|
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 |
$30.13 |
| Max. Negotiated Rate |
$393.22 |
| Rate for Payer: Aetna Commercial |
$393.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Aetna Managed Medicare |
$30.13
|
| Rate for Payer: Anthem Medicare Advantage |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.13
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$393.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.13
|
| Rate for Payer: Health EOS Commercial |
$376.67
|
| Rate for Payer: HFN Commercial |
$393.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.13
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: NAPHCARE Commercial |
$45.19
|
| Rate for Payer: Preferred Network Access Commercial |
$393.22
|
| Rate for Payer: Quartz Beloit One Network |
$182.12
|
| Rate for Payer: Quartz Commercial |
$235.93
|
| Rate for Payer: Quartz Medicare Advantage |
$30.13
|
| Rate for Payer: The Alliance Commercial |
$128.05
|
| Rate for Payer: United Healthcare Medicaid |
$49.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.13
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: WPS Commercial |
$135.58
|
|
|
Removal of Foreign Body: Cornea
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
1188892
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$403.10 |
| Rate for Payer: Aetna Commercial |
$403.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.92
|
| Rate for Payer: Aetna Managed Medicare |
$41.89
|
| Rate for Payer: Anthem Medicare Advantage |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.89
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna Commercial |
$403.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.89
|
| Rate for Payer: Health EOS Commercial |
$386.13
|
| Rate for Payer: HFN Commercial |
$403.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$339.46
|
| Rate for Payer: NAPHCARE Commercial |
$62.84
|
| Rate for Payer: Preferred Network Access Commercial |
$403.10
|
| Rate for Payer: Quartz Beloit One Network |
$186.70
|
| Rate for Payer: Quartz Commercial |
$241.86
|
| Rate for Payer: Quartz Medicare Advantage |
$41.89
|
| Rate for Payer: The Alliance Commercial |
$178.04
|
| Rate for Payer: United Healthcare Medicaid |
$49.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.89
|
| Rate for Payer: WEA Trust Commercial |
$233.38
|
| Rate for Payer: WPS Commercial |
$188.51
|
|
|
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 |
$24.54 |
| Max. Negotiated Rate |
$249.96 |
| Rate for Payer: Aetna Commercial |
$249.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Aetna Managed Medicare |
$24.54
|
| Rate for Payer: Anthem Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.54
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$249.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.54
|
| Rate for Payer: Health EOS Commercial |
$239.44
|
| Rate for Payer: HFN Commercial |
$249.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.54
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$249.96
|
| Rate for Payer: Quartz Beloit One Network |
$115.77
|
| Rate for Payer: Quartz Commercial |
$149.98
|
| Rate for Payer: Quartz Medicare Advantage |
$24.54
|
| Rate for Payer: The Alliance Commercial |
$104.31
|
| Rate for Payer: United Healthcare Medicaid |
$35.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.54
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$110.45
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; COMPLICATED
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 28193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Removal of foreign body, foot; subcutaneous
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 28190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$745.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
|
|
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 |
$40.21 |
| Max. Negotiated Rate |
$394.21 |
| Rate for Payer: Aetna Commercial |
$394.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$40.21
|
| Rate for Payer: Anthem Medicare Advantage |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.21
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$394.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.21
|
| Rate for Payer: Health EOS Commercial |
$377.61
|
| Rate for Payer: HFN Commercial |
$394.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.21
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$60.31
|
| Rate for Payer: Preferred Network Access Commercial |
$394.21
|
| Rate for Payer: Quartz Beloit One Network |
$182.58
|
| Rate for Payer: Quartz Commercial |
$236.53
|
| Rate for Payer: Quartz Medicare Advantage |
$40.21
|
| Rate for Payer: The Alliance Commercial |
$170.88
|
| Rate for Payer: United Healthcare Medicaid |
$47.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.21
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$180.93
|
|
|
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 |
$47.54 |
| Max. Negotiated Rate |
$634.30 |
| Rate for Payer: Aetna Commercial |
$634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$634.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.61
|
| Rate for Payer: Health EOS Commercial |
$607.59
|
| Rate for Payer: HFN Commercial |
$634.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.94
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: Preferred Network Access Commercial |
$634.30
|
| Rate for Payer: Quartz Beloit One Network |
$293.78
|
| Rate for Payer: Quartz Commercial |
$380.58
|
| Rate for Payer: The Alliance Commercial |
$333.84
|
| Rate for Payer: United Healthcare Medicaid |
$47.54
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 20525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,056.89 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
|
|
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 |
$64.77 |
| Max. Negotiated Rate |
$621.18 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Medicare Advantage |
$138.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.04
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.04
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$513.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$513.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.04
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$207.06
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$138.04
|
| Rate for Payer: The Alliance Commercial |
$586.67
|
| Rate for Payer: United Healthcare Medicaid |
$64.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.04
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$621.18
|
|
|
Removal of Foreign Body; Intranasal
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
1152803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$508.86 |
| Rate for Payer: Aetna Commercial |
$388.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$113.08
|
| Rate for Payer: Anthem Medicare Advantage |
$113.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.08
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$388.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.08
|
| Rate for Payer: Health EOS Commercial |
$371.94
|
| Rate for Payer: HFN Commercial |
$388.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.08
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$169.62
|
| Rate for Payer: Preferred Network Access Commercial |
$388.28
|
| Rate for Payer: Quartz Beloit One Network |
$179.84
|
| Rate for Payer: Quartz Commercial |
$232.97
|
| Rate for Payer: Quartz Medicare Advantage |
$113.08
|
| Rate for Payer: The Alliance Commercial |
$480.59
|
| Rate for Payer: United Healthcare Medicaid |
$66.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.08
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
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 |
$391.73 |
| Max. Negotiated Rate |
$1,805.08 |
| Rate for Payer: Aetna Commercial |
$1,805.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.07
|
| Rate for Payer: Aetna Managed Medicare |
$393.63
|
| Rate for Payer: Anthem Medicare Advantage |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.63
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,805.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.63
|
| Rate for Payer: Health EOS Commercial |
$1,729.07
|
| Rate for Payer: HFN Commercial |
$1,805.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.63
|
| Rate for Payer: Multiplan Commercial |
$1,520.06
|
| Rate for Payer: NAPHCARE Commercial |
$590.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,805.08
|
| Rate for Payer: Quartz Beloit One Network |
$836.04
|
| Rate for Payer: Quartz Commercial |
$1,083.05
|
| Rate for Payer: Quartz Medicare Advantage |
$393.63
|
| Rate for Payer: The Alliance Commercial |
$1,672.93
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.63
|
| Rate for Payer: WEA Trust Commercial |
$1,045.04
|
| Rate for Payer: WPS Commercial |
$1,771.33
|
|
|
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 |
$391.73 |
| Max. Negotiated Rate |
$1,978.96 |
| Rate for Payer: Aetna Commercial |
$1,978.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,791.48
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,978.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,249.87
|
| Rate for Payer: Health EOS Commercial |
$1,895.64
|
| Rate for Payer: HFN Commercial |
$1,978.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,462.82
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,978.96
|
| Rate for Payer: Quartz Beloit One Network |
$916.57
|
| Rate for Payer: Quartz Commercial |
$1,187.38
|
| Rate for Payer: The Alliance Commercial |
$1,041.56
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: WEA Trust Commercial |
$1,145.72
|
| Rate for Payer: WPS Commercial |
$1,542.91
|
|
|
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 |
$339.34 |
| Max. Negotiated Rate |
$2,053.06 |
| Rate for Payer: Aetna Commercial |
$2,053.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,858.56
|
| Rate for Payer: Aetna Managed Medicare |
$339.34
|
| Rate for Payer: Anthem Medicare Advantage |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$339.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$339.34
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$2,053.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.34
|
| Rate for Payer: Health EOS Commercial |
$1,966.62
|
| Rate for Payer: HFN Commercial |
$2,053.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,269.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$339.34
|
| Rate for Payer: Multiplan Commercial |
$1,728.90
|
| Rate for Payer: NAPHCARE Commercial |
$509.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.06
|
| Rate for Payer: Quartz Beloit One Network |
$950.89
|
| Rate for Payer: Quartz Commercial |
$1,231.84
|
| Rate for Payer: Quartz Medicare Advantage |
$339.34
|
| Rate for Payer: The Alliance Commercial |
$1,442.20
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.34
|
| Rate for Payer: WEA Trust Commercial |
$1,188.62
|
| Rate for Payer: WPS Commercial |
$1,527.04
|
|
|
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 |
$26.34 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$26.34
|
| Rate for Payer: Anthem Medicare Advantage |
$26.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.34
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.34
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.34
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$39.51
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$26.34
|
| Rate for Payer: The Alliance Commercial |
$72.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.34
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$46.10
|
|
|
Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)
|
Facility
|
OP
|
$12,227.57
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,056.89 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
Removal of intact breast implant
|
Facility
|
OP
|
$16,482.25
|
|
|
Service Code
|
CPT 19328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,120.56 |
| Max. Negotiated Rate |
$16,482.25 |
| Rate for Payer: Aetna Managed Medicare |
$4,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$4,120.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,120.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,328.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,120.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,120.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,120.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,120.56
|
| Rate for Payer: NAPHCARE Commercial |
$6,180.84
|
| Rate for Payer: Quartz Medicare Advantage |
$4,120.56
|
| Rate for Payer: The Alliance Commercial |
$16,482.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,120.56
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$4,120.56
|
|
|
REMOVAL OF INTRANASAL LESION 30117
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
CPT 30117
|
| Hospital Charge Code |
3014353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$1,647.83 |
| Rate for Payer: Aetna Commercial |
$927.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Aetna Managed Medicare |
$366.18
|
| Rate for Payer: Anthem Medicare Advantage |
$366.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$366.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$366.18
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$927.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.18
|
| Rate for Payer: Health EOS Commercial |
$888.67
|
| Rate for Payer: HFN Commercial |
$927.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,169.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,169.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$366.18
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: NAPHCARE Commercial |
$549.28
|
| Rate for Payer: Preferred Network Access Commercial |
$927.73
|
| Rate for Payer: Quartz Beloit One Network |
$429.69
|
| Rate for Payer: Quartz Commercial |
$556.64
|
| Rate for Payer: Quartz Medicare Advantage |
$366.18
|
| Rate for Payer: The Alliance Commercial |
$1,556.28
|
| Rate for Payer: United Healthcare Medicaid |
$27.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.18
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$1,647.83
|
|
|
Removal Of Intrauterine Device
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
1188879
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.64 |
| Max. Negotiated Rate |
$371.49 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$54.64
|
| Rate for Payer: Anthem Medicare Advantage |
$54.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.64
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$371.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.64
|
| Rate for Payer: Health EOS Commercial |
$355.85
|
| Rate for Payer: HFN Commercial |
$371.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.64
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$81.96
|
| Rate for Payer: Preferred Network Access Commercial |
$371.49
|
| Rate for Payer: Quartz Beloit One Network |
$172.06
|
| Rate for Payer: Quartz Commercial |
$222.89
|
| Rate for Payer: Quartz Medicare Advantage |
$54.64
|
| Rate for Payer: The Alliance Commercial |
$232.23
|
| Rate for Payer: United Healthcare Medicaid |
$111.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.64
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$245.89
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.69 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
|
|
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 |
$124.11 |
| Max. Negotiated Rate |
$2,159.77 |
| Rate for Payer: Aetna Commercial |
$2,159.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,955.16
|
| Rate for Payer: Aetna Managed Medicare |
$124.11
|
| Rate for Payer: Anthem Medicare Advantage |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.11
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cash Price |
$655.80
|
| Rate for Payer: Cigna Commercial |
$2,159.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.11
|
| Rate for Payer: Health EOS Commercial |
$2,068.83
|
| Rate for Payer: HFN Commercial |
$2,159.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.11
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: NAPHCARE Commercial |
$186.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,159.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,000.31
|
| Rate for Payer: Quartz Commercial |
$1,295.86
|
| Rate for Payer: Quartz Medicare Advantage |
$124.11
|
| Rate for Payer: The Alliance Commercial |
$527.48
|
| Rate for Payer: United Healthcare Medicaid |
$327.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.11
|
| Rate for Payer: WEA Trust Commercial |
$1,250.39
|
| Rate for Payer: WPS Commercial |
$558.51
|
|
|
Removal of Nail Bed 11750
|
Professional
|
Both
|
$853.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
3241482
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.93 |
| Max. Negotiated Rate |
$842.76 |
| Rate for Payer: Aetna Commercial |
$842.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.92
|
| Rate for Payer: Aetna Managed Medicare |
$92.93
|
| Rate for Payer: Anthem Medicare Advantage |
$92.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.93
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$842.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.93
|
| Rate for Payer: Health EOS Commercial |
$807.28
|
| Rate for Payer: HFN Commercial |
$842.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.93
|
| Rate for Payer: Multiplan Commercial |
$709.70
|
| Rate for Payer: NAPHCARE Commercial |
$139.40
|
| Rate for Payer: Preferred Network Access Commercial |
$842.76
|
| Rate for Payer: Quartz Beloit One Network |
$390.33
|
| Rate for Payer: Quartz Commercial |
$505.66
|
| Rate for Payer: Quartz Medicare Advantage |
$92.93
|
| Rate for Payer: The Alliance Commercial |
$394.97
|
| Rate for Payer: United Healthcare Medicaid |
$113.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.93
|
| Rate for Payer: WEA Trust Commercial |
$487.92
|
| Rate for Payer: WPS Commercial |
$418.20
|
|
|
REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING URETERAL STENT)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 50389
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$733.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$733.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$733.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$733.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$733.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$733.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Quartz Medicare Advantage |
$733.82
|
| Rate for Payer: The Alliance Commercial |
$2,935.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$733.82
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
|
|
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 |
$59.61 |
| Max. Negotiated Rate |
$388.28 |
| Rate for Payer: Aetna Commercial |
$388.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.50
|
| Rate for Payer: Aetna Managed Medicare |
$59.61
|
| Rate for Payer: Anthem Medicare Advantage |
$59.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.61
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cigna Commercial |
$388.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.61
|
| Rate for Payer: Health EOS Commercial |
$371.94
|
| Rate for Payer: HFN Commercial |
$388.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.61
|
| Rate for Payer: Multiplan Commercial |
$326.98
|
| Rate for Payer: NAPHCARE Commercial |
$89.42
|
| Rate for Payer: Preferred Network Access Commercial |
$388.28
|
| Rate for Payer: Quartz Beloit One Network |
$179.84
|
| Rate for Payer: Quartz Commercial |
$232.97
|
| Rate for Payer: Quartz Medicare Advantage |
$59.61
|
| Rate for Payer: The Alliance Commercial |
$253.35
|
| Rate for Payer: United Healthcare Medicaid |
$112.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.61
|
| Rate for Payer: WEA Trust Commercial |
$224.80
|
| Rate for Payer: WPS Commercial |
$268.26
|
|
