|
REVISION KIT INTERSTIM II 3560031
|
Facility
|
IP
|
$3,736.00
|
|
| Hospital Charge Code |
6201072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,903.87 |
| Max. Negotiated Rate |
$3,574.60 |
| Rate for Payer: Aetna Commercial |
$3,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.28
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,574.60
|
| Rate for Payer: Health EOS Commercial |
$3,458.04
|
| Rate for Payer: HFN Commercial |
$3,574.60
|
| Rate for Payer: Multiplan Commercial |
$3,108.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.87
|
| Rate for Payer: Quartz Commercial |
$2,331.26
|
| Rate for Payer: WEA Trust Commercial |
$2,136.99
|
| Rate for Payer: WPS Commercial |
$2,877.84
|
|
|
REVISION KIT INTERSTIM II 3560031
|
Facility
|
OP
|
$3,736.00
|
|
| Hospital Charge Code |
6201072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.92 |
| Max. Negotiated Rate |
$3,574.60 |
| Rate for Payer: Aetna Commercial |
$3,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,341.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,525.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,942.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,865.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,059.28
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cigna Commercial |
$3,574.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,174.35
|
| Rate for Payer: Health EOS Commercial |
$3,458.04
|
| Rate for Payer: HFN Commercial |
$3,574.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,914.08
|
| Rate for Payer: Multiplan Commercial |
$3,108.35
|
| Rate for Payer: NAPHCARE Commercial |
$2,331.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,574.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,903.87
|
| Rate for Payer: Quartz Commercial |
$2,525.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,331.26
|
| Rate for Payer: The Alliance Commercial |
$1,942.72
|
| Rate for Payer: WEA Trust Commercial |
$2,136.99
|
| Rate for Payer: WPS Commercial |
$2,877.84
|
|
|
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITH GRAFT
|
Facility
|
OP
|
$9,714.93
|
|
|
Service Code
|
CPT 66185
|
|
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 |
$4,947.89
|
| 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
|
|
|
REVISION OF BIG TOE 28310
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
CPT 28310
|
| Hospital Charge Code |
3014242
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.03 |
| Max. Negotiated Rate |
$1,535.46 |
| Rate for Payer: Aetna Commercial |
$1,493.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,352.33
|
| Rate for Payer: Aetna Managed Medicare |
$341.21
|
| Rate for Payer: Anthem Medicare Advantage |
$341.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$341.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$341.21
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cigna Commercial |
$1,493.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.21
|
| Rate for Payer: Health EOS Commercial |
$1,430.96
|
| Rate for Payer: HFN Commercial |
$1,493.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,264.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,264.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$341.21
|
| Rate for Payer: Multiplan Commercial |
$1,257.98
|
| Rate for Payer: NAPHCARE Commercial |
$511.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,493.86
|
| Rate for Payer: Quartz Beloit One Network |
$691.89
|
| Rate for Payer: Quartz Commercial |
$896.31
|
| Rate for Payer: Quartz Medicare Advantage |
$341.21
|
| Rate for Payer: The Alliance Commercial |
$1,450.16
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.21
|
| Rate for Payer: WEA Trust Commercial |
$864.86
|
| Rate for Payer: WPS Commercial |
$1,535.46
|
|
|
Revision Of Cornea
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
CPT 65600
|
| Hospital Charge Code |
1190832
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$297.37 |
| Max. Negotiated Rate |
$1,338.15 |
| Rate for Payer: Aetna Commercial |
$1,005.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$910.50
|
| Rate for Payer: Aetna Managed Medicare |
$297.37
|
| Rate for Payer: Anthem Medicare Advantage |
$297.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$297.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$297.37
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cash Price |
$305.40
|
| Rate for Payer: Cigna Commercial |
$1,005.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.37
|
| Rate for Payer: Health EOS Commercial |
$963.44
|
| Rate for Payer: HFN Commercial |
$1,005.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,188.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$297.37
|
| Rate for Payer: Multiplan Commercial |
$846.98
|
| Rate for Payer: NAPHCARE Commercial |
$446.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.78
|
| Rate for Payer: Quartz Beloit One Network |
$465.84
|
| Rate for Payer: Quartz Commercial |
$603.47
|
| Rate for Payer: Quartz Medicare Advantage |
$297.37
|
| Rate for Payer: The Alliance Commercial |
$1,263.81
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.37
|
| Rate for Payer: WEA Trust Commercial |
$582.30
|
| Rate for Payer: WPS Commercial |
$1,338.15
|
|
|
REVISION OF EYELID 67966
|
Professional
|
Both
|
$5,120.00
|
|
|
Service Code
|
CPT 67966
|
| Hospital Charge Code |
3015252
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$549.03 |
| Max. Negotiated Rate |
$5,058.56 |
| Rate for Payer: Aetna Commercial |
$5,058.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,579.33
|
| Rate for Payer: Aetna Managed Medicare |
$549.03
|
| Rate for Payer: Anthem Medicare Advantage |
$549.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$549.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$549.03
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cigna Commercial |
$5,058.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$630.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$549.03
|
| Rate for Payer: Health EOS Commercial |
$4,845.57
|
| Rate for Payer: HFN Commercial |
$5,058.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,284.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,284.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$549.03
|
| Rate for Payer: Multiplan Commercial |
$4,259.84
|
| Rate for Payer: NAPHCARE Commercial |
$823.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,058.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,342.91
|
| Rate for Payer: Quartz Commercial |
$3,035.14
|
| Rate for Payer: Quartz Medicare Advantage |
$549.03
|
| Rate for Payer: The Alliance Commercial |
$2,333.36
|
| Rate for Payer: United Healthcare Medicaid |
$630.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$549.03
|
| Rate for Payer: WEA Trust Commercial |
$2,928.64
|
| Rate for Payer: WPS Commercial |
$2,470.62
|
|
|
REVISION OF FOOT FASCIA 28250
|
Professional
|
Both
|
$2,163.00
|
|
|
Service Code
|
CPT 28250
|
| Hospital Charge Code |
3014225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$375.24 |
| Max. Negotiated Rate |
$2,137.04 |
| Rate for Payer: Aetna Commercial |
$2,137.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,934.59
|
| Rate for Payer: Aetna Managed Medicare |
$375.24
|
| Rate for Payer: Anthem Medicare Advantage |
$375.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$375.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$375.24
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cigna Commercial |
$2,137.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.24
|
| Rate for Payer: Health EOS Commercial |
$2,047.06
|
| Rate for Payer: HFN Commercial |
$2,137.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,405.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,405.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$375.24
|
| Rate for Payer: Multiplan Commercial |
$1,799.62
|
| Rate for Payer: NAPHCARE Commercial |
$562.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.04
|
| Rate for Payer: Quartz Beloit One Network |
$989.79
|
| Rate for Payer: Quartz Commercial |
$1,282.23
|
| Rate for Payer: Quartz Medicare Advantage |
$375.24
|
| Rate for Payer: The Alliance Commercial |
$1,594.78
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$375.24
|
| Rate for Payer: WEA Trust Commercial |
$1,237.24
|
| Rate for Payer: WPS Commercial |
$1,688.59
|
|
|
REVISION OF FOOT TENDON 28238
|
Professional
|
Both
|
$4,118.00
|
|
|
Service Code
|
CPT 28238
|
| Hospital Charge Code |
3014223
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.44 |
| Max. Negotiated Rate |
$4,068.58 |
| Rate for Payer: Aetna Commercial |
$4,068.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,683.14
|
| Rate for Payer: Aetna Managed Medicare |
$447.44
|
| Rate for Payer: Anthem Medicare Advantage |
$447.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$447.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$447.44
|
| Rate for Payer: Cash Price |
$1,235.40
|
| Rate for Payer: Cash Price |
$1,235.40
|
| Rate for Payer: Cash Price |
$1,235.40
|
| Rate for Payer: Cigna Commercial |
$4,068.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.44
|
| Rate for Payer: Health EOS Commercial |
$3,897.28
|
| Rate for Payer: HFN Commercial |
$4,068.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,695.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$447.44
|
| Rate for Payer: Multiplan Commercial |
$3,426.18
|
| Rate for Payer: NAPHCARE Commercial |
$671.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,068.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.40
|
| Rate for Payer: Quartz Commercial |
$2,441.15
|
| Rate for Payer: Quartz Medicare Advantage |
$447.44
|
| Rate for Payer: The Alliance Commercial |
$1,901.62
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$447.44
|
| Rate for Payer: WEA Trust Commercial |
$2,355.50
|
| Rate for Payer: WPS Commercial |
$2,013.48
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$96,727.28
|
|
|
Service Code
|
MSDRG 467
|
| Min. Negotiated Rate |
$27,514.19 |
| Max. Negotiated Rate |
$96,727.28 |
| Rate for Payer: Aetna Managed Medicare |
$27,514.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,947.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,979.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,034.57
|
| Rate for Payer: Anthem Medicare Advantage |
$27,514.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,514.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,514.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,514.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,203.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,514.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,702.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,514.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,514.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,514.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,514.19
|
| Rate for Payer: NAPHCARE Commercial |
$41,271.28
|
| Rate for Payer: Quartz Medicare Advantage |
$27,514.19
|
| Rate for Payer: The Alliance Commercial |
$96,727.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,514.19
|
| Rate for Payer: United Healthcare PPO |
$55,042.54
|
| Rate for Payer: Wellcare Medicare |
$27,514.19
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$143,739.44
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$40,370.76 |
| Max. Negotiated Rate |
$143,739.44 |
| Rate for Payer: Aetna Managed Medicare |
$40,370.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113,577.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87,056.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82,709.23
|
| Rate for Payer: Anthem Medicare Advantage |
$40,370.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40,370.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40,370.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$40,370.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91,814.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$40,370.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105,184.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40,370.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40,370.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$40,370.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$40,370.76
|
| Rate for Payer: NAPHCARE Commercial |
$60,556.14
|
| Rate for Payer: Quartz Medicare Advantage |
$40,370.76
|
| Rate for Payer: The Alliance Commercial |
$143,739.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40,370.76
|
| Rate for Payer: United Healthcare PPO |
$81,887.28
|
| Rate for Payer: Wellcare Medicare |
$40,370.76
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$74,145.76
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$21,551.50 |
| Max. Negotiated Rate |
$74,145.76 |
| Rate for Payer: Aetna Managed Medicare |
$21,551.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,959.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,958.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,663.30
|
| Rate for Payer: Anthem Medicare Advantage |
$21,551.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,551.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,551.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,470.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,551.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54,139.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,551.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,551.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,551.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,551.50
|
| Rate for Payer: NAPHCARE Commercial |
$32,327.26
|
| Rate for Payer: Quartz Medicare Advantage |
$21,551.50
|
| Rate for Payer: The Alliance Commercial |
$74,145.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,551.50
|
| Rate for Payer: United Healthcare PPO |
$42,148.29
|
| Rate for Payer: Wellcare Medicare |
$21,551.50
|
|
|
REVISION OF LOWER LEG TENDON 27685
|
Professional
|
Both
|
$2,531.00
|
|
|
Service Code
|
CPT 27685
|
| Hospital Charge Code |
3014131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$420.48 |
| Max. Negotiated Rate |
$2,500.63 |
| Rate for Payer: Aetna Commercial |
$2,500.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,263.73
|
| Rate for Payer: Aetna Managed Medicare |
$430.67
|
| Rate for Payer: Anthem Medicare Advantage |
$430.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$430.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$430.67
|
| Rate for Payer: Cash Price |
$759.30
|
| Rate for Payer: Cash Price |
$759.30
|
| Rate for Payer: Cash Price |
$759.30
|
| Rate for Payer: Cigna Commercial |
$2,500.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$420.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.67
|
| Rate for Payer: Health EOS Commercial |
$2,395.34
|
| Rate for Payer: HFN Commercial |
$2,500.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,621.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$430.67
|
| Rate for Payer: Multiplan Commercial |
$2,105.79
|
| Rate for Payer: NAPHCARE Commercial |
$646.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,500.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,158.19
|
| Rate for Payer: Quartz Commercial |
$1,500.38
|
| Rate for Payer: Quartz Medicare Advantage |
$430.67
|
| Rate for Payer: The Alliance Commercial |
$1,830.37
|
| Rate for Payer: United Healthcare Medicaid |
$420.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$430.67
|
| Rate for Payer: WEA Trust Commercial |
$1,447.73
|
| Rate for Payer: WPS Commercial |
$1,938.03
|
|
|
Revision of Nose 30120
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
CPT 30120
|
| Hospital Charge Code |
3147588
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$363.78 |
| Max. Negotiated Rate |
$1,637.02 |
| Rate for Payer: Aetna Commercial |
$1,121.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$363.78
|
| Rate for Payer: Anthem Medicare Advantage |
$363.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$363.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$363.78
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,121.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$548.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.78
|
| Rate for Payer: Health EOS Commercial |
$1,074.16
|
| Rate for Payer: HFN Commercial |
$1,121.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,477.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,477.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$363.78
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$545.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,121.38
|
| Rate for Payer: Quartz Beloit One Network |
$519.38
|
| Rate for Payer: Quartz Commercial |
$672.83
|
| Rate for Payer: Quartz Medicare Advantage |
$363.78
|
| Rate for Payer: The Alliance Commercial |
$1,546.07
|
| Rate for Payer: United Healthcare Medicaid |
$548.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$363.78
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$1,637.02
|
|
|
Revision of total hip arthroplasty; femoral component only, with or without allograft
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 27138
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,790.08 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
Revision of total knee arthroplasty, with or without allograft; 1 component
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 27486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,790.08 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component
|
Facility
|
OP
|
$73,809.59
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,790.08 |
| Max. Negotiated Rate |
$73,809.59 |
| Rate for Payer: Aetna Managed Medicare |
$18,452.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$18,452.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,452.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,452.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,452.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,452.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,642.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,452.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,452.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,452.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,452.40
|
| Rate for Payer: NAPHCARE Commercial |
$27,678.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18,452.40
|
| Rate for Payer: The Alliance Commercial |
$73,809.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,452.40
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$18,452.40
|
|
|
Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 23474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$12,349.86 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
Revision of Upper Eyelid 1582350
|
Professional
|
Both
|
$4,990.00
|
|
|
Service Code
|
CPT 15823 50
|
| Hospital Charge Code |
4422813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$576.87 |
| Max. Negotiated Rate |
$4,930.12 |
| Rate for Payer: Aetna Commercial |
$4,930.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.06
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Cash Price |
$1,497.00
|
| Rate for Payer: Cigna Commercial |
$4,930.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,113.76
|
| Rate for Payer: Health EOS Commercial |
$4,722.54
|
| Rate for Payer: HFN Commercial |
$4,930.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,932.49
|
| Rate for Payer: Multiplan Commercial |
$4,151.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,930.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,283.42
|
| Rate for Payer: Quartz Commercial |
$2,958.07
|
| Rate for Payer: The Alliance Commercial |
$2,594.80
|
| Rate for Payer: United Healthcare Medicaid |
$576.87
|
| Rate for Payer: WEA Trust Commercial |
$2,854.28
|
| Rate for Payer: WPS Commercial |
$3,843.80
|
|
|
Revision, open, arteriovenous fistula; without thrombectomy, autogenous or nonautogenous dialysis graft (separate procedure)
|
Facility
|
OP
|
$23,424.04
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
|
|
Revision or removal of implanted spinal neurostimulator pulse generator or receiver, with detachable connection to electrode array
|
Facility
|
OP
|
$14,717.04
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,679.26 |
| Max. Negotiated Rate |
$14,717.04 |
| Rate for Payer: Aetna Managed Medicare |
$3,679.26
|
| 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 |
$3,679.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,679.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,679.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,679.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,679.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,686.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,679.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,679.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,679.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,679.26
|
| Rate for Payer: NAPHCARE Commercial |
$5,518.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,679.26
|
| Rate for Payer: The Alliance Commercial |
$14,717.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,679.26
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,679.26
|
|
|
Revision or removal of peripheral, sacral, or gastric neurostimulator pulse generator or receiver, with detachable connection to electrode array
|
Facility
|
OP
|
$14,717.04
|
|
|
Service Code
|
CPT 64595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,679.26 |
| Max. Negotiated Rate |
$14,717.04 |
| Rate for Payer: Aetna Managed Medicare |
$3,679.26
|
| 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 |
$3,679.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,679.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,679.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,679.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,679.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,686.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,679.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,679.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,679.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,679.26
|
| Rate for Payer: NAPHCARE Commercial |
$5,518.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,679.26
|
| Rate for Payer: The Alliance Commercial |
$14,717.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,679.26
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,679.26
|
|
|
REVISION, REPAIR OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE
|
Facility
|
OP
|
$159.21
|
|
|
Service Code
|
EAPG 00076
|
| Min. Negotiated Rate |
$153.08 |
| Max. Negotiated Rate |
$159.21 |
| Rate for Payer: Anthem Medicaid |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$153.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.08
|
| Rate for Payer: Dean Health Medicaid |
$153.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$153.08
|
| Rate for Payer: Managed Health Services Medicaid |
$159.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$153.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$153.08
|
| Rate for Payer: United Healthcare Medicaid |
$153.08
|
|
|
REVISION, REPLACEMENT OR REMOVAL OF CARDIAC DEVICE COMPONENT
|
Facility
|
OP
|
$327.79
|
|
|
Service Code
|
EAPG 00074
|
| Min. Negotiated Rate |
$315.18 |
| Max. Negotiated Rate |
$327.79 |
| Rate for Payer: Anthem Medicaid |
$315.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$315.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.18
|
| Rate for Payer: Dean Health Medicaid |
$315.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$315.18
|
| Rate for Payer: Managed Health Services Medicaid |
$327.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$315.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$315.18
|
| Rate for Payer: United Healthcare Medicaid |
$315.18
|
|
|
REVJ URINARY-CUTANEOUS ANASTAMOSIS (revise urinary opening to skin) 50727
|
Professional
|
Both
|
$2,035.00
|
|
|
Service Code
|
CPT 50727
|
| Hospital Charge Code |
6173583
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$458.59 |
| Max. Negotiated Rate |
$2,063.65 |
| Rate for Payer: Aetna Commercial |
$2,010.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,820.10
|
| Rate for Payer: Aetna Managed Medicare |
$458.59
|
| Rate for Payer: Anthem Medicare Advantage |
$458.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$458.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$458.59
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cigna Commercial |
$2,010.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$802.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.59
|
| Rate for Payer: Health EOS Commercial |
$1,925.92
|
| Rate for Payer: HFN Commercial |
$2,010.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,774.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,774.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$458.59
|
| Rate for Payer: Multiplan Commercial |
$1,693.12
|
| Rate for Payer: NAPHCARE Commercial |
$687.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,010.58
|
| Rate for Payer: Quartz Beloit One Network |
$931.22
|
| Rate for Payer: Quartz Commercial |
$1,206.35
|
| Rate for Payer: Quartz Medicare Advantage |
$458.59
|
| Rate for Payer: The Alliance Commercial |
$1,949.00
|
| Rate for Payer: United Healthcare Medicaid |
$802.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$458.59
|
| Rate for Payer: WEA Trust Commercial |
$1,164.02
|
| Rate for Payer: WPS Commercial |
$2,063.65
|
|
