|
Change of Bladder Tube 51705PP
|
Professional
|
$525.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
3439519
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Aetna Managed Medicare |
$48.09
|
| Rate for Payer: Anthem Medicare Advantage |
$48.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.09
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.09
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.09
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: Quartz Medicare Advantage |
$48.09
|
| Rate for Payer: The Alliance Commercial |
$204.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.09
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$216.40
|
|
|
Change of Cystostomy Tube; Complicated
|
Professional
|
$994.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
1188970
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.65 |
| Max. Negotiated Rate |
$944.30 |
| Rate for Payer: Aetna Commercial |
$944.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.84
|
| Rate for Payer: Aetna Managed Medicare |
$74.38
|
| Rate for Payer: Anthem Medicare Advantage |
$74.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.38
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cash Price |
$298.20
|
| Rate for Payer: Cigna Commercial |
$944.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$497.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.38
|
| Rate for Payer: Health EOS Commercial |
$904.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.38
|
| Rate for Payer: Multiplan Commercial |
$795.20
|
| Rate for Payer: Preferred Network Access Commercial |
$944.30
|
| Rate for Payer: Quartz Beloit One Network |
$437.36
|
| Rate for Payer: Quartz Commercial |
$566.58
|
| Rate for Payer: Quartz Medicare Advantage |
$74.38
|
| Rate for Payer: The Alliance Commercial |
$316.12
|
| Rate for Payer: United Healthcare Medicaid |
$36.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.38
|
| Rate for Payer: WEA Trust Commercial |
$546.70
|
| Rate for Payer: WPS Commercial |
$334.71
|
|
|
Change of Cystostomy Tube; simple
|
Professional
|
$449.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
1188969
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Aetna Commercial |
$426.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Aetna Managed Medicare |
$48.09
|
| Rate for Payer: Anthem Medicare Advantage |
$48.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.09
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$426.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.09
|
| Rate for Payer: Health EOS Commercial |
$408.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.09
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$426.55
|
| Rate for Payer: Quartz Beloit One Network |
$197.56
|
| Rate for Payer: Quartz Commercial |
$255.93
|
| Rate for Payer: Quartz Medicare Advantage |
$48.09
|
| Rate for Payer: The Alliance Commercial |
$204.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.09
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$216.40
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
OP
|
$7,762.64
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$7,762.64 |
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| 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 |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$7,762.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
|
|
Change Of Gastrostomy Tube, Percutaneous, Without Imaging Or Contrast
|
Professional
|
$212.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
1190853
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$33.77
|
| Rate for Payer: Anthem Medicare Advantage |
$33.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.77
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.77
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.77
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: Quartz Medicare Advantage |
$33.77
|
| Rate for Payer: The Alliance Commercial |
$143.52
|
| Rate for Payer: United Healthcare Medicaid |
$173.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.77
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$151.96
|
|
|
CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT
|
Facility
OP
|
$76,878.00
|
|
|
Service Code
|
CPT 50688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,013.20 |
| Max. Negotiated Rate |
$76,878.00 |
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| 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 |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$76,878.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
|
|
Change Suprapubic Tube
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
5386630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
Change Suprapubic Tube
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
5386630
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$7,762.64 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$7,762.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
CHEILECTOMY
|
Facility
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2959924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
CHEILECTOMY
|
Facility
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
Chemical Cauterizaion of Granulation Tissue 17250
|
Professional
|
$253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
2568799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$240.35 |
| Rate for Payer: Aetna Commercial |
$240.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.58
|
| Rate for Payer: Aetna Managed Medicare |
$34.86
|
| Rate for Payer: Anthem Medicare Advantage |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.86
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$240.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.86
|
| Rate for Payer: Health EOS Commercial |
$230.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.86
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Preferred Network Access Commercial |
$240.35
|
| Rate for Payer: Quartz Beloit One Network |
$111.32
|
| Rate for Payer: Quartz Commercial |
$144.21
|
| Rate for Payer: Quartz Medicare Advantage |
$34.86
|
| Rate for Payer: The Alliance Commercial |
$148.16
|
| Rate for Payer: United Healthcare Medicaid |
$24.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.86
|
| Rate for Payer: WEA Trust Commercial |
$139.15
|
| Rate for Payer: WPS Commercial |
$156.87
|
|
|
CHEMICAL PEEL/DERMABRASION
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CHEMICAL PEEL/DERMABRASION
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959995
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Chemodenervation Internal Anal Sphincter 46505
|
Professional
|
$1,217.00
|
|
|
Service Code
|
CPT 46505
|
| Hospital Charge Code |
4622629
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$189.67 |
| Max. Negotiated Rate |
$1,156.15 |
| Rate for Payer: Aetna Commercial |
$1,156.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.62
|
| Rate for Payer: Aetna Managed Medicare |
$235.95
|
| Rate for Payer: Anthem Medicare Advantage |
$235.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$235.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$235.95
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,156.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$608.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.95
|
| Rate for Payer: Health EOS Commercial |
$1,107.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$235.95
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,156.15
|
| Rate for Payer: Quartz Beloit One Network |
$535.48
|
| Rate for Payer: Quartz Commercial |
$693.69
|
| Rate for Payer: Quartz Medicare Advantage |
$235.95
|
| Rate for Payer: The Alliance Commercial |
$1,002.79
|
| Rate for Payer: United Healthcare Medicaid |
$189.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.95
|
| Rate for Payer: WEA Trust Commercial |
$669.35
|
| Rate for Payer: WPS Commercial |
$1,061.78
|
|
|
Chemodenervation muscle neck unilat for dystonia 6461650
|
Professional
|
$2,722.00
|
|
|
Service Code
|
CPT 64616 50
|
| Hospital Charge Code |
5432926
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$2,585.90 |
| Rate for Payer: Aetna Commercial |
$2,585.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,340.92
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cash Price |
$816.60
|
| Rate for Payer: Cigna Commercial |
$2,585.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,361.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,633.20
|
| Rate for Payer: Health EOS Commercial |
$2,477.02
|
| Rate for Payer: Multiplan Commercial |
$2,177.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.68
|
| Rate for Payer: Quartz Commercial |
$1,551.54
|
| Rate for Payer: The Alliance Commercial |
$1,361.00
|
| Rate for Payer: United Healthcare Medicaid |
$76.56
|
| Rate for Payer: WEA Trust Commercial |
$1,497.10
|
| Rate for Payer: WPS Commercial |
$2,016.19
|
|
|
Chemodenervation of 1 extremity; 1-4 muscle(s) 64642
|
Professional
|
$737.00
|
|
|
Service Code
|
CPT 64642
|
| Hospital Charge Code |
5072639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Aetna Commercial |
$700.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Aetna Managed Medicare |
$96.34
|
| Rate for Payer: Anthem Medicare Advantage |
$96.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.34
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$700.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.34
|
| Rate for Payer: Health EOS Commercial |
$670.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.34
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Preferred Network Access Commercial |
$700.15
|
| Rate for Payer: Quartz Beloit One Network |
$324.28
|
| Rate for Payer: Quartz Commercial |
$420.09
|
| Rate for Payer: Quartz Medicare Advantage |
$96.34
|
| Rate for Payer: The Alliance Commercial |
$409.44
|
| Rate for Payer: United Healthcare Medicaid |
$77.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.34
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: WPS Commercial |
$433.53
|
|
|
Chemodenervation of 1 extremity; => 5 muscles 64644
|
Professional
|
$836.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
5072637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.91 |
| Max. Negotiated Rate |
$794.20 |
| Rate for Payer: Aetna Commercial |
$794.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.96
|
| Rate for Payer: Aetna Managed Medicare |
$105.31
|
| Rate for Payer: Anthem Medicare Advantage |
$105.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.31
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$794.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$418.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.31
|
| Rate for Payer: Health EOS Commercial |
$760.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$381.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$381.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.31
|
| Rate for Payer: Multiplan Commercial |
$668.80
|
| Rate for Payer: Preferred Network Access Commercial |
$794.20
|
| Rate for Payer: Quartz Beloit One Network |
$367.84
|
| Rate for Payer: Quartz Commercial |
$476.52
|
| Rate for Payer: Quartz Medicare Advantage |
$105.31
|
| Rate for Payer: The Alliance Commercial |
$447.57
|
| Rate for Payer: United Healthcare Medicaid |
$84.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.31
|
| Rate for Payer: WEA Trust Commercial |
$459.80
|
| Rate for Payer: WPS Commercial |
$473.90
|
|
|
Chemodenervation of 1 extremity; ea addi'l extremity, 1-4 muscle(s) 64643
|
Professional
|
$288.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
5072638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.01 |
| Max. Negotiated Rate |
$287.82 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Aetna Managed Medicare |
$63.96
|
| Rate for Payer: Anthem Medicare Advantage |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.96
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.96
|
| Rate for Payer: Health EOS Commercial |
$262.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$273.60
|
| Rate for Payer: Quartz Beloit One Network |
$126.72
|
| Rate for Payer: Quartz Commercial |
$164.16
|
| Rate for Payer: Quartz Medicare Advantage |
$63.96
|
| Rate for Payer: The Alliance Commercial |
$271.83
|
| Rate for Payer: United Healthcare Medicaid |
$52.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$287.82
|
|
|
Chemodenervation of parotid and submandibular salivary glands, bilateral 64611
|
Professional
|
$416.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
5244779
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.78 |
| Max. Negotiated Rate |
$453.42 |
| Rate for Payer: Aetna Commercial |
$395.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$100.76
|
| Rate for Payer: Anthem Medicare Advantage |
$100.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.76
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.76
|
| Rate for Payer: Health EOS Commercial |
$378.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$348.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.76
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$395.20
|
| Rate for Payer: Quartz Beloit One Network |
$183.04
|
| Rate for Payer: Quartz Commercial |
$237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$100.76
|
| Rate for Payer: The Alliance Commercial |
$428.23
|
| Rate for Payer: United Healthcare Medicaid |
$62.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.76
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$453.42
|
|
|
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES 64647
|
Professional
|
$513.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
5749666
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.11 |
| Max. Negotiated Rate |
$535.46 |
| Rate for Payer: Aetna Commercial |
$487.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Aetna Managed Medicare |
$118.99
|
| Rate for Payer: Anthem Medicare Advantage |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.99
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$487.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.99
|
| Rate for Payer: Health EOS Commercial |
$466.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.99
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$487.35
|
| Rate for Payer: Quartz Beloit One Network |
$225.72
|
| Rate for Payer: Quartz Commercial |
$292.41
|
| Rate for Payer: Quartz Medicare Advantage |
$118.99
|
| Rate for Payer: The Alliance Commercial |
$505.71
|
| Rate for Payer: United Healthcare Medicaid |
$97.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.99
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$535.46
|
|
|
Chemodenervation of trunk muscle(s); 1-5 muscle(s) 64616
|
Professional
|
$953.00
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
5308637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.56 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna Commercial |
$905.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Aetna Managed Medicare |
$96.23
|
| Rate for Payer: Anthem Medicare Advantage |
$96.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.23
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$905.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$476.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.23
|
| Rate for Payer: Health EOS Commercial |
$867.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.23
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Preferred Network Access Commercial |
$905.35
|
| Rate for Payer: Quartz Beloit One Network |
$419.32
|
| Rate for Payer: Quartz Commercial |
$543.21
|
| Rate for Payer: Quartz Medicare Advantage |
$96.23
|
| Rate for Payer: The Alliance Commercial |
$408.98
|
| Rate for Payer: United Healthcare Medicaid |
$76.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.23
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$433.04
|
|
|
Chemodenervation trunk muscles, 1-5 muscles 64646
|
Professional
|
$806.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
5551848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.12 |
| Max. Negotiated Rate |
$765.70 |
| Rate for Payer: Aetna Commercial |
$765.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Aetna Managed Medicare |
$103.55
|
| Rate for Payer: Anthem Medicare Advantage |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.55
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$765.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.55
|
| Rate for Payer: Health EOS Commercial |
$733.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$371.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$371.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.55
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: Preferred Network Access Commercial |
$765.70
|
| Rate for Payer: Quartz Beloit One Network |
$354.64
|
| Rate for Payer: Quartz Commercial |
$459.42
|
| Rate for Payer: Quartz Medicare Advantage |
$103.55
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicaid |
$84.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.55
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$465.98
|
|
|
CHEMODENERV ECCRINE GLANDS 64650
|
Professional
|
$268.00
|
|
|
Service Code
|
CPT 64650
|
| Hospital Charge Code |
3015200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.55 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$254.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.55
|
| Rate for Payer: Anthem Medicare Advantage |
$37.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.55
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$254.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.55
|
| Rate for Payer: Health EOS Commercial |
$243.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.55
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Preferred Network Access Commercial |
$254.60
|
| Rate for Payer: Quartz Beloit One Network |
$117.92
|
| Rate for Payer: Quartz Commercial |
$152.76
|
| Rate for Payer: Quartz Medicare Advantage |
$37.55
|
| Rate for Payer: The Alliance Commercial |
$159.59
|
| Rate for Payer: United Healthcare Medicaid |
$50.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.55
|
| Rate for Payer: WEA Trust Commercial |
$147.40
|
| Rate for Payer: WPS Commercial |
$168.98
|
|
|
Chemodenerv Musc Migraine 64615
|
Professional
|
$876.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
3587518
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.21 |
| Max. Negotiated Rate |
$832.20 |
| Rate for Payer: Aetna Commercial |
$832.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Aetna Managed Medicare |
$107.60
|
| Rate for Payer: Anthem Medicare Advantage |
$107.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.60
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$832.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$438.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.60
|
| Rate for Payer: Health EOS Commercial |
$797.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$386.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.60
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: Preferred Network Access Commercial |
$832.20
|
| Rate for Payer: Quartz Beloit One Network |
$385.44
|
| Rate for Payer: Quartz Commercial |
$499.32
|
| Rate for Payer: Quartz Medicare Advantage |
$107.60
|
| Rate for Payer: The Alliance Commercial |
$457.30
|
| Rate for Payer: United Healthcare Medicaid |
$94.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.60
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$484.20
|
|
|
CHEMO INTRALESIONAL, UP TO 7 96405
|
Professional
|
$384.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
3015503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.70 |
| Max. Negotiated Rate |
$364.80 |
| Rate for Payer: Aetna Commercial |
$364.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Aetna Managed Medicare |
$27.70
|
| Rate for Payer: Anthem Medicare Advantage |
$27.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.70
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$364.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.70
|
| Rate for Payer: Health EOS Commercial |
$349.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$291.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.70
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$364.80
|
| Rate for Payer: Quartz Beloit One Network |
$168.96
|
| Rate for Payer: Quartz Commercial |
$218.88
|
| Rate for Payer: Quartz Medicare Advantage |
$27.70
|
| Rate for Payer: The Alliance Commercial |
$69.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.70
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$110.80
|
|
