|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$6,626.51
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,656.63 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| 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 |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
|
|
Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
1190869
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$682.71 |
| Rate for Payer: Aetna Commercial |
$682.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$120.13
|
| Rate for Payer: Anthem Medicare Advantage |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.13
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$682.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.13
|
| Rate for Payer: Health EOS Commercial |
$653.96
|
| Rate for Payer: HFN Commercial |
$682.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.13
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.71
|
| Rate for Payer: Quartz Beloit One Network |
$316.20
|
| Rate for Payer: Quartz Commercial |
$409.62
|
| Rate for Payer: Quartz Medicare Advantage |
$120.13
|
| Rate for Payer: The Alliance Commercial |
$510.55
|
| Rate for Payer: United Healthcare Medicaid |
$157.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.13
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$540.59
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$660.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| 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 |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
|
|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REMOVAL OF URETHRA GLAND 53270
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
CPT 53270
|
| Hospital Charge Code |
3015013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.67 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$1,647.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,490.96
|
| Rate for Payer: Aetna Managed Medicare |
$164.15
|
| Rate for Payer: Anthem Medicare Advantage |
$164.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.15
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cigna Commercial |
$1,647.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.15
|
| Rate for Payer: Health EOS Commercial |
$1,577.65
|
| Rate for Payer: HFN Commercial |
$1,647.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.15
|
| Rate for Payer: Multiplan Commercial |
$1,386.94
|
| Rate for Payer: NAPHCARE Commercial |
$246.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.00
|
| Rate for Payer: Quartz Beloit One Network |
$762.82
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: Quartz Medicare Advantage |
$164.15
|
| Rate for Payer: The Alliance Commercial |
$697.65
|
| Rate for Payer: United Healthcare Medicaid |
$109.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.15
|
| Rate for Payer: WEA Trust Commercial |
$953.52
|
| Rate for Payer: WPS Commercial |
$738.69
|
|
|
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
|
Facility
|
OP
|
$9,714.93
|
|
|
Service Code
|
CPT 67005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,428.73 |
| Max. Negotiated Rate |
$9,714.93 |
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| 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 |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
|
|
REMOVAL OR REVISION OF PACEMAKERS AND OTHER CARDIOVASCULAR DEVICES
|
Facility
|
OP
|
$1,554.43
|
|
|
Service Code
|
EAPG 00087
|
| Min. Negotiated Rate |
$1,494.64 |
| Max. Negotiated Rate |
$1,554.43 |
| Rate for Payer: Anthem Medicaid |
$1,494.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,494.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,494.64
|
| Rate for Payer: Dean Health Medicaid |
$1,494.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,494.64
|
| Rate for Payer: Managed Health Services Medicaid |
$1,554.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,494.64
|
| Rate for Payer: United Healthcare Medicaid |
$1,494.64
|
|
|
Removal or revision of sling for stress incontinence (e.g., fascia or synthetic)
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 57287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| 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 |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
REMOVAL/REVISION OF CAST 29705
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
3014307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$174.33 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$38.74
|
| Rate for Payer: Anthem Medicare Advantage |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.74
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.74
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.74
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$58.11
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$38.74
|
| Rate for Payer: The Alliance Commercial |
$164.65
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.74
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$174.33
|
|
|
REMOVAL SUTURES/STAPLES NOT REQUIRING ANESTHESIA 15853
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
6219984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$58.87 |
| Rate for Payer: Quartz Beloit One Network |
$11.90
|
| Rate for Payer: Aetna Commercial |
$25.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$13.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.08
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$25.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.08
|
| Rate for Payer: Health EOS Commercial |
$24.61
|
| Rate for Payer: HFN Commercial |
$25.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.08
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$19.62
|
| Rate for Payer: Preferred Network Access Commercial |
$25.69
|
| Rate for Payer: Quartz Commercial |
$15.41
|
| Rate for Payer: Quartz Medicare Advantage |
$13.08
|
| Rate for Payer: The Alliance Commercial |
$55.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.08
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$58.87
|
|
|
REMOVAL, SWEAT GLAND LESION 11450
|
Professional
|
Both
|
$1,451.00
|
|
|
Service Code
|
CPT 11450
|
| Hospital Charge Code |
3013551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.24 |
| Max. Negotiated Rate |
$1,433.59 |
| Rate for Payer: Aetna Commercial |
$1,433.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,297.77
|
| Rate for Payer: Aetna Managed Medicare |
$242.24
|
| Rate for Payer: Anthem Medicare Advantage |
$242.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.24
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cash Price |
$435.30
|
| Rate for Payer: Cigna Commercial |
$1,433.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.24
|
| Rate for Payer: Health EOS Commercial |
$1,373.23
|
| Rate for Payer: HFN Commercial |
$1,433.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$882.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$882.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.24
|
| Rate for Payer: Multiplan Commercial |
$1,207.23
|
| Rate for Payer: NAPHCARE Commercial |
$363.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,433.59
|
| Rate for Payer: Quartz Beloit One Network |
$663.98
|
| Rate for Payer: Quartz Commercial |
$860.15
|
| Rate for Payer: Quartz Medicare Advantage |
$242.24
|
| Rate for Payer: The Alliance Commercial |
$1,029.51
|
| Rate for Payer: United Healthcare Medicaid |
$298.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.24
|
| Rate for Payer: WEA Trust Commercial |
$829.97
|
| Rate for Payer: WPS Commercial |
$1,090.07
|
|
|
REMOVAL, SWEAT GLAND LESION 11462
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
CPT 11462
|
| Hospital Charge Code |
3013552
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$231.75 |
| Max. Negotiated Rate |
$1,651.94 |
| Rate for Payer: Aetna Commercial |
$1,651.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.44
|
| Rate for Payer: Aetna Managed Medicare |
$231.75
|
| Rate for Payer: Anthem Medicare Advantage |
$231.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.75
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cigna Commercial |
$1,651.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.75
|
| Rate for Payer: Health EOS Commercial |
$1,582.38
|
| Rate for Payer: HFN Commercial |
$1,651.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$839.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$839.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$1,391.10
|
| Rate for Payer: NAPHCARE Commercial |
$347.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,651.94
|
| Rate for Payer: Quartz Beloit One Network |
$765.11
|
| Rate for Payer: Quartz Commercial |
$991.16
|
| Rate for Payer: Quartz Medicare Advantage |
$231.75
|
| Rate for Payer: The Alliance Commercial |
$984.95
|
| Rate for Payer: United Healthcare Medicaid |
$504.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.75
|
| Rate for Payer: WEA Trust Commercial |
$956.38
|
| Rate for Payer: WPS Commercial |
$1,042.89
|
|
|
REMOVAL, SWEAT GLAND LESION 11470
|
Professional
|
Both
|
$2,113.00
|
|
|
Service Code
|
CPT 11470
|
| Hospital Charge Code |
3013553
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.35 |
| Max. Negotiated Rate |
$2,087.64 |
| Rate for Payer: Aetna Commercial |
$2,087.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Aetna Managed Medicare |
$267.35
|
| Rate for Payer: Anthem Medicare Advantage |
$267.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.35
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,087.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.35
|
| Rate for Payer: Health EOS Commercial |
$1,999.74
|
| Rate for Payer: HFN Commercial |
$2,087.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.35
|
| Rate for Payer: Multiplan Commercial |
$1,758.02
|
| Rate for Payer: NAPHCARE Commercial |
$401.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,087.64
|
| Rate for Payer: Quartz Beloit One Network |
$966.91
|
| Rate for Payer: Quartz Commercial |
$1,252.59
|
| Rate for Payer: Quartz Medicare Advantage |
$267.35
|
| Rate for Payer: The Alliance Commercial |
$1,136.25
|
| Rate for Payer: United Healthcare Medicaid |
$328.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.35
|
| Rate for Payer: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: WPS Commercial |
$1,203.09
|
|
|
REMOVAL, SWEAT GLAND LESION 11471
|
Professional
|
Both
|
$2,414.00
|
|
|
Service Code
|
CPT 11471
|
| Hospital Charge Code |
3013554
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$316.64 |
| Max. Negotiated Rate |
$2,385.03 |
| Rate for Payer: Aetna Commercial |
$2,385.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.08
|
| Rate for Payer: Aetna Managed Medicare |
$316.64
|
| Rate for Payer: Anthem Medicare Advantage |
$316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$316.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$316.64
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cash Price |
$724.20
|
| Rate for Payer: Cigna Commercial |
$2,385.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.64
|
| Rate for Payer: Health EOS Commercial |
$2,284.61
|
| Rate for Payer: HFN Commercial |
$2,385.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,195.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,195.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$316.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.45
|
| Rate for Payer: NAPHCARE Commercial |
$474.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,385.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.65
|
| Rate for Payer: Quartz Commercial |
$1,431.02
|
| Rate for Payer: Quartz Medicare Advantage |
$316.64
|
| Rate for Payer: The Alliance Commercial |
$1,345.71
|
| Rate for Payer: United Healthcare Medicaid |
$352.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.64
|
| Rate for Payer: WEA Trust Commercial |
$1,380.81
|
| Rate for Payer: WPS Commercial |
$1,424.87
|
|
|
Removal Tunneled CV Cath 36589
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
3935352
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$682.71 |
| Rate for Payer: Aetna Commercial |
$682.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$120.13
|
| Rate for Payer: Anthem Medicare Advantage |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.13
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$682.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.13
|
| Rate for Payer: Health EOS Commercial |
$653.96
|
| Rate for Payer: HFN Commercial |
$682.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.13
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$180.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.71
|
| Rate for Payer: Quartz Beloit One Network |
$316.20
|
| Rate for Payer: Quartz Commercial |
$409.62
|
| Rate for Payer: Quartz Medicare Advantage |
$120.13
|
| Rate for Payer: The Alliance Commercial |
$510.55
|
| Rate for Payer: United Healthcare Medicaid |
$157.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.13
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$540.59
|
|
|
Removal Tunneled CV Cath 3658922
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
CPT 36589 22
|
| Hospital Charge Code |
5552206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$157.57 |
| Max. Negotiated Rate |
$816.09 |
| Rate for Payer: Aetna Commercial |
$816.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$738.77
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cash Price |
$247.80
|
| Rate for Payer: Cigna Commercial |
$816.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.42
|
| Rate for Payer: Health EOS Commercial |
$781.73
|
| Rate for Payer: HFN Commercial |
$816.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.94
|
| Rate for Payer: Multiplan Commercial |
$687.23
|
| Rate for Payer: Preferred Network Access Commercial |
$816.09
|
| Rate for Payer: Quartz Beloit One Network |
$377.98
|
| Rate for Payer: Quartz Commercial |
$489.65
|
| Rate for Payer: The Alliance Commercial |
$429.52
|
| Rate for Payer: United Healthcare Medicaid |
$157.57
|
| Rate for Payer: WEA Trust Commercial |
$472.47
|
| Rate for Payer: WPS Commercial |
$636.27
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$6,768.94
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| 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 |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLING URETERAL STENT VIA TRANSURETHRAL APPROACH, WITHOUT USE OF CYSTOSCOPY, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 50386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| 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 |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
REMOVE ARM/ELBOW LESION 24075
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
3013807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$1,373.30 |
| Rate for Payer: Aetna Commercial |
$1,189.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.86
|
| Rate for Payer: Aetna Managed Medicare |
$305.18
|
| Rate for Payer: Anthem Medicare Advantage |
$305.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$305.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$305.18
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cash Price |
$361.20
|
| Rate for Payer: Cigna Commercial |
$1,189.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.18
|
| Rate for Payer: Health EOS Commercial |
$1,139.47
|
| Rate for Payer: HFN Commercial |
$1,189.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,132.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,132.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$305.18
|
| Rate for Payer: Multiplan Commercial |
$1,001.73
|
| Rate for Payer: NAPHCARE Commercial |
$457.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.55
|
| Rate for Payer: Quartz Beloit One Network |
$550.95
|
| Rate for Payer: Quartz Commercial |
$713.73
|
| Rate for Payer: Quartz Medicare Advantage |
$305.18
|
| Rate for Payer: The Alliance Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare Medicaid |
$81.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$305.18
|
| Rate for Payer: WEA Trust Commercial |
$688.69
|
| Rate for Payer: WPS Commercial |
$1,373.30
|
|
|
REMOVE BLADDER/REVISE TRACT 51590
|
Professional
|
Both
|
$10,627.00
|
|
|
Service Code
|
CPT 51590
|
| Hospital Charge Code |
3014971
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,650.82 |
| Max. Negotiated Rate |
$10,499.48 |
| Rate for Payer: Aetna Commercial |
$10,499.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,504.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,650.82
|
| Rate for Payer: Anthem Medicare Advantage |
$1,650.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,650.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,650.82
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cash Price |
$3,188.10
|
| Rate for Payer: Cigna Commercial |
$10,499.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,193.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,650.82
|
| Rate for Payer: Health EOS Commercial |
$10,057.39
|
| Rate for Payer: HFN Commercial |
$10,499.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,696.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,696.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,650.82
|
| Rate for Payer: Multiplan Commercial |
$8,841.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,476.23
|
| Rate for Payer: Preferred Network Access Commercial |
$10,499.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,862.92
|
| Rate for Payer: Quartz Commercial |
$6,299.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,650.82
|
| Rate for Payer: The Alliance Commercial |
$7,016.00
|
| Rate for Payer: United Healthcare Medicaid |
$2,193.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,650.82
|
| Rate for Payer: WEA Trust Commercial |
$6,078.64
|
| Rate for Payer: WPS Commercial |
$7,428.70
|
|
|
REMOVE BLADDER/REVISE TRACT 51595
|
Professional
|
Both
|
$12,086.00
|
|
|
Service Code
|
CPT 51595
|
| Hospital Charge Code |
3014972
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,867.13 |
| Max. Negotiated Rate |
$11,940.97 |
| Rate for Payer: Aetna Commercial |
$11,940.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,809.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,867.13
|
| Rate for Payer: Anthem Medicare Advantage |
$1,867.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,867.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,867.13
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cash Price |
$3,625.80
|
| Rate for Payer: Cigna Commercial |
$11,940.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,424.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,867.13
|
| Rate for Payer: Health EOS Commercial |
$11,438.19
|
| Rate for Payer: HFN Commercial |
$11,940.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,579.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,867.13
|
| Rate for Payer: Multiplan Commercial |
$10,055.55
|
| Rate for Payer: NAPHCARE Commercial |
$2,800.70
|
| Rate for Payer: Preferred Network Access Commercial |
$11,940.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,530.55
|
| Rate for Payer: Quartz Commercial |
$7,164.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,867.13
|
| Rate for Payer: The Alliance Commercial |
$7,935.31
|
| Rate for Payer: United Healthcare Medicaid |
$2,424.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,867.13
|
| Rate for Payer: WEA Trust Commercial |
$6,913.19
|
| Rate for Payer: WPS Commercial |
$8,402.10
|
|
|
REMOVE BLADDER/REVISE TRACT, EXT 5159022
|
Professional
|
Both
|
$12,752.00
|
|
|
Service Code
|
CPT 51590 22
|
| Hospital Charge Code |
6243936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,193.68 |
| Max. Negotiated Rate |
$12,598.98 |
| Rate for Payer: Aetna Commercial |
$12,598.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,405.39
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cigna Commercial |
$12,598.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,193.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,957.25
|
| Rate for Payer: Health EOS Commercial |
$12,068.49
|
| Rate for Payer: HFN Commercial |
$12,598.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,696.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,696.85
|
| Rate for Payer: Multiplan Commercial |
$10,609.66
|
| Rate for Payer: Preferred Network Access Commercial |
$12,598.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,835.32
|
| Rate for Payer: Quartz Commercial |
$7,559.39
|
| Rate for Payer: The Alliance Commercial |
$6,631.04
|
| Rate for Payer: United Healthcare Medicaid |
$2,193.68
|
| Rate for Payer: WEA Trust Commercial |
$7,294.14
|
| Rate for Payer: WPS Commercial |
$9,822.87
|
|
|
REMOVE BLADDER/REVISE TRACT, EXT 5159522
|
Professional
|
Both
|
$14,507.00
|
|
|
Service Code
|
CPT 51595 22
|
| Hospital Charge Code |
6243513
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,424.62 |
| Max. Negotiated Rate |
$14,332.92 |
| Rate for Payer: Aetna Commercial |
$14,332.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,975.06
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cash Price |
$4,352.10
|
| Rate for Payer: Cigna Commercial |
$14,332.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,424.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,052.37
|
| Rate for Payer: Health EOS Commercial |
$13,729.42
|
| Rate for Payer: HFN Commercial |
$14,332.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,579.49
|
| Rate for Payer: Multiplan Commercial |
$12,069.82
|
| Rate for Payer: Preferred Network Access Commercial |
$14,332.92
|
| Rate for Payer: Quartz Beloit One Network |
$6,638.40
|
| Rate for Payer: Quartz Commercial |
$8,599.75
|
| Rate for Payer: The Alliance Commercial |
$7,543.64
|
| Rate for Payer: United Healthcare Medicaid |
$2,424.62
|
| Rate for Payer: WEA Trust Commercial |
$8,298.00
|
| Rate for Payer: WPS Commercial |
$11,174.74
|
|
|
REMOVE BLADDER STONE 52317
|
Professional
|
Both
|
$4,944.00
|
|
|
Service Code
|
CPT 52317
|
| Hospital Charge Code |
3014992
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$293.51 |
| Max. Negotiated Rate |
$4,884.67 |
| Rate for Payer: Aetna Commercial |
$4,884.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,421.91
|
| Rate for Payer: Aetna Managed Medicare |
$293.51
|
| Rate for Payer: Anthem Medicare Advantage |
$293.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$293.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$293.51
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cash Price |
$1,483.20
|
| Rate for Payer: Cigna Commercial |
$4,884.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$373.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.51
|
| Rate for Payer: Health EOS Commercial |
$4,679.00
|
| Rate for Payer: HFN Commercial |
$4,884.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,198.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$293.51
|
| Rate for Payer: Multiplan Commercial |
$4,113.41
|
| Rate for Payer: NAPHCARE Commercial |
$440.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,884.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,262.37
|
| Rate for Payer: Quartz Commercial |
$2,930.80
|
| Rate for Payer: Quartz Medicare Advantage |
$293.51
|
| Rate for Payer: The Alliance Commercial |
$1,247.41
|
| Rate for Payer: United Healthcare Medicaid |
$373.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.51
|
| Rate for Payer: WEA Trust Commercial |
$2,827.97
|
| Rate for Payer: WPS Commercial |
$1,320.79
|
|
|
REMOVE BONE FIXATION DEVICE 20694
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
CPT 20694
|
| Hospital Charge Code |
3013712
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$315.37 |
| Max. Negotiated Rate |
$1,419.16 |
| Rate for Payer: Aetna Commercial |
$1,166.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,056.29
|
| Rate for Payer: Aetna Managed Medicare |
$315.37
|
| Rate for Payer: Anthem Medicare Advantage |
$315.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$315.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$315.37
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cash Price |
$354.30
|
| Rate for Payer: Cigna Commercial |
$1,166.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.37
|
| Rate for Payer: Health EOS Commercial |
$1,117.70
|
| Rate for Payer: HFN Commercial |
$1,166.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,174.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,174.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$315.37
|
| Rate for Payer: Multiplan Commercial |
$982.59
|
| Rate for Payer: NAPHCARE Commercial |
$473.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.83
|
| Rate for Payer: Quartz Beloit One Network |
$540.43
|
| Rate for Payer: Quartz Commercial |
$700.10
|
| Rate for Payer: Quartz Medicare Advantage |
$315.37
|
| Rate for Payer: The Alliance Commercial |
$1,340.32
|
| Rate for Payer: United Healthcare Medicaid |
$368.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.37
|
| Rate for Payer: WEA Trust Commercial |
$675.53
|
| Rate for Payer: WPS Commercial |
$1,419.16
|
|
