|
RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED 49596
|
Professional
|
Both
|
$8,479.00
|
|
|
Service Code
|
CPT 49596
|
| Hospital Charge Code |
6179960
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$716.86 |
| Max. Negotiated Rate |
$8,055.05 |
| Rate for Payer: Aetna Commercial |
$8,055.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,291.94
|
| Rate for Payer: Cash Price |
$2,543.70
|
| Rate for Payer: Cash Price |
$2,543.70
|
| Rate for Payer: Cigna Commercial |
$8,055.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$716.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,087.40
|
| Rate for Payer: Health EOS Commercial |
$7,715.89
|
| Rate for Payer: HFN Commercial |
$8,055.05
|
| Rate for Payer: Multiplan Commercial |
$6,783.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,055.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,730.76
|
| Rate for Payer: Quartz Commercial |
$4,833.03
|
| Rate for Payer: The Alliance Commercial |
$4,239.50
|
| Rate for Payer: United Healthcare Medicaid |
$716.86
|
| Rate for Payer: WEA Trust Commercial |
$4,663.45
|
| Rate for Payer: WPS Commercial |
$6,280.40
|
|
|
RPR AA HERNIA 1ST > 10 CM NCRC8/STRANGULATED, EXT CARE 4959622
|
Professional
|
Both
|
$10,175.00
|
|
|
Service Code
|
CPT 49596 22
|
| Hospital Charge Code |
6195224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,477.00 |
| Max. Negotiated Rate |
$9,666.25 |
| Rate for Payer: Aetna Commercial |
$9,666.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,750.50
|
| Rate for Payer: Cash Price |
$3,052.50
|
| Rate for Payer: Cash Price |
$3,052.50
|
| Rate for Payer: Cigna Commercial |
$9,666.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,087.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,105.00
|
| Rate for Payer: Health EOS Commercial |
$9,259.25
|
| Rate for Payer: HFN Commercial |
$9,666.25
|
| Rate for Payer: Multiplan Commercial |
$8,140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,666.25
|
| Rate for Payer: Quartz Beloit One Network |
$4,477.00
|
| Rate for Payer: Quartz Commercial |
$5,799.75
|
| Rate for Payer: The Alliance Commercial |
$5,087.50
|
| Rate for Payer: WEA Trust Commercial |
$5,596.25
|
| Rate for Payer: WPS Commercial |
$7,536.62
|
|
|
RPR AA HERNIA 1ST > 10 CM REDUCIBLE 49595
|
Professional
|
Both
|
$7,793.00
|
|
|
Service Code
|
CPT 49595
|
| Hospital Charge Code |
6179959
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$539.57 |
| Max. Negotiated Rate |
$7,403.35 |
| Rate for Payer: Aetna Commercial |
$7,403.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,701.98
|
| Rate for Payer: Cash Price |
$2,337.90
|
| Rate for Payer: Cash Price |
$2,337.90
|
| Rate for Payer: Cigna Commercial |
$7,403.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$539.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,675.80
|
| Rate for Payer: Health EOS Commercial |
$7,091.63
|
| Rate for Payer: HFN Commercial |
$7,403.35
|
| Rate for Payer: Multiplan Commercial |
$6,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,403.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,428.92
|
| Rate for Payer: Quartz Commercial |
$4,442.01
|
| Rate for Payer: The Alliance Commercial |
$3,896.50
|
| Rate for Payer: United Healthcare Medicaid |
$539.57
|
| Rate for Payer: WEA Trust Commercial |
$4,286.15
|
| Rate for Payer: WPS Commercial |
$5,772.28
|
|
|
RPR AA HERNIA 1ST 3-10 CM REDUCIBLE 49593
|
Professional
|
Both
|
$3,898.00
|
|
|
Service Code
|
CPT 49593
|
| Hospital Charge Code |
6179957
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$401.18 |
| Max. Negotiated Rate |
$3,703.10 |
| Rate for Payer: Aetna Commercial |
$3,703.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,352.28
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cash Price |
$1,169.40
|
| Rate for Payer: Cigna Commercial |
$3,703.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$401.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,338.80
|
| Rate for Payer: Health EOS Commercial |
$3,547.18
|
| Rate for Payer: HFN Commercial |
$3,703.10
|
| Rate for Payer: Multiplan Commercial |
$3,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,703.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,715.12
|
| Rate for Payer: Quartz Commercial |
$2,221.86
|
| Rate for Payer: The Alliance Commercial |
$1,949.00
|
| Rate for Payer: United Healthcare Medicaid |
$401.18
|
| Rate for Payer: WEA Trust Commercial |
$2,143.90
|
| Rate for Payer: WPS Commercial |
$2,887.25
|
|
|
RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED 49592
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
CPT 49592
|
| Hospital Charge Code |
6179956
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.74 |
| Max. Negotiated Rate |
$3,054.25 |
| Rate for Payer: Aetna Commercial |
$3,054.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,764.90
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,054.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,929.00
|
| Rate for Payer: Health EOS Commercial |
$2,925.65
|
| Rate for Payer: HFN Commercial |
$3,054.25
|
| Rate for Payer: Multiplan Commercial |
$2,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,054.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.60
|
| Rate for Payer: Quartz Commercial |
$1,832.55
|
| Rate for Payer: The Alliance Commercial |
$1,607.50
|
| Rate for Payer: United Healthcare Medicaid |
$332.74
|
| Rate for Payer: WEA Trust Commercial |
$1,768.25
|
| Rate for Payer: WPS Commercial |
$2,381.35
|
|
|
RPR AA HERNIA 1ST < 3 CM REDUCIBLE 49591
|
Professional
|
Both
|
$2,470.00
|
|
|
Service Code
|
CPT 49591
|
| Hospital Charge Code |
6179955
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$239.78 |
| Max. Negotiated Rate |
$2,346.50 |
| Rate for Payer: Aetna Commercial |
$2,346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,124.20
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cash Price |
$741.00
|
| Rate for Payer: Cigna Commercial |
$2,346.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,482.00
|
| Rate for Payer: Health EOS Commercial |
$2,247.70
|
| Rate for Payer: HFN Commercial |
$2,346.50
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,346.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.80
|
| Rate for Payer: Quartz Commercial |
$1,407.90
|
| Rate for Payer: The Alliance Commercial |
$1,235.00
|
| Rate for Payer: United Healthcare Medicaid |
$239.78
|
| Rate for Payer: WEA Trust Commercial |
$1,358.50
|
| Rate for Payer: WPS Commercial |
$1,829.53
|
|
|
RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED 49618
|
Professional
|
Both
|
$9,409.00
|
|
|
Service Code
|
CPT 49618
|
| Hospital Charge Code |
6179923
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$867.98 |
| Max. Negotiated Rate |
$8,938.55 |
| Rate for Payer: Aetna Commercial |
$8,938.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,091.74
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cash Price |
$2,822.70
|
| Rate for Payer: Cigna Commercial |
$8,938.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$867.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,645.40
|
| Rate for Payer: Health EOS Commercial |
$8,562.19
|
| Rate for Payer: HFN Commercial |
$8,938.55
|
| Rate for Payer: Multiplan Commercial |
$7,527.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,938.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,139.96
|
| Rate for Payer: Quartz Commercial |
$5,363.13
|
| Rate for Payer: The Alliance Commercial |
$4,704.50
|
| Rate for Payer: United Healthcare Medicaid |
$867.98
|
| Rate for Payer: WEA Trust Commercial |
$5,174.95
|
| Rate for Payer: WPS Commercial |
$6,969.25
|
|
|
RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED, EXT 4961822
|
Professional
|
Both
|
$11,290.00
|
|
|
Service Code
|
CPT 49618 22
|
| Hospital Charge Code |
6181710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,967.60 |
| Max. Negotiated Rate |
$10,725.50 |
| Rate for Payer: Aetna Commercial |
$10,725.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,709.40
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cash Price |
$3,387.00
|
| Rate for Payer: Cigna Commercial |
$10,725.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,645.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,774.00
|
| Rate for Payer: Health EOS Commercial |
$10,273.90
|
| Rate for Payer: HFN Commercial |
$10,725.50
|
| Rate for Payer: Multiplan Commercial |
$9,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,725.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,967.60
|
| Rate for Payer: Quartz Commercial |
$6,435.30
|
| Rate for Payer: The Alliance Commercial |
$5,645.00
|
| Rate for Payer: WEA Trust Commercial |
$6,209.50
|
| Rate for Payer: WPS Commercial |
$8,362.50
|
|
|
RPR AA HERNIA RECR > 10 CM REDUCIBLE 49617
|
Professional
|
Both
|
$6,968.00
|
|
|
Service Code
|
CPT 49617
|
| Hospital Charge Code |
6179922
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$620.44 |
| Max. Negotiated Rate |
$6,619.60 |
| Rate for Payer: Aetna Commercial |
$6,619.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,992.48
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cash Price |
$2,090.40
|
| Rate for Payer: Cigna Commercial |
$6,619.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$620.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,180.80
|
| Rate for Payer: Health EOS Commercial |
$6,340.88
|
| Rate for Payer: HFN Commercial |
$6,619.60
|
| Rate for Payer: Multiplan Commercial |
$5,574.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,619.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,065.92
|
| Rate for Payer: Quartz Commercial |
$3,971.76
|
| Rate for Payer: The Alliance Commercial |
$3,484.00
|
| Rate for Payer: United Healthcare Medicaid |
$620.44
|
| Rate for Payer: WEA Trust Commercial |
$3,832.40
|
| Rate for Payer: WPS Commercial |
$5,161.20
|
|
|
RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED 49616
|
Professional
|
Both
|
$6,911.00
|
|
|
Service Code
|
CPT 49616
|
| Hospital Charge Code |
6179889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$600.46 |
| Max. Negotiated Rate |
$6,565.45 |
| Rate for Payer: Aetna Commercial |
$6,565.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,943.46
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cash Price |
$2,073.30
|
| Rate for Payer: Cigna Commercial |
$6,565.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,146.60
|
| Rate for Payer: Health EOS Commercial |
$6,289.01
|
| Rate for Payer: HFN Commercial |
$6,565.45
|
| Rate for Payer: Multiplan Commercial |
$5,528.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,565.45
|
| Rate for Payer: Quartz Beloit One Network |
$3,040.84
|
| Rate for Payer: Quartz Commercial |
$3,939.27
|
| Rate for Payer: The Alliance Commercial |
$3,455.50
|
| Rate for Payer: United Healthcare Medicaid |
$600.46
|
| Rate for Payer: WEA Trust Commercial |
$3,801.05
|
| Rate for Payer: WPS Commercial |
$5,118.98
|
|
|
RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED EXTENDED 4961622
|
Professional
|
Both
|
$8,293.00
|
|
|
Service Code
|
CPT 49616 22
|
| Hospital Charge Code |
6179888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,648.92 |
| Max. Negotiated Rate |
$7,878.35 |
| Rate for Payer: Aetna Commercial |
$7,878.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,131.98
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cash Price |
$2,487.90
|
| Rate for Payer: Cigna Commercial |
$7,878.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,975.80
|
| Rate for Payer: Health EOS Commercial |
$7,546.63
|
| Rate for Payer: HFN Commercial |
$7,878.35
|
| Rate for Payer: Multiplan Commercial |
$6,634.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,878.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,648.92
|
| Rate for Payer: Quartz Commercial |
$4,727.01
|
| Rate for Payer: The Alliance Commercial |
$4,146.50
|
| Rate for Payer: WEA Trust Commercial |
$4,561.15
|
| Rate for Payer: WPS Commercial |
$6,142.63
|
|
|
RPR AA HERNIA RECR 3-10 CM REDUCIBLE 49615
|
Professional
|
Both
|
$5,368.00
|
|
|
Service Code
|
CPT 49615
|
| Hospital Charge Code |
6179921
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$447.71 |
| Max. Negotiated Rate |
$5,099.60 |
| Rate for Payer: Aetna Commercial |
$5,099.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.48
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Cigna Commercial |
$5,099.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$447.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.80
|
| Rate for Payer: Health EOS Commercial |
$4,884.88
|
| Rate for Payer: HFN Commercial |
$5,099.60
|
| Rate for Payer: Multiplan Commercial |
$4,294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,099.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.92
|
| Rate for Payer: Quartz Commercial |
$3,059.76
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare Medicaid |
$447.71
|
| Rate for Payer: WEA Trust Commercial |
$2,952.40
|
| Rate for Payer: WPS Commercial |
$3,976.08
|
|
|
RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED 49614
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
CPT 49614
|
| Hospital Charge Code |
6179920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$400.15 |
| Max. Negotiated Rate |
$3,700.25 |
| Rate for Payer: Aetna Commercial |
$3,700.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,349.70
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cash Price |
$1,168.50
|
| Rate for Payer: Cigna Commercial |
$3,700.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$400.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,337.00
|
| Rate for Payer: Health EOS Commercial |
$3,544.45
|
| Rate for Payer: HFN Commercial |
$3,700.25
|
| Rate for Payer: Multiplan Commercial |
$3,116.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,700.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.80
|
| Rate for Payer: Quartz Commercial |
$2,220.15
|
| Rate for Payer: The Alliance Commercial |
$1,947.50
|
| Rate for Payer: United Healthcare Medicaid |
$400.15
|
| Rate for Payer: WEA Trust Commercial |
$2,142.25
|
| Rate for Payer: WPS Commercial |
$2,885.03
|
|
|
RPR AA HERNIA RECR < 3 CM REDUCIBLE 49613
|
Professional
|
Both
|
$3,743.00
|
|
|
Service Code
|
CPT 49613
|
| Hospital Charge Code |
6179919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.87 |
| Max. Negotiated Rate |
$3,555.85 |
| Rate for Payer: Aetna Commercial |
$3,555.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.98
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cash Price |
$1,122.90
|
| Rate for Payer: Cigna Commercial |
$3,555.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,245.80
|
| Rate for Payer: Health EOS Commercial |
$3,406.13
|
| Rate for Payer: HFN Commercial |
$3,555.85
|
| Rate for Payer: Multiplan Commercial |
$2,994.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,555.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,646.92
|
| Rate for Payer: Quartz Commercial |
$2,133.51
|
| Rate for Payer: The Alliance Commercial |
$1,871.50
|
| Rate for Payer: United Healthcare Medicaid |
$295.87
|
| Rate for Payer: WEA Trust Commercial |
$2,058.65
|
| Rate for Payer: WPS Commercial |
$2,772.44
|
|
|
RPR AARPR AA HERNIA RECR > 10 CM REDUCIBLE, EXT 4961722
|
Professional
|
Both
|
$8,362.00
|
|
|
Service Code
|
CPT 49617 22
|
| Hospital Charge Code |
6186963
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,679.28 |
| Max. Negotiated Rate |
$7,943.90 |
| Rate for Payer: Aetna Commercial |
$7,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,191.32
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cash Price |
$2,508.60
|
| Rate for Payer: Cigna Commercial |
$7,943.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,181.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,017.20
|
| Rate for Payer: Health EOS Commercial |
$7,609.42
|
| Rate for Payer: HFN Commercial |
$7,943.90
|
| Rate for Payer: Multiplan Commercial |
$6,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,943.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.28
|
| Rate for Payer: Quartz Commercial |
$4,766.34
|
| Rate for Payer: The Alliance Commercial |
$4,181.00
|
| Rate for Payer: WEA Trust Commercial |
$4,599.10
|
| Rate for Payer: WPS Commercial |
$6,193.73
|
|
|
RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL 67901
|
Professional
|
Both
|
$4,420.00
|
|
|
Service Code
|
CPT 67901
|
| Hospital Charge Code |
6242599
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$889.43 |
| Max. Negotiated Rate |
$4,199.00 |
| Rate for Payer: Aetna Commercial |
$4,199.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,801.20
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cash Price |
$1,326.00
|
| Rate for Payer: Cigna Commercial |
$4,199.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$889.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,652.00
|
| Rate for Payer: Health EOS Commercial |
$4,022.20
|
| Rate for Payer: HFN Commercial |
$4,199.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,976.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,976.20
|
| Rate for Payer: Multiplan Commercial |
$3,536.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,199.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,944.80
|
| Rate for Payer: Quartz Commercial |
$2,519.40
|
| Rate for Payer: The Alliance Commercial |
$2,210.00
|
| Rate for Payer: United Healthcare Medicaid |
$889.43
|
| Rate for Payer: WEA Trust Commercial |
$2,431.00
|
| Rate for Payer: WPS Commercial |
$3,273.89
|
|
|
RPR BLPOS Conjunctivo-Tarso-Mus 67908
|
Professional
|
Both
|
$3,215.00
|
|
|
Service Code
|
CPT 67908
|
| Hospital Charge Code |
5102674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$677.97 |
| Max. Negotiated Rate |
$3,054.25 |
| Rate for Payer: Aetna Commercial |
$3,054.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,764.90
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,054.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$677.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,929.00
|
| Rate for Payer: Health EOS Commercial |
$2,925.65
|
| Rate for Payer: HFN Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,450.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,450.16
|
| Rate for Payer: Multiplan Commercial |
$2,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,054.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.60
|
| Rate for Payer: Quartz Commercial |
$1,832.55
|
| Rate for Payer: The Alliance Commercial |
$1,607.50
|
| Rate for Payer: United Healthcare Medicaid |
$677.97
|
| Rate for Payer: WEA Trust Commercial |
$1,768.25
|
| Rate for Payer: WPS Commercial |
$2,381.35
|
|
|
RPR BLPOS Conjunctivo-Tarso-Mus 6790850
|
Professional
|
Both
|
$6,430.00
|
|
|
Service Code
|
CPT 67908 50
|
| Hospital Charge Code |
5102675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$677.97 |
| Max. Negotiated Rate |
$6,108.50 |
| Rate for Payer: Aetna Commercial |
$6,108.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.80
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cash Price |
$1,929.00
|
| Rate for Payer: Cigna Commercial |
$6,108.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$677.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,858.00
|
| Rate for Payer: Health EOS Commercial |
$5,851.30
|
| Rate for Payer: HFN Commercial |
$6,108.50
|
| Rate for Payer: Multiplan Commercial |
$5,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,108.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,829.20
|
| Rate for Payer: Quartz Commercial |
$3,665.10
|
| Rate for Payer: The Alliance Commercial |
$3,215.00
|
| Rate for Payer: United Healthcare Medicaid |
$677.97
|
| Rate for Payer: WEA Trust Commercial |
$3,536.50
|
| Rate for Payer: WPS Commercial |
$4,762.70
|
|
|
RPR CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ SIT 36576
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
6242814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.65 |
| Max. Negotiated Rate |
$1,307.20 |
| Rate for Payer: Aetna Commercial |
$1,307.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.36
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,307.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$409.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$825.60
|
| Rate for Payer: Health EOS Commercial |
$1,252.16
|
| Rate for Payer: HFN Commercial |
$1,307.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.77
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.20
|
| Rate for Payer: Quartz Beloit One Network |
$605.44
|
| Rate for Payer: Quartz Commercial |
$784.32
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: United Healthcare Medicaid |
$409.65
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
RPR NSL VLV COLLAPSE LW NRG SUBQ/SBMCSL RMDLG 30469
|
Professional
|
Both
|
$9,812.00
|
|
|
Service Code
|
CPT 30469
|
| Hospital Charge Code |
6243937
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,317.28 |
| Max. Negotiated Rate |
$9,321.40 |
| Rate for Payer: Aetna Commercial |
$9,321.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,438.32
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cash Price |
$2,943.60
|
| Rate for Payer: Cigna Commercial |
$9,321.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,906.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,887.20
|
| Rate for Payer: Health EOS Commercial |
$8,928.92
|
| Rate for Payer: HFN Commercial |
$9,321.40
|
| Rate for Payer: Multiplan Commercial |
$7,849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,321.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,317.28
|
| Rate for Payer: Quartz Commercial |
$5,592.84
|
| Rate for Payer: The Alliance Commercial |
$4,906.00
|
| Rate for Payer: WEA Trust Commercial |
$5,396.60
|
| Rate for Payer: WPS Commercial |
$7,267.75
|
|
|
RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT - 30468
|
Professional
|
Both
|
$3,824.00
|
|
|
Service Code
|
CPT 30468
|
| Hospital Charge Code |
5923671
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$554.81 |
| Max. Negotiated Rate |
$3,632.80 |
| Rate for Payer: Aetna Commercial |
$3,632.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,288.64
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cigna Commercial |
$3,632.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,912.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,294.40
|
| Rate for Payer: Health EOS Commercial |
$3,479.84
|
| Rate for Payer: HFN Commercial |
$3,632.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$554.81
|
| Rate for Payer: Multiplan Commercial |
$3,059.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,632.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.56
|
| Rate for Payer: Quartz Commercial |
$2,179.68
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: WEA Trust Commercial |
$2,103.20
|
| Rate for Payer: WPS Commercial |
$2,832.44
|
|
|
RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE 49621
|
Professional
|
Both
|
$7,592.00
|
|
|
Service Code
|
CPT 49621
|
| Hospital Charge Code |
6180266
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$524.37 |
| Max. Negotiated Rate |
$7,212.40 |
| Rate for Payer: Aetna Commercial |
$7,212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,529.12
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cigna Commercial |
$7,212.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$524.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,555.20
|
| Rate for Payer: Health EOS Commercial |
$6,908.72
|
| Rate for Payer: HFN Commercial |
$7,212.40
|
| Rate for Payer: Multiplan Commercial |
$6,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,212.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,340.48
|
| Rate for Payer: Quartz Commercial |
$4,327.44
|
| Rate for Payer: The Alliance Commercial |
$3,796.00
|
| Rate for Payer: United Healthcare Medicaid |
$524.37
|
| Rate for Payer: WEA Trust Commercial |
$4,175.60
|
| Rate for Payer: WPS Commercial |
$5,623.39
|
|
|
RPR PARASTOMAL HERNIA 1ST/RECR REDUCIBLE, EXT 4962122
|
Professional
|
Both
|
$7,592.00
|
|
|
Service Code
|
CPT 49621 22
|
| Hospital Charge Code |
6180267
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,340.48 |
| Max. Negotiated Rate |
$7,212.40 |
| Rate for Payer: Aetna Commercial |
$7,212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,529.12
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cigna Commercial |
$7,212.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,796.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,555.20
|
| Rate for Payer: Health EOS Commercial |
$6,908.72
|
| Rate for Payer: HFN Commercial |
$7,212.40
|
| Rate for Payer: Multiplan Commercial |
$6,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,212.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,340.48
|
| Rate for Payer: Quartz Commercial |
$4,327.44
|
| Rate for Payer: The Alliance Commercial |
$3,796.00
|
| Rate for Payer: WEA Trust Commercial |
$4,175.60
|
| Rate for Payer: WPS Commercial |
$5,623.39
|
|
|
RPR PARASTOMAL HRNA 1ST/RECR NCRC8/STRANGULATED 49622
|
Professional
|
Both
|
$9,464.00
|
|
|
Service Code
|
CPT 49622
|
| Hospital Charge Code |
6180268
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$647.28 |
| Max. Negotiated Rate |
$8,990.80 |
| Rate for Payer: Aetna Commercial |
$8,990.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,139.04
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cigna Commercial |
$8,990.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$647.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,678.40
|
| Rate for Payer: Health EOS Commercial |
$8,612.24
|
| Rate for Payer: HFN Commercial |
$8,990.80
|
| Rate for Payer: Multiplan Commercial |
$7,571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,990.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,164.16
|
| Rate for Payer: Quartz Commercial |
$5,394.48
|
| Rate for Payer: The Alliance Commercial |
$4,732.00
|
| Rate for Payer: United Healthcare Medicaid |
$647.28
|
| Rate for Payer: WEA Trust Commercial |
$5,205.20
|
| Rate for Payer: WPS Commercial |
$7,009.98
|
|
|
.RPR Titer
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
