|
Color Flow 93325
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5381791
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$3,668.00 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$256.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.15
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$596.05
|
| Rate for Payer: Quartz Medicare Advantage |
$550.20
|
| Rate for Payer: The Alliance Commercial |
$3,668.00
|
| Rate for Payer: United Healthcare PPO |
$687.75
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
|
Color vision examination, extended, eg. 92283
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
CPT 92283
|
| Hospital Charge Code |
1188936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$184.12 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$43.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$41.86
|
| Rate for Payer: HFN Commercial |
$43.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.12
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Preferred Network Access Commercial |
$43.70
|
| Rate for Payer: Quartz Beloit One Network |
$20.24
|
| Rate for Payer: Quartz Commercial |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
Color vision examination, extended, eg. 9228326
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
CPT 92283 26
|
| Hospital Charge Code |
5551952
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: Aetna Commercial |
$43.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$43.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$41.86
|
| Rate for Payer: HFN Commercial |
$43.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.57
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Preferred Network Access Commercial |
$43.70
|
| Rate for Payer: Quartz Beloit One Network |
$20.24
|
| Rate for Payer: Quartz Commercial |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
COLOSTOMY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959941
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,344.84 |
| Max. Negotiated Rate |
$19,212.00 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,121.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,602.25
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$3,121.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.80
|
| Rate for Payer: The Alliance Commercial |
$19,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
COLOSTOMY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959941
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,353.47 |
| Max. Negotiated Rate |
$4,418.76 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$2,881.80
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
COLOSTOMY KIT 2 3/4 19154
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS A5063
|
| Hospital Charge Code |
2963748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.12 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Aetna Managed Medicare |
$57.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$122.40
|
| Rate for Payer: The Alliance Commercial |
$816.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
COLOSTOMY KIT 2 3/4 19154
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS A5063
|
| Hospital Charge Code |
2963748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
COLOSTOMY TAKEDOWN
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959940
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,353.47 |
| Max. Negotiated Rate |
$4,418.76 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$2,881.80
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
COLOSTOMY TAKEDOWN
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959940
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,344.84 |
| Max. Negotiated Rate |
$19,212.00 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,121.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,602.25
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$3,121.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.80
|
| Rate for Payer: The Alliance Commercial |
$19,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
COLPOSCOPY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959943
|
|
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
|
|
|
COLPOSCOPY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959943
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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
|
|
|
COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX - 57461
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
6135630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$294.51 |
| Max. Negotiated Rate |
$1,302.45 |
| Rate for Payer: Aetna Commercial |
$1,302.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.06
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna Commercial |
$1,302.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$294.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$822.60
|
| Rate for Payer: Health EOS Commercial |
$1,247.61
|
| Rate for Payer: HFN Commercial |
$1,302.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$610.41
|
| Rate for Payer: Multiplan Commercial |
$1,096.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,302.45
|
| Rate for Payer: Quartz Beloit One Network |
$603.24
|
| Rate for Payer: Quartz Commercial |
$781.47
|
| Rate for Payer: The Alliance Commercial |
$685.50
|
| Rate for Payer: United Healthcare Medicaid |
$294.51
|
| Rate for Payer: WEA Trust Commercial |
$754.05
|
| Rate for Payer: WPS Commercial |
$1,015.50
|
|
|
Colposcopy Entire Vagina W/Cervix if present 57420
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
4780606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.99 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Aetna Commercial |
$493.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$493.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.40
|
| Rate for Payer: Health EOS Commercial |
$472.29
|
| Rate for Payer: HFN Commercial |
$493.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$296.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$296.70
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: Preferred Network Access Commercial |
$493.05
|
| Rate for Payer: Quartz Beloit One Network |
$228.36
|
| Rate for Payer: Quartz Commercial |
$295.83
|
| Rate for Payer: The Alliance Commercial |
$259.50
|
| Rate for Payer: United Healthcare Medicaid |
$102.99
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
Colposcopy Entire Vagina, w/Cervix if Present w/Biopsy 57421
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
5543198
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.43 |
| Max. Negotiated Rate |
$676.40 |
| Rate for Payer: Aetna Commercial |
$676.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$612.32
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cigna Commercial |
$676.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.20
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$676.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$401.71
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$676.40
|
| Rate for Payer: Quartz Beloit One Network |
$313.28
|
| Rate for Payer: Quartz Commercial |
$405.84
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: United Healthcare Medicaid |
$141.43
|
| Rate for Payer: WEA Trust Commercial |
$391.60
|
| Rate for Payer: WPS Commercial |
$527.38
|
|
|
Colposcopy Of Cervix
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
1188886
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.27 |
| Max. Negotiated Rate |
$344.85 |
| Rate for Payer: Aetna Commercial |
$344.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$344.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.80
|
| Rate for Payer: Health EOS Commercial |
$330.33
|
| Rate for Payer: HFN Commercial |
$344.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$301.04
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$344.85
|
| Rate for Payer: Quartz Beloit One Network |
$159.72
|
| Rate for Payer: Quartz Commercial |
$206.91
|
| Rate for Payer: The Alliance Commercial |
$181.50
|
| Rate for Payer: United Healthcare Medicaid |
$86.27
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
Colposcopy with Biopsy Cervix 57454
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
1188885
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.92 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$665.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.00
|
| Rate for Payer: Health EOS Commercial |
$637.00
|
| Rate for Payer: HFN Commercial |
$665.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.19
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$665.00
|
| Rate for Payer: Quartz Beloit One Network |
$308.00
|
| Rate for Payer: Quartz Commercial |
$399.00
|
| Rate for Payer: The Alliance Commercial |
$350.00
|
| Rate for Payer: United Healthcare Medicaid |
$129.92
|
| Rate for Payer: WEA Trust Commercial |
$385.00
|
| Rate for Payer: WPS Commercial |
$518.49
|
|
|
Colposscopy Cervix Endocervical Curettage 57456
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
5104791
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.24 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$712.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cash Price |
$225.00
|
| Rate for Payer: Cigna Commercial |
$712.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.00
|
| Rate for Payer: Health EOS Commercial |
$682.50
|
| Rate for Payer: HFN Commercial |
$712.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.53
|
| Rate for Payer: Multiplan Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$712.50
|
| Rate for Payer: Quartz Beloit One Network |
$330.00
|
| Rate for Payer: Quartz Commercial |
$427.50
|
| Rate for Payer: The Alliance Commercial |
$375.00
|
| Rate for Payer: United Healthcare Medicaid |
$122.24
|
| Rate for Payer: WEA Trust Commercial |
$412.50
|
| Rate for Payer: WPS Commercial |
$555.52
|
|
|
COLPOSUSPENSION PERIVAGINAL REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959944
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
COLPOSUSPENSION PERIVAGINAL REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959944
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC
|
Facility
|
IP
|
$162,928.00
|
|
|
Service Code
|
MSDRG 454
|
| Min. Negotiated Rate |
$58,607.24 |
| Max. Negotiated Rate |
$162,928.00 |
| Rate for Payer: Aetna Managed Medicare |
$58,607.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128,397.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98,415.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93,501.36
|
| Rate for Payer: Anthem Medicare Advantage |
$58,607.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58,607.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58,607.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$58,607.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103,795.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$58,607.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119,267.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58,607.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58,607.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$58,607.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$58,607.24
|
| Rate for Payer: NAPHCARE Commercial |
$87,910.86
|
| Rate for Payer: Quartz Medicare Advantage |
$58,607.24
|
| Rate for Payer: The Alliance Commercial |
$162,928.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58,607.24
|
| Rate for Payer: United Healthcare PPO |
$92,851.55
|
| Rate for Payer: Wellcare Medicare |
$58,607.24
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$235,909.00
|
|
|
Service Code
|
MSDRG 453
|
| Min. Negotiated Rate |
$84,859.44 |
| Max. Negotiated Rate |
$235,909.00 |
| Rate for Payer: Aetna Managed Medicare |
$84,859.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185,882.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142,477.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135,363.08
|
| Rate for Payer: Anthem Medicare Advantage |
$84,859.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84,859.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84,859.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$84,859.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150,265.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$84,859.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172,797.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84,859.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84,859.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$84,859.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$84,859.44
|
| Rate for Payer: NAPHCARE Commercial |
$127,289.16
|
| Rate for Payer: Quartz Medicare Advantage |
$84,859.44
|
| Rate for Payer: The Alliance Commercial |
$235,909.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84,859.44
|
| Rate for Payer: United Healthcare PPO |
$134,524.91
|
| Rate for Payer: Wellcare Medicare |
$84,859.44
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$122,765.00
|
|
|
Service Code
|
MSDRG 455
|
| Min. Negotiated Rate |
$44,159.97 |
| Max. Negotiated Rate |
$122,765.00 |
| Rate for Payer: Aetna Managed Medicare |
$44,159.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96,717.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74,133.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70,431.58
|
| Rate for Payer: Anthem Medicare Advantage |
$44,159.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44,159.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44,159.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44,159.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78,185.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44,159.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89,809.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44,159.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44,159.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44,159.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44,159.97
|
| Rate for Payer: NAPHCARE Commercial |
$66,239.96
|
| Rate for Payer: Quartz Medicare Advantage |
$44,159.97
|
| Rate for Payer: The Alliance Commercial |
$122,765.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,159.97
|
| Rate for Payer: United Healthcare PPO |
$69,917.61
|
| Rate for Payer: Wellcare Medicare |
$44,159.97
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$19,665.00
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$19,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$19,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$19,665.00
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$19,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$19,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
COMBITUBE KIT 37 FR/ ADULT 4-6' 5-18537
|
Facility
|
IP
|
$746.00
|
|
| Hospital Charge Code |
2963045
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$365.54 |
| Max. Negotiated Rate |
$686.32 |
| Rate for Payer: Aetna Commercial |
$671.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$641.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.38
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$686.32
|
| Rate for Payer: Health EOS Commercial |
$663.94
|
| Rate for Payer: HFN Commercial |
$686.32
|
| Rate for Payer: Multiplan Commercial |
$596.80
|
| Rate for Payer: NAPHCARE Commercial |
$447.60
|
| Rate for Payer: Preferred Network Access Commercial |
$686.32
|
| Rate for Payer: Quartz Beloit One Network |
$365.54
|
| Rate for Payer: Quartz Commercial |
$447.60
|
| Rate for Payer: WEA Trust Commercial |
$410.30
|
| Rate for Payer: WPS Commercial |
$552.56
|
|
