|
REMOVAL OF NOSE POLYP(S) 30110
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 30110
|
| Hospital Charge Code |
3014351
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Aetna Commercial |
$790.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$116.67
|
| Rate for Payer: Anthem Medicare Advantage |
$116.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.67
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$790.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.67
|
| Rate for Payer: Health EOS Commercial |
$757.12
|
| Rate for Payer: HFN Commercial |
$790.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$451.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.67
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.00
|
| Rate for Payer: Preferred Network Access Commercial |
$790.40
|
| Rate for Payer: Quartz Beloit One Network |
$366.08
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: Quartz Medicare Advantage |
$116.67
|
| Rate for Payer: The Alliance Commercial |
$495.84
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.67
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$525.00
|
|
|
REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEAL CAVITY
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 49402
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| 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 |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
REMOVAL OF PILONIDAL LESION 11770
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
3013576
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.37 |
| Max. Negotiated Rate |
$766.68 |
| Rate for Payer: Aetna Commercial |
$718.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$650.23
|
| Rate for Payer: Aetna Managed Medicare |
$170.37
|
| Rate for Payer: Anthem Medicare Advantage |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.37
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$718.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.37
|
| Rate for Payer: Health EOS Commercial |
$688.03
|
| Rate for Payer: HFN Commercial |
$718.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$633.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$633.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.37
|
| Rate for Payer: Multiplan Commercial |
$604.86
|
| Rate for Payer: NAPHCARE Commercial |
$255.56
|
| Rate for Payer: Preferred Network Access Commercial |
$718.28
|
| Rate for Payer: Quartz Beloit One Network |
$332.68
|
| Rate for Payer: Quartz Commercial |
$430.97
|
| Rate for Payer: Quartz Medicare Advantage |
$170.37
|
| Rate for Payer: The Alliance Commercial |
$724.08
|
| Rate for Payer: United Healthcare Medicaid |
$222.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.37
|
| Rate for Payer: WEA Trust Commercial |
$415.84
|
| Rate for Payer: WPS Commercial |
$766.68
|
|
|
REMOVAL OF PILONIDAL LESION 11771
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
CPT 11771
|
| Hospital Charge Code |
3013577
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$416.64 |
| Max. Negotiated Rate |
$2,543.11 |
| Rate for Payer: Aetna Commercial |
$2,543.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,302.19
|
| Rate for Payer: Aetna Managed Medicare |
$416.64
|
| Rate for Payer: Anthem Medicare Advantage |
$416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$416.64
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cash Price |
$772.20
|
| Rate for Payer: Cigna Commercial |
$2,543.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$458.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.64
|
| Rate for Payer: Health EOS Commercial |
$2,436.03
|
| Rate for Payer: HFN Commercial |
$2,543.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,515.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$416.64
|
| Rate for Payer: Multiplan Commercial |
$2,141.57
|
| Rate for Payer: NAPHCARE Commercial |
$624.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,543.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,177.86
|
| Rate for Payer: Quartz Commercial |
$1,525.87
|
| Rate for Payer: Quartz Medicare Advantage |
$416.64
|
| Rate for Payer: The Alliance Commercial |
$1,770.74
|
| Rate for Payer: United Healthcare Medicaid |
$458.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$416.64
|
| Rate for Payer: WEA Trust Commercial |
$1,472.33
|
| Rate for Payer: WPS Commercial |
$1,874.90
|
|
|
REMOVAL OF PILONIDAL LESION 11772
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
3013578
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$440.73 |
| Max. Negotiated Rate |
$2,445.58 |
| Rate for Payer: Aetna Commercial |
$1,714.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,551.78
|
| Rate for Payer: Aetna Managed Medicare |
$543.46
|
| Rate for Payer: Anthem Medicare Advantage |
$543.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.46
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cash Price |
$520.50
|
| Rate for Payer: Cigna Commercial |
$1,714.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$440.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.46
|
| Rate for Payer: Health EOS Commercial |
$1,642.00
|
| Rate for Payer: HFN Commercial |
$1,714.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,006.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,006.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$543.46
|
| Rate for Payer: Multiplan Commercial |
$1,443.52
|
| Rate for Payer: NAPHCARE Commercial |
$815.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.18
|
| Rate for Payer: Quartz Beloit One Network |
$793.94
|
| Rate for Payer: Quartz Commercial |
$1,028.51
|
| Rate for Payer: Quartz Medicare Advantage |
$543.46
|
| Rate for Payer: The Alliance Commercial |
$2,309.72
|
| Rate for Payer: United Healthcare Medicaid |
$440.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$543.46
|
| Rate for Payer: WEA Trust Commercial |
$992.42
|
| Rate for Payer: WPS Commercial |
$2,445.58
|
|
|
REMOVAL OF PROSTHESIS, INCLUDES DEBRIDEMENT AND SYNOVECTOMY WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 23334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| 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 |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
REMOVAL OF SALIVARY STONE 42330
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
3014630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$654.78 |
| Rate for Payer: Aetna Commercial |
$565.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Aetna Managed Medicare |
$145.51
|
| Rate for Payer: Anthem Medicare Advantage |
$145.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$145.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$145.51
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$565.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.51
|
| Rate for Payer: Health EOS Commercial |
$541.34
|
| Rate for Payer: HFN Commercial |
$565.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$145.51
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: NAPHCARE Commercial |
$218.26
|
| Rate for Payer: Preferred Network Access Commercial |
$565.14
|
| Rate for Payer: Quartz Beloit One Network |
$261.75
|
| Rate for Payer: Quartz Commercial |
$339.08
|
| Rate for Payer: Quartz Medicare Advantage |
$145.51
|
| Rate for Payer: The Alliance Commercial |
$618.40
|
| Rate for Payer: United Healthcare Medicaid |
$107.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$145.51
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$654.78
|
|
|
Removal of Salivary Stone 42335
|
Professional
|
Both
|
$812.00
|
|
|
Service Code
|
CPT 42335
|
| Hospital Charge Code |
3190217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,046.73 |
| Rate for Payer: Aetna Commercial |
$802.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$726.25
|
| Rate for Payer: Aetna Managed Medicare |
$232.61
|
| Rate for Payer: Anthem Medicare Advantage |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$232.61
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$802.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.61
|
| Rate for Payer: Health EOS Commercial |
$768.48
|
| Rate for Payer: HFN Commercial |
$802.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$899.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$899.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$232.61
|
| Rate for Payer: Multiplan Commercial |
$675.58
|
| Rate for Payer: NAPHCARE Commercial |
$348.91
|
| Rate for Payer: Preferred Network Access Commercial |
$802.26
|
| Rate for Payer: Quartz Beloit One Network |
$371.57
|
| Rate for Payer: Quartz Commercial |
$481.35
|
| Rate for Payer: Quartz Medicare Advantage |
$232.61
|
| Rate for Payer: The Alliance Commercial |
$988.58
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.61
|
| Rate for Payer: WEA Trust Commercial |
$464.46
|
| Rate for Payer: WPS Commercial |
$1,046.73
|
|
|
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 |
$210.24 |
| Max. Negotiated Rate |
$1,450.38 |
| Rate for Payer: Aetna Commercial |
$1,450.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$304.74
|
| Rate for Payer: Anthem Medicare Advantage |
$304.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$304.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$304.74
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,450.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.74
|
| Rate for Payer: Health EOS Commercial |
$1,389.32
|
| Rate for Payer: HFN Commercial |
$1,450.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,147.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,147.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$304.74
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$457.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.38
|
| Rate for Payer: Quartz Beloit One Network |
$671.76
|
| Rate for Payer: Quartz Commercial |
$870.23
|
| Rate for Payer: Quartz Medicare Advantage |
$304.74
|
| Rate for Payer: The Alliance Commercial |
$1,295.15
|
| Rate for Payer: United Healthcare Medicaid |
$210.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.74
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,371.33
|
|
|
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 |
$125.20 |
| Max. Negotiated Rate |
$1,374.05 |
| Rate for Payer: Aetna Commercial |
$1,098.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$994.57
|
| Rate for Payer: Aetna Managed Medicare |
$305.34
|
| Rate for Payer: Anthem Medicare Advantage |
$305.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$305.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$305.34
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cigna Commercial |
$1,098.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.34
|
| Rate for Payer: Health EOS Commercial |
$1,052.40
|
| Rate for Payer: HFN Commercial |
$1,098.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,126.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,126.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$305.34
|
| Rate for Payer: Multiplan Commercial |
$925.18
|
| Rate for Payer: NAPHCARE Commercial |
$458.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,098.66
|
| Rate for Payer: Quartz Beloit One Network |
$508.85
|
| Rate for Payer: Quartz Commercial |
$659.19
|
| Rate for Payer: Quartz Medicare Advantage |
$305.34
|
| Rate for Payer: The Alliance Commercial |
$1,297.71
|
| Rate for Payer: United Healthcare Medicaid |
$125.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.34
|
| Rate for Payer: WEA Trust Commercial |
$636.06
|
| Rate for Payer: WPS Commercial |
$1,374.05
|
|
|
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 |
$41.30 |
| Max. Negotiated Rate |
$307.10 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$68.24
|
| Rate for Payer: Anthem Medicare Advantage |
$68.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.24
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.24
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.24
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$102.37
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$68.24
|
| Rate for Payer: The Alliance Commercial |
$290.04
|
| Rate for Payer: United Healthcare Medicaid |
$41.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.24
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$307.10
|
|
|
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 |
$12.71 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.71
|
| Rate for Payer: Anthem Medicare Advantage |
$12.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.71
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.71
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.06
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.71
|
| Rate for Payer: The Alliance Commercial |
$54.01
|
| Rate for Payer: United Healthcare Medicaid |
$15.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.71
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10 LESIONS, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11201
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.84 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: The Alliance Commercial |
$50.84
|
|
|
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| 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 |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
|
|
Removal of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 63661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
REMOVAL OF SUPPORT IMPLANT 20670
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
3013708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.28 |
| Max. Negotiated Rate |
$646.15 |
| Rate for Payer: Aetna Commercial |
$646.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$584.94
|
| Rate for Payer: Aetna Managed Medicare |
$135.89
|
| Rate for Payer: Anthem Medicare Advantage |
$135.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.89
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cash Price |
$196.20
|
| Rate for Payer: Cigna Commercial |
$646.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.89
|
| Rate for Payer: Health EOS Commercial |
$618.95
|
| Rate for Payer: HFN Commercial |
$646.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.89
|
| Rate for Payer: Multiplan Commercial |
$544.13
|
| Rate for Payer: NAPHCARE Commercial |
$203.83
|
| Rate for Payer: Preferred Network Access Commercial |
$646.15
|
| Rate for Payer: Quartz Beloit One Network |
$299.27
|
| Rate for Payer: Quartz Commercial |
$387.69
|
| Rate for Payer: Quartz Medicare Advantage |
$135.89
|
| Rate for Payer: The Alliance Commercial |
$577.52
|
| Rate for Payer: United Healthcare Medicaid |
$55.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.89
|
| Rate for Payer: WEA Trust Commercial |
$374.09
|
| Rate for Payer: WPS Commercial |
$611.49
|
|
|
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 |
$238.25 |
| Max. Negotiated Rate |
$2,368.24 |
| Rate for Payer: Aetna Commercial |
$2,368.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,143.88
|
| Rate for Payer: Aetna Managed Medicare |
$377.55
|
| Rate for Payer: Anthem Medicare Advantage |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.55
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,368.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.55
|
| Rate for Payer: Health EOS Commercial |
$2,268.52
|
| Rate for Payer: HFN Commercial |
$2,368.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,448.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,448.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.55
|
| Rate for Payer: Multiplan Commercial |
$1,994.30
|
| Rate for Payer: NAPHCARE Commercial |
$566.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,368.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.87
|
| Rate for Payer: Quartz Commercial |
$1,420.94
|
| Rate for Payer: Quartz Medicare Advantage |
$377.55
|
| Rate for Payer: The Alliance Commercial |
$1,604.59
|
| Rate for Payer: United Healthcare Medicaid |
$238.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.55
|
| Rate for Payer: WEA Trust Commercial |
$1,371.08
|
| Rate for Payer: WPS Commercial |
$1,698.98
|
|
|
REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA (IE, GENERAL ANESTHESIA, MODERATE SEDATION)
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 15851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
|
|
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 |
$331.34 |
| Max. Negotiated Rate |
$1,512.90 |
| Rate for Payer: Aetna Commercial |
$1,330.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.76
|
| Rate for Payer: Aetna Managed Medicare |
$336.20
|
| Rate for Payer: Anthem Medicare Advantage |
$336.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.20
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,330.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$331.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.20
|
| Rate for Payer: Health EOS Commercial |
$1,274.80
|
| Rate for Payer: HFN Commercial |
$1,330.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,257.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,257.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.20
|
| Rate for Payer: Multiplan Commercial |
$1,120.70
|
| Rate for Payer: NAPHCARE Commercial |
$504.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,330.84
|
| Rate for Payer: Quartz Beloit One Network |
$616.39
|
| Rate for Payer: Quartz Commercial |
$798.50
|
| Rate for Payer: Quartz Medicare Advantage |
$336.20
|
| Rate for Payer: The Alliance Commercial |
$1,428.85
|
| Rate for Payer: United Healthcare Medicaid |
$331.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.20
|
| Rate for Payer: WEA Trust Commercial |
$770.48
|
| Rate for Payer: WPS Commercial |
$1,512.90
|
|
|
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 |
$32.67 |
| Max. Negotiated Rate |
$1,322.15 |
| Rate for Payer: Aetna Commercial |
$1,053.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.43
|
| Rate for Payer: Aetna Managed Medicare |
$293.81
|
| Rate for Payer: Anthem Medicare Advantage |
$293.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$293.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$293.81
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cash Price |
$319.80
|
| Rate for Payer: Cigna Commercial |
$1,053.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.81
|
| Rate for Payer: Health EOS Commercial |
$1,008.86
|
| Rate for Payer: HFN Commercial |
$1,053.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,074.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,074.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$293.81
|
| Rate for Payer: Multiplan Commercial |
$886.91
|
| Rate for Payer: NAPHCARE Commercial |
$440.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.21
|
| Rate for Payer: Quartz Beloit One Network |
$487.80
|
| Rate for Payer: Quartz Commercial |
$631.92
|
| Rate for Payer: Quartz Medicare Advantage |
$293.81
|
| Rate for Payer: The Alliance Commercial |
$1,248.69
|
| Rate for Payer: United Healthcare Medicaid |
$32.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.81
|
| Rate for Payer: WEA Trust Commercial |
$609.75
|
| Rate for Payer: WPS Commercial |
$1,322.15
|
|
|
REMOVAL OF TOE 28150
|
Professional
|
Both
|
$1,797.00
|
|
|
Service Code
|
CPT 28150
|
| Hospital Charge Code |
3014210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,775.44 |
| Rate for Payer: Aetna Commercial |
$1,775.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,607.24
|
| Rate for Payer: Aetna Managed Medicare |
$260.86
|
| Rate for Payer: Anthem Medicare Advantage |
$260.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.86
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cigna Commercial |
$1,775.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.86
|
| Rate for Payer: Health EOS Commercial |
$1,700.68
|
| Rate for Payer: HFN Commercial |
$1,775.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$977.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.86
|
| Rate for Payer: Multiplan Commercial |
$1,495.10
|
| Rate for Payer: NAPHCARE Commercial |
$391.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,775.44
|
| Rate for Payer: Quartz Beloit One Network |
$822.31
|
| Rate for Payer: Quartz Commercial |
$1,065.26
|
| Rate for Payer: Quartz Medicare Advantage |
$260.86
|
| Rate for Payer: The Alliance Commercial |
$1,108.67
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.86
|
| Rate for Payer: WEA Trust Commercial |
$1,027.88
|
| Rate for Payer: WPS Commercial |
$1,173.88
|
|
|
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 |
$156.69 |
| Max. Negotiated Rate |
$1,560.05 |
| Rate for Payer: Aetna Commercial |
$1,560.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.26
|
| Rate for Payer: Aetna Managed Medicare |
$256.47
|
| Rate for Payer: Anthem Medicare Advantage |
$256.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.47
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,560.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.47
|
| Rate for Payer: Health EOS Commercial |
$1,494.37
|
| Rate for Payer: HFN Commercial |
$1,560.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$943.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$943.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.47
|
| Rate for Payer: Multiplan Commercial |
$1,313.73
|
| Rate for Payer: NAPHCARE Commercial |
$384.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.05
|
| Rate for Payer: Quartz Beloit One Network |
$722.55
|
| Rate for Payer: Quartz Commercial |
$936.03
|
| Rate for Payer: Quartz Medicare Advantage |
$256.47
|
| Rate for Payer: The Alliance Commercial |
$1,090.02
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.47
|
| Rate for Payer: WEA Trust Commercial |
$903.19
|
| Rate for Payer: WPS Commercial |
$1,154.13
|
|
|
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 |
$269.84 |
| Max. Negotiated Rate |
$1,827.80 |
| Rate for Payer: Aetna Commercial |
$1,827.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Aetna Managed Medicare |
$269.84
|
| Rate for Payer: Anthem Medicare Advantage |
$269.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$269.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$269.84
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cash Price |
$555.00
|
| Rate for Payer: Cigna Commercial |
$1,827.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.84
|
| Rate for Payer: Health EOS Commercial |
$1,750.84
|
| Rate for Payer: HFN Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,009.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,009.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$269.84
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$404.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.80
|
| Rate for Payer: Quartz Beloit One Network |
$846.56
|
| Rate for Payer: Quartz Commercial |
$1,096.68
|
| Rate for Payer: Quartz Medicare Advantage |
$269.84
|
| Rate for Payer: The Alliance Commercial |
$1,146.81
|
| Rate for Payer: United Healthcare Medicaid |
$282.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$269.84
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,214.27
|
|
|
REMOVAL OF TOTAL OR NEAR TOTAL NON-INFECTED MESH OR OTHER PROSTHESIS AT THE TIME OF INITIAL OR RECURRENT ANTERIOR ABDOMINAL HERNIA REPAIR OR PARASTOMAL HERNIA REPAIR, ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$669.01
|
|
|
Service Code
|
CPT 49623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.01 |
| Max. Negotiated Rate |
$669.01 |
| Rate for Payer: The Alliance Commercial |
$669.01
|
|
|
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 |
$164.49 |
| Max. Negotiated Rate |
$1,056.17 |
| Rate for Payer: Aetna Commercial |
$1,056.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$164.49
|
| Rate for Payer: Anthem Medicare Advantage |
$164.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.49
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,056.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.49
|
| Rate for Payer: Health EOS Commercial |
$1,011.70
|
| Rate for Payer: HFN Commercial |
$1,056.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$648.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.49
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$246.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.17
|
| Rate for Payer: Quartz Beloit One Network |
$489.17
|
| Rate for Payer: Quartz Commercial |
$633.70
|
| Rate for Payer: Quartz Medicare Advantage |
$164.49
|
| Rate for Payer: The Alliance Commercial |
$699.07
|
| Rate for Payer: United Healthcare Medicaid |
$254.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.49
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$740.19
|
|
