|
DEBRIDE SKIN/MUSCLE/BONE, FX 11012
|
Professional
|
$3,656.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
3013517
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$380.99 |
| Max. Negotiated Rate |
$3,473.20 |
| Rate for Payer: Aetna Commercial |
$3,473.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,144.16
|
| Rate for Payer: Aetna Managed Medicare |
$380.99
|
| Rate for Payer: Anthem Medicare Advantage |
$380.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.99
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cash Price |
$1,096.80
|
| Rate for Payer: Cigna Commercial |
$3,473.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,828.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.99
|
| Rate for Payer: Health EOS Commercial |
$3,326.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,361.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,361.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.99
|
| Rate for Payer: Multiplan Commercial |
$2,924.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,473.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,608.64
|
| Rate for Payer: Quartz Commercial |
$2,083.92
|
| Rate for Payer: Quartz Medicare Advantage |
$380.99
|
| Rate for Payer: The Alliance Commercial |
$1,619.21
|
| Rate for Payer: United Healthcare Medicaid |
$546.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.99
|
| Rate for Payer: WEA Trust Commercial |
$2,010.80
|
| Rate for Payer: WPS Commercial |
$1,714.46
|
|
|
DEBRIDE SKIN/MUSCLE, FX 11011
|
Professional
|
$3,031.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
3013516
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$270.87 |
| Max. Negotiated Rate |
$2,879.45 |
| Rate for Payer: Aetna Commercial |
$2,879.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,606.66
|
| Rate for Payer: Aetna Managed Medicare |
$270.87
|
| Rate for Payer: Anthem Medicare Advantage |
$270.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$270.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$270.87
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,879.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,515.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.87
|
| Rate for Payer: Health EOS Commercial |
$2,758.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$973.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$973.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$270.87
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,879.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.64
|
| Rate for Payer: Quartz Commercial |
$1,727.67
|
| Rate for Payer: Quartz Medicare Advantage |
$270.87
|
| Rate for Payer: The Alliance Commercial |
$1,151.20
|
| Rate for Payer: United Healthcare Medicaid |
$399.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$270.87
|
| Rate for Payer: WEA Trust Commercial |
$1,667.05
|
| Rate for Payer: WPS Commercial |
$1,218.92
|
|
|
Debride Skin/Tissue First 20 sq or 1104222
|
Professional
|
$929.00
|
|
|
Service Code
|
CPT 11042 22
|
| Hospital Charge Code |
5250607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$408.76 |
| Max. Negotiated Rate |
$882.55 |
| Rate for Payer: Aetna Commercial |
$882.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$798.94
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cash Price |
$278.70
|
| Rate for Payer: Cigna Commercial |
$882.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$464.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.40
|
| Rate for Payer: Health EOS Commercial |
$845.39
|
| Rate for Payer: Multiplan Commercial |
$743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$882.55
|
| Rate for Payer: Quartz Beloit One Network |
$408.76
|
| Rate for Payer: Quartz Commercial |
$529.53
|
| Rate for Payer: The Alliance Commercial |
$464.50
|
| Rate for Payer: WEA Trust Commercial |
$510.95
|
| Rate for Payer: WPS Commercial |
$688.11
|
|
|
DECANTER BAG 10-102
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
6207063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
DECANTER BAG 10-102
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
6207063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Declotting or Thrombolytic Agent of Implnted Vascular Access Device or Catheter 36593
|
Professional
|
$108.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
1188958
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$141.48 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$31.44
|
| Rate for Payer: Anthem Medicare Advantage |
$31.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.44
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$102.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.44
|
| Rate for Payer: Health EOS Commercial |
$98.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.44
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$102.60
|
| Rate for Payer: Quartz Beloit One Network |
$47.52
|
| Rate for Payer: Quartz Commercial |
$61.56
|
| Rate for Payer: Quartz Medicare Advantage |
$31.44
|
| Rate for Payer: The Alliance Commercial |
$133.62
|
| Rate for Payer: United Healthcare Medicaid |
$23.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.44
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$141.48
|
|
|
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL COMPARTMENTS ONLY
|
Facility
OP
|
$27,265.32
|
|
|
Service Code
|
CPT 27600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
Deep Muscle Biopsy 20205
|
Professional
|
$1,519.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
3404962
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.38 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Aetna Commercial |
$1,443.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Aetna Managed Medicare |
$138.38
|
| Rate for Payer: Anthem Medicare Advantage |
$138.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.38
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,443.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$759.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.38
|
| Rate for Payer: Health EOS Commercial |
$1,382.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.38
|
| Rate for Payer: Multiplan Commercial |
$1,215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,443.05
|
| Rate for Payer: Quartz Beloit One Network |
$668.36
|
| Rate for Payer: Quartz Commercial |
$865.83
|
| Rate for Payer: Quartz Medicare Advantage |
$138.38
|
| Rate for Payer: The Alliance Commercial |
$588.12
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.38
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$622.71
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC
|
Facility
IP
|
$29,397.00
|
|
|
Service Code
|
MS-DRG 294
|
| Min. Negotiated Rate |
$10,574.64 |
| Max. Negotiated Rate |
$29,397.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,574.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,868.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,528.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,653.02
|
| Rate for Payer: Anthem Medicare Advantage |
$10,574.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,574.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,574.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,574.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,486.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,574.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,327.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,574.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,574.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,574.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,574.64
|
| Rate for Payer: NAPHCARE Commercial |
$15,861.96
|
| Rate for Payer: Quartz Medicare Advantage |
$10,574.64
|
| Rate for Payer: The Alliance Commercial |
$29,397.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,574.64
|
| Rate for Payer: United Healthcare PPO |
$16,603.46
|
| Rate for Payer: Wellcare Medicare |
$10,574.64
|
|
|
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC
|
Facility
IP
|
$21,512.00
|
|
|
Service Code
|
MS-DRG 295
|
| Min. Negotiated Rate |
$7,738.17 |
| Max. Negotiated Rate |
$21,512.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,738.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,217.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,131.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,625.14
|
| Rate for Payer: Anthem Medicare Advantage |
$7,738.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,738.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,738.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,738.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,684.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,738.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,314.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,738.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,738.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,738.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,738.17
|
| Rate for Payer: NAPHCARE Commercial |
$11,607.26
|
| Rate for Payer: Quartz Medicare Advantage |
$7,738.17
|
| Rate for Payer: The Alliance Commercial |
$21,512.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,738.17
|
| Rate for Payer: United Healthcare PPO |
$9,586.80
|
| Rate for Payer: Wellcare Medicare |
$7,738.17
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$63,967.00
|
|
|
Service Code
|
MS-DRG 056
|
| Min. Negotiated Rate |
$23,009.79 |
| Max. Negotiated Rate |
$63,967.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,009.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,142.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,433.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,514.42
|
| Rate for Payer: Anthem Medicare Advantage |
$23,009.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,009.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,009.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,009.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,534.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,009.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,683.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,009.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,009.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,009.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,009.79
|
| Rate for Payer: NAPHCARE Commercial |
$34,514.68
|
| Rate for Payer: Quartz Medicare Advantage |
$23,009.79
|
| Rate for Payer: The Alliance Commercial |
$63,967.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,009.79
|
| Rate for Payer: United Healthcare PPO |
$36,343.31
|
| Rate for Payer: Wellcare Medicare |
$23,009.79
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
IP
|
$36,562.00
|
|
|
Service Code
|
MS-DRG 057
|
| Min. Negotiated Rate |
$13,151.95 |
| Max. Negotiated Rate |
$36,562.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,151.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,151.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,151.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,151.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,151.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,151.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,582.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,151.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,151.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,151.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,151.95
|
| Rate for Payer: NAPHCARE Commercial |
$19,727.92
|
| Rate for Payer: Quartz Medicare Advantage |
$13,151.95
|
| Rate for Payer: The Alliance Commercial |
$36,562.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,151.95
|
| Rate for Payer: United Healthcare PPO |
$20,694.74
|
| Rate for Payer: Wellcare Medicare |
$13,151.95
|
|
|
Deglyced RBC
|
Facility
OP
|
$723.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
5190719
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$223.25 |
| Max. Negotiated Rate |
$1,196.24 |
| Rate for Payer: Aetna Commercial |
$650.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.78
|
| Rate for Payer: Aetna Managed Medicare |
$223.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$469.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$361.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.04
|
| Rate for Payer: Anthem Medicare Advantage |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.25
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$665.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.25
|
| Rate for Payer: Health EOS Commercial |
$643.47
|
| Rate for Payer: HFN Commercial |
$665.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$830.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.25
|
| Rate for Payer: Multiplan Commercial |
$578.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.88
|
| Rate for Payer: Preferred Network Access Commercial |
$665.16
|
| Rate for Payer: Quartz Beloit One Network |
$354.27
|
| Rate for Payer: Quartz Commercial |
$469.95
|
| Rate for Payer: Quartz Medicare Advantage |
$223.25
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.25
|
| Rate for Payer: United Healthcare PPO |
$542.25
|
| Rate for Payer: WEA Trust Commercial |
$397.65
|
| Rate for Payer: Wellcare Medicare |
$223.25
|
| Rate for Payer: WPS Commercial |
$535.53
|
|
|
Deglyced RBC
|
Facility
IP
|
$723.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
5190719
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$354.27 |
| Max. Negotiated Rate |
$665.16 |
| Rate for Payer: Aetna Commercial |
$650.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.19
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna Commercial |
$665.16
|
| Rate for Payer: Health EOS Commercial |
$643.47
|
| Rate for Payer: HFN Commercial |
$665.16
|
| Rate for Payer: Multiplan Commercial |
$578.40
|
| Rate for Payer: NAPHCARE Commercial |
$433.80
|
| Rate for Payer: Preferred Network Access Commercial |
$665.16
|
| Rate for Payer: Quartz Beloit One Network |
$354.27
|
| Rate for Payer: Quartz Commercial |
$433.80
|
| Rate for Payer: WEA Trust Commercial |
$397.65
|
| Rate for Payer: WPS Commercial |
$535.53
|
|
|
Dehydroepiandrosterone
|
Professional
|
$491.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
977924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Aetna Commercial |
$466.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$25.27
|
| Rate for Payer: Anthem Medicare Advantage |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.27
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$466.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.27
|
| Rate for Payer: Health EOS Commercial |
$446.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.27
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Preferred Network Access Commercial |
$466.45
|
| Rate for Payer: Quartz Beloit One Network |
$216.04
|
| Rate for Payer: Quartz Commercial |
$279.87
|
| Rate for Payer: Quartz Medicare Advantage |
$25.27
|
| Rate for Payer: The Alliance Commercial |
$99.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.27
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$111.19
|
|
|
Dehydroepiandrosterone
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
977924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$451.72 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$294.60
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$294.60
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
Dehydroepiandrosterone
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
977924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$1,964.00 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$25.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.95
|
| Rate for Payer: Anthem Medicaid |
$26.11
|
| Rate for Payer: Anthem Medicare Advantage |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.27
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.11
|
| Rate for Payer: Dean Health Medicaid |
$26.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.27
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.27
|
| Rate for Payer: Managed Health Services Medicaid |
$27.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.27
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$37.90
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.11
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$319.15
|
| Rate for Payer: Quartz Medicare Advantage |
$25.27
|
| Rate for Payer: The Alliance Commercial |
$1,964.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.27
|
| Rate for Payer: United Healthcare PPO |
$368.25
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: Wellcare Medicare |
$25.27
|
| Rate for Payer: WMAP Medicaid |
$26.11
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
Dehydroepiandrosterone Sulfate
|
Professional
|
$174.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
977925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$165.30 |
| Rate for Payer: Aetna Commercial |
$165.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.64
|
| Rate for Payer: Aetna Managed Medicare |
$22.23
|
| Rate for Payer: Anthem Medicare Advantage |
$22.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.23
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$165.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.23
|
| Rate for Payer: Health EOS Commercial |
$158.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$165.30
|
| Rate for Payer: Quartz Beloit One Network |
$76.56
|
| Rate for Payer: Quartz Commercial |
$99.18
|
| Rate for Payer: Quartz Medicare Advantage |
$22.23
|
| Rate for Payer: The Alliance Commercial |
$87.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.23
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: WPS Commercial |
$97.81
|
|
|
Dehydroepiandrosterone Sulfate
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
977925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.26 |
| Max. Negotiated Rate |
$160.08 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.22
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$160.08
|
| Rate for Payer: Health EOS Commercial |
$154.86
|
| Rate for Payer: HFN Commercial |
$160.08
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: NAPHCARE Commercial |
$104.40
|
| Rate for Payer: Preferred Network Access Commercial |
$160.08
|
| Rate for Payer: Quartz Beloit One Network |
$85.26
|
| Rate for Payer: Quartz Commercial |
$104.40
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: WPS Commercial |
$128.88
|
|
|
Dehydroepiandrosterone Sulfate
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
977925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$696.00 |
| Rate for Payer: Aetna Commercial |
$156.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.64
|
| Rate for Payer: Aetna Managed Medicare |
$22.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.90
|
| Rate for Payer: Anthem Medicaid |
$22.97
|
| Rate for Payer: Anthem Medicare Advantage |
$22.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.23
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$160.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.97
|
| Rate for Payer: Dean Health Medicaid |
$22.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.23
|
| Rate for Payer: Health EOS Commercial |
$154.86
|
| Rate for Payer: HFN Commercial |
$160.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.23
|
| Rate for Payer: Managed Health Services Medicaid |
$23.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.23
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: NAPHCARE Commercial |
$33.34
|
| Rate for Payer: Preferred Network Access Commercial |
$160.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.97
|
| Rate for Payer: Quartz Beloit One Network |
$85.26
|
| Rate for Payer: Quartz Commercial |
$113.10
|
| Rate for Payer: Quartz Medicare Advantage |
$22.23
|
| Rate for Payer: The Alliance Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicaid |
$22.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.23
|
| Rate for Payer: United Healthcare PPO |
$130.50
|
| Rate for Payer: WEA Trust Commercial |
$95.70
|
| Rate for Payer: Wellcare Medicare |
$22.23
|
| Rate for Payer: WMAP Medicaid |
$22.97
|
| Rate for Payer: WPS Commercial |
$128.88
|
|
|
Delatestryl 100 mg Charge
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
2958976
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Delatestryl 100 mg Charge
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
2958976
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Delatestryl 100 mg Charge
|
Professional
|
$18.00
|
|
| Hospital Charge Code |
2958976
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.80
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Delay Flap/SCTJ Flap Eyelids Nose Ears/Lips 15630
|
Professional
|
$3,492.00
|
|
|
Service Code
|
CPT 15630
|
| Hospital Charge Code |
5082946
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$3,317.40 |
| Rate for Payer: Aetna Commercial |
$3,317.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,003.12
|
| Rate for Payer: Aetna Managed Medicare |
$325.36
|
| Rate for Payer: Anthem Medicare Advantage |
$325.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$325.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$325.36
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cash Price |
$1,047.60
|
| Rate for Payer: Cigna Commercial |
$3,317.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,746.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.36
|
| Rate for Payer: Health EOS Commercial |
$3,177.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,140.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,140.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$325.36
|
| Rate for Payer: Multiplan Commercial |
$2,793.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,317.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.48
|
| Rate for Payer: Quartz Commercial |
$1,990.44
|
| Rate for Payer: Quartz Medicare Advantage |
$325.36
|
| Rate for Payer: The Alliance Commercial |
$1,382.78
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.36
|
| Rate for Payer: WEA Trust Commercial |
$1,920.60
|
| Rate for Payer: WPS Commercial |
$1,464.12
|
|
|
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); AT EYELIDS, NOSE, EARS, OR LIPS
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 15630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| 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 |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
