50
|
| Rate for Payer: HFN Commercial |
$1,317.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$801.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$221.49
|
| Rate for Payer: Multiplan Commercial |
$1,109.89
|
| Rate for Payer: NAPHCARE Commercial |
$332.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.99
|
| Rate for Payer: Quartz Beloit One Network |
$610.44
|
| Rate for Payer: Quartz Commercial |
$790.80
|
| Rate for Payer: Quartz Medicare Advantage |
$221.49
|
| Rate for Payer: The Alliance Commercial |
$941.33
|
| Rate for Payer: United Healthcare Medicaid |
$133.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$221.49
|
| Rate for Payer: WEA Trust Commercial |
$763.05
|
| Rate for Payer: WPS Commercial |
$996.70
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$5,037.34
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.34 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| 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 |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28190
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3014213
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.54 |
| Max. Negotiated Rate |
$613.55 |
| Rate for Payer: Aetna Commercial |
$613.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.24
|
| Rate for Payer: Anthem Medicare Advantage |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.24
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$613.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.24
|
| Rate for Payer: Health EOS Commercial |
$587.71
|
| Rate for Payer: HFN Commercial |
$613.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$467.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$467.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.24
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$187.86
|
| Rate for Payer: Preferred Network Access Commercial |
$613.55
|
| Rate for Payer: Quartz Beloit One Network |
$284.17
|
| Rate for Payer: Quartz Commercial |
$368.13
|
| Rate for Payer: Quartz Medicare Advantage |
$125.24
|
| Rate for Payer: The Alliance Commercial |
$532.26
|
| Rate for Payer: United Healthcare Medicaid |
$43.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.24
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$563.57
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28192
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
3014214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.28 |
| Max. Negotiated Rate |
$1,300.15 |
| Rate for Payer: Aetna Commercial |
$481.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.57
|
| Rate for Payer: Aetna Managed Medicare |
$288.92
|
| Rate for Payer: Anthem Medicare Advantage |
$288.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.92
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.92
|
| Rate for Payer: Health EOS Commercial |
$460.90
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,095.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.92
|
| Rate for Payer: Multiplan Commercial |
$405.18
|
| Rate for Payer: NAPHCARE Commercial |
$433.38
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$222.85
|
| Rate for Payer: Quartz Commercial |
$288.69
|
| Rate for Payer: Quartz Medicare Advantage |
$288.92
|
| Rate for Payer: The Alliance Commercial |
$1,227.92
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.92
|
| Rate for Payer: WEA Trust Commercial |
$278.56
|
| Rate for Payer: WPS Commercial |
$1,300.15
|
|
|
REMOVAL OF FOOT FOREIGN BODY 28193
|
Professional
|
Both
|
$1,746.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
3014215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.65 |
| Max. Negotiated Rate |
$1,725.05 |
| Rate for Payer: Aetna Commercial |
$1,725.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,561.62
|
| Rate for Payer: Aetna Managed Medicare |
$336.19
|
| Rate for Payer: Anthem Medicare Advantage |
$336.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.19
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$1,725.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.19
|
| Rate for Payer: Health EOS Commercial |
$1,652.41
|
| Rate for Payer: HFN Commercial |
$1,725.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,294.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,294.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.19
|
| Rate for Payer: Multiplan Commercial |
$1,452.67
|
| Rate for Payer: NAPHCARE Commercial |
$504.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.05
|
| Rate for Payer: Quartz Beloit One Network |
$798.97
|
| Rate for Payer: Quartz Commercial |
$1,035.03
|
| Rate for Payer: Quartz Medicare Advantage |
$336.19
|
| Rate for Payer: The Alliance Commercial |
$1,428.81
|
| Rate for Payer: United Healthcare Medicaid |
$218.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.19
|
| Rate for Payer: WEA Trust Commercial |
$998.71
|
| Rate for Payer: WPS Commercial |
$1,512.86
|
|
|
REMOVAL OF FOOT LESION 28080
|
Professional
|
Both
|
$1,424.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
3014194
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$1,632.99 |
| Rate for Payer: Aetna Commercial |
$1,406.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$362.89
|
| Rate for Payer: Anthem Medicare Advantage |
$362.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$362.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$362.89
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,406.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$272.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$362.89
|
| Rate for Payer: Health EOS Commercial |
$1,347.67
|
| Rate for Payer: HFN Commercial |
$1,406.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,308.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$362.89
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$544.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.91
|
| Rate for Payer: Quartz Beloit One Network |
$651.62
|
| Rate for Payer: Quartz Commercial |
$844.15
|
| Rate for Payer: Quartz Medicare Advantage |
$362.89
|
| Rate for Payer: The Alliance Commercial |
$1,542.27
|
| Rate for Payer: United Healthcare Medicaid |
$272.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.89
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,632.99
|
|
|
Removal of Foot Lesion 2808050
|
Professional
|
Both
|
$2,844.00
|
|
|
Service Code
|
CPT 28080 50
|
| Hospital Charge Code |
3292170
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$2,809.87 |
| Rate for Payer: Aetna Commercial |
$2,809.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,543.67
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,809.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$272.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.66
|
| Rate for Payer: Health EOS Commercial |
$2,691.56
|
| Rate for Payer: HFN Commercial |
$2,809.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,308.46
|
| Rate for Payer: Multiplan Commercial |
$2,366.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,301.41
|
| Rate for Payer: Quartz Commercial |
$1,685.92
|
| Rate for Payer: The Alliance Commercial |
$1,478.88
|
| Rate for Payer: United Healthcare Medicaid |
$272.16
|
| Rate for Payer: WEA Trust Commercial |
$1,626.77
|
| Rate for Payer: WPS Commercial |
$2,190.73
|
|
|
REMOVAL OF FOOT LESION 28090
|
Professional
|
Both
|
$1,466.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
3014196
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$289.15 |
| Max. Negotiated Rate |
$1,448.41 |
| Rate for Payer: Aetna Commercial |
$1,448.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Aetna Managed Medicare |
$289.15
|
| Rate for Payer: Anthem Medicare Advantage |
$289.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$289.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$289.15
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,448.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$373.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.15
|
| Rate for Payer: Health EOS Commercial |
$1,387.42
|
| Rate for Payer: HFN Commercial |
$1,448.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,076.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$289.15
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: NAPHCARE Commercial |
$433.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.41
|
| Rate for Payer: Quartz Beloit One Network |
$670.84
|
| Rate for Payer: Quartz Commercial |
$869.04
|
| Rate for Payer: Quartz Medicare Advantage |
$289.15
|
| Rate for Payer: The Alliance Commercial |
$1,228.89
|
| Rate for Payer: United Healthcare Medicaid |
$373.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.15
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,301.18
|
|
|
REMOVAL OF FOOT LESION 28104
|
Professional
|
Both
|
$2,130.00
|
|
|
Service Code
|
CPT 28104
|
| Hospital Charge Code |
3014198
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$331.14 |
| Max. Negotiated Rate |
$2,104.44 |
| Rate for Payer: Aetna Commercial |
$2,104.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,905.07
|
| Rate for Payer: Aetna Managed Medicare |
$331.14
|
| Rate for Payer: Anthem Medicare Advantage |
$331.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331.14
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cash Price |
$639.00
|
| Rate for Payer: Cigna Commercial |
$2,104.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.14
|
| Rate for Payer: Health EOS Commercial |
$2,015.83
|
| Rate for Payer: HFN Commercial |
$2,104.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,239.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,239.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331.14
|
| Rate for Payer: Multiplan Commercial |
$1,772.16
|
| Rate for Payer: NAPHCARE Commercial |
$496.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.44
|
| Rate for Payer: Quartz Beloit One Network |
$974.69
|
| Rate for Payer: Quartz Commercial |
$1,262.66
|
| Rate for Payer: Quartz Medicare Advantage |
$331.14
|
| Rate for Payer: The Alliance Commercial |
$1,407.33
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331.14
|
| Rate for Payer: WEA Trust Commercial |
$1,218.36
|
| Rate for Payer: WPS Commercial |
$1,490.11
|
|
|
REMOVAL OF FOREIGN BODY 27372
|
Professional
|
Both
|
$2,046.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
3014063
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.27 |
| Max. Negotiated Rate |
$2,021.45 |
| Rate for Payer: Aetna Commercial |
$2,021.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,829.94
|
| Rate for Payer: Aetna Managed Medicare |
$373.27
|
| Rate for Payer: Anthem Medicare Advantage |
$373.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$373.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$373.27
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$2,021.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.27
|
| Rate for Payer: Health EOS Commercial |
$1,936.33
|
| Rate for Payer: HFN Commercial |
$2,021.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,381.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,381.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$373.27
|
| Rate for Payer: Multiplan Commercial |
$1,702.27
|
| Rate for Payer: NAPHCARE Commercial |
$559.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,021.45
|
| Rate for Payer: Quartz Beloit One Network |
$936.25
|
| Rate for Payer: Quartz Commercial |
$1,212.87
|
| Rate for Payer: Quartz Medicare Advantage |
$373.27
|
| Rate for Payer: The Alliance Commercial |
$1,586.38
|
| Rate for Payer: United Healthcare Medicaid |
$163.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$373.27
|
| Rate for Payer: WEA Trust Commercial |
$1,170.31
|
| Rate for Payer: WPS Commercial |
$1,679.70
|
|
