|
Hemogram
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2975837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$29.61
|
|
|
Hemogram
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
979866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$29.61
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
|
IP
|
$4,734.89
|
|
|
Service Code
|
APR-DRG 8101
|
| Min. Negotiated Rate |
$4,205.82 |
| Max. Negotiated Rate |
$4,734.89 |
| Rate for Payer: Anthem Medicaid |
$4,533.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,533.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,533.92
|
| Rate for Payer: Dean Health Medicaid |
$4,533.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,205.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4,734.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,533.92
|
| Rate for Payer: United Healthcare Medicaid |
$4,533.92
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
|
IP
|
$10,434.29
|
|
|
Service Code
|
APR-DRG 8103
|
| Min. Negotiated Rate |
$9,268.39 |
| Max. Negotiated Rate |
$10,434.29 |
| Rate for Payer: Anthem Medicaid |
$9,991.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,991.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,991.41
|
| Rate for Payer: Dean Health Medicaid |
$9,991.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,268.39
|
| Rate for Payer: Managed Health Services Medicaid |
$10,434.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,991.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,991.41
|
| Rate for Payer: United Healthcare Medicaid |
$9,991.41
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 8102
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION
|
Facility
|
IP
|
$20,079.43
|
|
|
Service Code
|
APR-DRG 8104
|
| Min. Negotiated Rate |
$17,835.80 |
| Max. Negotiated Rate |
$20,079.43 |
| Rate for Payer: Anthem Medicaid |
$19,227.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,227.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,227.16
|
| Rate for Payer: Dean Health Medicaid |
$19,227.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,835.80
|
| Rate for Payer: Managed Health Services Medicaid |
$20,079.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,227.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,227.16
|
| Rate for Payer: United Healthcare Medicaid |
$19,227.16
|
|
|
HEMORRHOIDECTOMY 46250
|
Professional
|
Both
|
$2,001.00
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
3014829
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$304.54 |
| Max. Negotiated Rate |
$1,976.99 |
| Rate for Payer: Aetna Commercial |
$1,976.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,789.69
|
| Rate for Payer: Aetna Managed Medicare |
$304.54
|
| Rate for Payer: Anthem Medicare Advantage |
$304.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$304.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$304.54
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna Commercial |
$1,976.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.54
|
| Rate for Payer: Health EOS Commercial |
$1,893.75
|
| Rate for Payer: HFN Commercial |
$1,976.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,109.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,109.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$304.54
|
| Rate for Payer: Multiplan Commercial |
$1,664.83
|
| Rate for Payer: NAPHCARE Commercial |
$456.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,976.99
|
| Rate for Payer: Quartz Beloit One Network |
$915.66
|
| Rate for Payer: Quartz Commercial |
$1,186.19
|
| Rate for Payer: Quartz Medicare Advantage |
$304.54
|
| Rate for Payer: The Alliance Commercial |
$1,294.31
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$304.54
|
| Rate for Payer: WEA Trust Commercial |
$1,144.57
|
| Rate for Payer: WPS Commercial |
$1,370.44
|
|
|
HEMORRHOIDECTOMY 46255
|
Professional
|
Both
|
$2,410.00
|
|
|
Service Code
|
CPT 46255
|
| Hospital Charge Code |
3014830
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.93 |
| Max. Negotiated Rate |
$2,381.08 |
| Rate for Payer: Aetna Commercial |
$2,381.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.50
|
| Rate for Payer: Aetna Managed Medicare |
$335.93
|
| Rate for Payer: Anthem Medicare Advantage |
$335.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$335.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$335.93
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cash Price |
$723.00
|
| Rate for Payer: Cigna Commercial |
$2,381.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.93
|
| Rate for Payer: Health EOS Commercial |
$2,280.82
|
| Rate for Payer: HFN Commercial |
$2,381.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,237.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,237.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$335.93
|
| Rate for Payer: Multiplan Commercial |
$2,005.12
|
| Rate for Payer: NAPHCARE Commercial |
$503.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,381.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.82
|
| Rate for Payer: Quartz Commercial |
$1,428.65
|
| Rate for Payer: Quartz Medicare Advantage |
$335.93
|
| Rate for Payer: The Alliance Commercial |
$1,427.70
|
| Rate for Payer: United Healthcare Medicaid |
$406.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.93
|
| Rate for Payer: WEA Trust Commercial |
$1,378.52
|
| Rate for Payer: WPS Commercial |
$1,511.69
|
|
|
HEMORRHOIDECTOMY 46999-46250
|
Professional
|
Both
|
$2,001.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
6210064
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$915.66 |
| Max. Negotiated Rate |
$1,976.99 |
| Rate for Payer: Aetna Commercial |
$1,976.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,789.69
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna Commercial |
$1,976.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,040.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,248.62
|
| Rate for Payer: Health EOS Commercial |
$1,893.75
|
| Rate for Payer: HFN Commercial |
$1,976.99
|
| Rate for Payer: Multiplan Commercial |
$1,664.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,976.99
|
| Rate for Payer: Quartz Beloit One Network |
$915.66
|
| Rate for Payer: Quartz Commercial |
$1,186.19
|
| Rate for Payer: The Alliance Commercial |
$1,040.52
|
| Rate for Payer: WEA Trust Commercial |
$1,144.57
|
| Rate for Payer: WPS Commercial |
$1,541.37
|
|
|
HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 46250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
HEMORRHOIDECTOMY/HEMORRHOIDPEXY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HEMORRHOIDECTOMY/HEMORRHOIDPEXY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 46260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
Hemorrhoidectomy, Internal, By Rubber Band Ligation 46221
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
1190848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$862.06 |
| Rate for Payer: Aetna Commercial |
$729.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Aetna Managed Medicare |
$191.57
|
| Rate for Payer: Anthem Medicare Advantage |
$191.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$191.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$191.57
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$729.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.57
|
| Rate for Payer: Health EOS Commercial |
$698.44
|
| Rate for Payer: HFN Commercial |
$729.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$680.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$680.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$191.57
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: NAPHCARE Commercial |
$287.35
|
| Rate for Payer: Preferred Network Access Commercial |
$729.14
|
| Rate for Payer: Quartz Beloit One Network |
$337.71
|
| Rate for Payer: Quartz Commercial |
$437.49
|
| Rate for Payer: Quartz Medicare Advantage |
$191.57
|
| Rate for Payer: The Alliance Commercial |
$814.16
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$862.06
|
|
|
HEMORRHOIDECTOMY, INTERNAL, BY TRANSANAL HEMORRHOIDAL DEARTERIALIZATION, 2 OR MORE HEMORRHOID COLUMNS/GROUPS, INCLUDING ULTRASOUND GUIDANCE, WITH MUCOPEXY, WHEN PERFORMED
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 46948
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,921.08 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| Rate for Payer: Anthem Medicare Advantage |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
Hemosiderin Stain Qualitative Urine
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
977968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.20
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: United Healthcare PPO |
$180.18
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: Wellcare Medicare |
$4.94
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Hemosiderin Stain Qualitative Urine
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
977968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$21.74
|
|
|
Hemosiderin Stain Qualitative Urine
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 83070
|
| Hospital Charge Code |
977968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Hemostatic Pads
|
Facility
|
OP
|
$531.00
|
|
| Hospital Charge Code |
5184609
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$154.63 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$154.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.04
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.18
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$331.34
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$358.96
|
| Rate for Payer: Quartz Medicare Advantage |
$331.34
|
| Rate for Payer: The Alliance Commercial |
$276.12
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
Hemostatic Pads
|
Facility
|
IP
|
$531.00
|
|
| Hospital Charge Code |
5184609
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$331.34
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
Hep A/Hep B Vacc, Adult IM 90636
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
3553548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.73 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.62
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$194.05
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: The Alliance Commercial |
$199.68
|
| Rate for Payer: United Healthcare Medicaid |
$137.73
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
Hep A/Hep B Vacc, Adult IM 90636
|
Facility
|
OP
|
$384.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
3553548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.82 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$111.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$259.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.49
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.52
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$239.62
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$259.58
|
| Rate for Payer: Quartz Medicare Advantage |
$239.62
|
| Rate for Payer: The Alliance Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
Hep A/Hep B Vacc, Adult IM 90636
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
CPT 90636
|
| Hospital Charge Code |
3553548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.69 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$239.62
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
heparin 10,000units/ml [MED]
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
3072323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
heparin 10,000units/ml [MED]
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
3072323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.38
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$0.75
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$0.71
|
|
