|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 12042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 12035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.12 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 12032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
|
|
REPAIR LEG FASCIA DEFECT 27656
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
CPT 27656
|
| Hospital Charge Code |
3014126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$2,051.05 |
| Rate for Payer: Aetna Commercial |
$2,051.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,856.74
|
| Rate for Payer: Cash Price |
$647.70
|
| Rate for Payer: Cash Price |
$647.70
|
| Rate for Payer: Cigna Commercial |
$2,051.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,295.40
|
| Rate for Payer: Health EOS Commercial |
$1,964.69
|
| Rate for Payer: HFN Commercial |
$2,051.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,186.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,186.22
|
| Rate for Payer: Multiplan Commercial |
$1,727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,051.05
|
| Rate for Payer: Quartz Beloit One Network |
$949.96
|
| Rate for Payer: Quartz Commercial |
$1,230.63
|
| Rate for Payer: The Alliance Commercial |
$1,079.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,187.45
|
| Rate for Payer: WPS Commercial |
$1,599.17
|
|
|
REPAIR LIP 40652
|
Professional
|
Both
|
$1,552.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
3014603
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$529.29 |
| Max. Negotiated Rate |
$1,474.40 |
| Rate for Payer: Aetna Commercial |
$1,474.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,474.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$529.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.20
|
| Rate for Payer: Health EOS Commercial |
$1,412.32
|
| Rate for Payer: HFN Commercial |
$1,474.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,186.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,186.43
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,474.40
|
| Rate for Payer: Quartz Beloit One Network |
$682.88
|
| Rate for Payer: Quartz Commercial |
$884.64
|
| Rate for Payer: The Alliance Commercial |
$776.00
|
| Rate for Payer: United Healthcare Medicaid |
$529.29
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
Repair / Modification Of A Hearing Aid
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS V5014
|
| Hospital Charge Code |
1230812
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.28
|
| Rate for Payer: Aetna Managed Medicare |
$55.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.94
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$182.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.80
|
| Rate for Payer: Health EOS Commercial |
$176.22
|
| Rate for Payer: HFN Commercial |
$182.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.50
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.80
|
| Rate for Payer: Preferred Network Access Commercial |
$182.16
|
| Rate for Payer: Quartz Beloit One Network |
$97.02
|
| Rate for Payer: Quartz Commercial |
$128.70
|
| Rate for Payer: Quartz Medicare Advantage |
$118.80
|
| Rate for Payer: The Alliance Commercial |
$792.00
|
| Rate for Payer: United Healthcare PPO |
$148.50
|
| Rate for Payer: WEA Trust Commercial |
$108.90
|
| Rate for Payer: WPS Commercial |
$146.66
|
|
|
Repair / Modification Of A Hearing Aid
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS V5014
|
| Hospital Charge Code |
1230812
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$182.16 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.94
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$182.16
|
| Rate for Payer: Health EOS Commercial |
$176.22
|
| Rate for Payer: HFN Commercial |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.80
|
| Rate for Payer: Preferred Network Access Commercial |
$182.16
|
| Rate for Payer: Quartz Beloit One Network |
$97.02
|
| Rate for Payer: Quartz Commercial |
$118.80
|
| Rate for Payer: WEA Trust Commercial |
$108.90
|
| Rate for Payer: WPS Commercial |
$146.66
|
|
|
Repair / Modification Of A Hearing Aid
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS V5014
|
| Hospital Charge Code |
1230812
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$323.74 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.28
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$188.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.80
|
| Rate for Payer: Health EOS Commercial |
$180.18
|
| Rate for Payer: HFN Commercial |
$188.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.74
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$188.10
|
| Rate for Payer: Quartz Beloit One Network |
$87.12
|
| Rate for Payer: Quartz Commercial |
$112.86
|
| Rate for Payer: The Alliance Commercial |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$108.90
|
| Rate for Payer: WPS Commercial |
$146.66
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 49594
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,703.09 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); GREATER THAN 10 CM, REDUCIBLE
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 49592
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,703.09 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49591
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 49614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,703.09 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
Repair Of Blepharoptosis: Levator Resection Or Advancement, Exteranl Approach
|
Professional
|
Both
|
$5,810.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
1188910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$576.78 |
| Max. Negotiated Rate |
$5,519.50 |
| Rate for Payer: Aetna Commercial |
$5,519.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,996.60
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cash Price |
$1,743.00
|
| Rate for Payer: Cigna Commercial |
$5,519.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,486.00
|
| Rate for Payer: Health EOS Commercial |
$5,287.10
|
| Rate for Payer: HFN Commercial |
$5,519.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,999.39
|
| Rate for Payer: Multiplan Commercial |
$4,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,519.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,556.40
|
| Rate for Payer: Quartz Commercial |
$3,311.70
|
| Rate for Payer: The Alliance Commercial |
$2,905.00
|
| Rate for Payer: United Healthcare Medicaid |
$576.78
|
| Rate for Payer: WEA Trust Commercial |
$3,195.50
|
| Rate for Payer: WPS Commercial |
$4,303.47
|
|
|
REPAIR OF BODY CAST 29720
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
3014308
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$142.22 |
| Rate for Payer: Aetna Commercial |
$76.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$76.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.60
|
| Rate for Payer: Health EOS Commercial |
$73.71
|
| Rate for Payer: HFN Commercial |
$76.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.22
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.95
|
| Rate for Payer: Quartz Beloit One Network |
$35.64
|
| Rate for Payer: Quartz Commercial |
$46.17
|
| Rate for Payer: The Alliance Commercial |
$40.50
|
| Rate for Payer: United Healthcare Medicaid |
$25.40
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
REPAIR OF EARDRUM 69620
|
Professional
|
Both
|
$3,922.00
|
|
|
Service Code
|
CPT 69620
|
| Hospital Charge Code |
3015273
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$583.72 |
| Max. Negotiated Rate |
$3,725.90 |
| Rate for Payer: Aetna Commercial |
$3,725.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.92
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cash Price |
$1,176.60
|
| Rate for Payer: Cigna Commercial |
$3,725.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$583.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,353.20
|
| Rate for Payer: Health EOS Commercial |
$3,569.02
|
| Rate for Payer: HFN Commercial |
$3,725.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,654.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,654.09
|
| Rate for Payer: Multiplan Commercial |
$3,137.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,725.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.68
|
| Rate for Payer: Quartz Commercial |
$2,235.54
|
| Rate for Payer: The Alliance Commercial |
$1,961.00
|
| Rate for Payer: United Healthcare Medicaid |
$583.72
|
| Rate for Payer: WEA Trust Commercial |
$2,157.10
|
| Rate for Payer: WPS Commercial |
$2,905.03
|
|
|
Repair of Ectropion, Extensive
|
Professional
|
Both
|
$3,504.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
1188908
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$466.09 |
| Max. Negotiated Rate |
$3,328.80 |
| Rate for Payer: Aetna Commercial |
$3,328.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.44
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,328.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$466.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.40
|
| Rate for Payer: Health EOS Commercial |
$3,188.64
|
| Rate for Payer: HFN Commercial |
$3,328.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,530.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,530.75
|
| Rate for Payer: Multiplan Commercial |
$2,803.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.76
|
| Rate for Payer: Quartz Commercial |
$1,997.28
|
| Rate for Payer: The Alliance Commercial |
$1,752.00
|
| Rate for Payer: United Healthcare Medicaid |
$466.09
|
| Rate for Payer: WEA Trust Commercial |
$1,927.20
|
| Rate for Payer: WPS Commercial |
$2,595.41
|
|
|
REPAIR OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)
|
Facility
|
OP
|
$9,238.84
|
|
|
Service Code
|
CPT 67917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,309.71 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$9,238.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
|
|
REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$19,665.00
|
|
|
Service Code
|
CPT 57268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$19,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$19,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
Repair Of Entropion,Extensive
|
Professional
|
Both
|
$4,775.00
|
|
|
Service Code
|
CPT 67924
|
| Hospital Charge Code |
1188909
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.62 |
| Max. Negotiated Rate |
$4,536.25 |
| Rate for Payer: Aetna Commercial |
$4,536.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,106.50
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cash Price |
$1,432.50
|
| Rate for Payer: Cigna Commercial |
$4,536.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$602.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.00
|
| Rate for Payer: Health EOS Commercial |
$4,345.25
|
| Rate for Payer: HFN Commercial |
$4,536.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,531.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,531.53
|
| Rate for Payer: Multiplan Commercial |
$3,820.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,536.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,101.00
|
| Rate for Payer: Quartz Commercial |
$2,721.75
|
| Rate for Payer: The Alliance Commercial |
$2,387.50
|
| Rate for Payer: United Healthcare Medicaid |
$602.62
|
| Rate for Payer: WEA Trust Commercial |
$2,626.25
|
| Rate for Payer: WPS Commercial |
$3,536.84
|
|
|
REPAIR OF ENTROPION; EXTENSIVE (EG, TARSAL STRIP OR CAPSULOPALPEBRAL FASCIA REPAIRS OPERATION)
|
Facility
|
OP
|
$9,238.84
|
|
|
Service Code
|
CPT 67924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,309.71 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$9,238.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
|
|
REPAIR OF EYE WOUND 65270
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
3015220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$749.55 |
| Rate for Payer: Aetna Commercial |
$749.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.54
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$749.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.40
|
| Rate for Payer: Health EOS Commercial |
$717.99
|
| Rate for Payer: HFN Commercial |
$749.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.39
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: Preferred Network Access Commercial |
$749.55
|
| Rate for Payer: Quartz Beloit One Network |
$347.16
|
| Rate for Payer: Quartz Commercial |
$449.73
|
| Rate for Payer: The Alliance Commercial |
$394.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$433.95
|
| Rate for Payer: WPS Commercial |
$584.41
|
|
