|
In-111 Satumomab pendetide
|
Facility
|
IP
|
$6,376.00
|
|
|
Service Code
|
HCPCS A4642
|
| Hospital Charge Code |
1486844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,249.21 |
| Max. Negotiated Rate |
$6,100.56 |
| Rate for Payer: Aetna Commercial |
$5,967.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,702.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,514.45
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cigna Commercial |
$6,100.56
|
| Rate for Payer: Health EOS Commercial |
$5,901.63
|
| Rate for Payer: HFN Commercial |
$6,100.56
|
| Rate for Payer: Multiplan Commercial |
$5,304.83
|
| Rate for Payer: Preferred Network Access Commercial |
$6,100.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,249.21
|
| Rate for Payer: Quartz Commercial |
$3,978.62
|
| Rate for Payer: WEA Trust Commercial |
$3,647.07
|
| Rate for Payer: WPS Commercial |
$4,911.43
|
|
|
In-111 Satumomab pendetide
|
Professional
|
Both
|
$6,376.00
|
|
|
Service Code
|
HCPCS A4642
|
| Hospital Charge Code |
1486844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,234.42 |
| Max. Negotiated Rate |
$6,299.49 |
| Rate for Payer: Aetna Commercial |
$6,299.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,702.69
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cigna Commercial |
$6,299.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,315.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,978.62
|
| Rate for Payer: Health EOS Commercial |
$6,034.25
|
| Rate for Payer: HFN Commercial |
$6,299.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,234.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,234.42
|
| Rate for Payer: Multiplan Commercial |
$5,304.83
|
| Rate for Payer: Preferred Network Access Commercial |
$6,299.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,917.66
|
| Rate for Payer: Quartz Commercial |
$3,779.69
|
| Rate for Payer: The Alliance Commercial |
$3,315.52
|
| Rate for Payer: WEA Trust Commercial |
$3,647.07
|
| Rate for Payer: WPS Commercial |
$4,911.43
|
|
|
In-111 Satumomab pendetide
|
Facility
|
OP
|
$6,376.00
|
|
|
Service Code
|
HCPCS A4642
|
| Hospital Charge Code |
1486844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,856.69 |
| Max. Negotiated Rate |
$6,100.56 |
| Rate for Payer: Aetna Commercial |
$5,967.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,702.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,856.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,310.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,315.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,182.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,514.45
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cigna Commercial |
$6,100.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,710.83
|
| Rate for Payer: Health EOS Commercial |
$5,901.63
|
| Rate for Payer: HFN Commercial |
$6,100.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,973.28
|
| Rate for Payer: Multiplan Commercial |
$5,304.83
|
| Rate for Payer: NAPHCARE Commercial |
$3,978.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,100.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,249.21
|
| Rate for Payer: Quartz Commercial |
$4,310.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,978.62
|
| Rate for Payer: The Alliance Commercial |
$3,315.52
|
| Rate for Payer: WEA Trust Commercial |
$3,647.07
|
| Rate for Payer: WPS Commercial |
$4,911.43
|
|
|
INBORN AND OTHER DISORDERS OF METABOLISM
|
Facility
|
IP
|
$36,368.80
|
|
|
Service Code
|
MSDRG 642
|
| Min. Negotiated Rate |
$11,397.51 |
| Max. Negotiated Rate |
$36,368.80 |
| Rate for Payer: Aetna Managed Medicare |
$11,397.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,029.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,783.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,595.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11,397.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,397.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,397.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,397.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,083.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,397.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,430.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,397.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,397.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,397.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,397.51
|
| Rate for Payer: NAPHCARE Commercial |
$17,096.26
|
| Rate for Payer: Quartz Medicare Advantage |
$11,397.51
|
| Rate for Payer: The Alliance Commercial |
$36,368.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,397.51
|
| Rate for Payer: United Healthcare PPO |
$20,576.82
|
| Rate for Payer: Wellcare Medicare |
$11,397.51
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$33,319.58
|
|
|
Service Code
|
APR-DRG 4234
|
| Min. Negotiated Rate |
$29,596.53 |
| Max. Negotiated Rate |
$33,319.58 |
| Rate for Payer: Anthem Medicaid |
$31,905.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,905.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,905.33
|
| Rate for Payer: Dean Health Medicaid |
$31,905.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,596.53
|
| Rate for Payer: Managed Health Services Medicaid |
$33,319.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,905.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,905.33
|
| Rate for Payer: United Healthcare Medicaid |
$31,905.33
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
OP
|
$79.93
|
|
|
Service Code
|
EAPG 00691
|
| Min. Negotiated Rate |
$76.85 |
| Max. Negotiated Rate |
$79.93 |
| Rate for Payer: Anthem Medicaid |
$76.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$76.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.85
|
| Rate for Payer: Dean Health Medicaid |
$76.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$76.85
|
| Rate for Payer: Managed Health Services Medicaid |
$79.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$76.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$76.85
|
| Rate for Payer: United Healthcare Medicaid |
$76.85
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$6,050.13
|
|
|
Service Code
|
APR-DRG 4231
|
| Min. Negotiated Rate |
$5,374.11 |
| Max. Negotiated Rate |
$6,050.13 |
| Rate for Payer: Anthem Medicaid |
$5,793.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,793.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,793.34
|
| Rate for Payer: Dean Health Medicaid |
$5,793.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,374.11
|
| Rate for Payer: Managed Health Services Medicaid |
$6,050.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,793.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,793.34
|
| Rate for Payer: United Healthcare Medicaid |
$5,793.34
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$12,977.10
|
|
|
Service Code
|
APR-DRG 4233
|
| Min. Negotiated Rate |
$11,527.07 |
| Max. Negotiated Rate |
$12,977.10 |
| Rate for Payer: Anthem Medicaid |
$12,426.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,426.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,426.29
|
| Rate for Payer: Dean Health Medicaid |
$12,426.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,527.07
|
| Rate for Payer: Managed Health Services Medicaid |
$12,977.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,426.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,426.29
|
| Rate for Payer: United Healthcare Medicaid |
$12,426.29
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$8,505.26
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$7,554.90 |
| Max. Negotiated Rate |
$8,505.26 |
| Rate for Payer: Anthem Medicaid |
$8,144.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,144.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,144.26
|
| Rate for Payer: Dean Health Medicaid |
$8,144.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,554.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8,505.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,144.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,144.26
|
| Rate for Payer: United Healthcare Medicaid |
$8,144.26
|
|
|
INCIDENTAL INTRAOPERATIVE PROCEDURES
|
Facility
|
OP
|
$1,213.34
|
|
|
Service Code
|
EAPG 02008
|
| Min. Negotiated Rate |
$1,166.67 |
| Max. Negotiated Rate |
$1,213.34 |
| Rate for Payer: Anthem Medicaid |
$1,166.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,166.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,166.67
|
| Rate for Payer: Dean Health Medicaid |
$1,166.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,166.67
|
| Rate for Payer: Managed Health Services Medicaid |
$1,213.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,166.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,166.67
|
| Rate for Payer: United Healthcare Medicaid |
$1,166.67
|
|
|
INCIDENTAL SKIN SUBSTITUTES
|
Facility
|
OP
|
$846.45
|
|
|
Service Code
|
EAPG 02010
|
| Min. Negotiated Rate |
$813.90 |
| Max. Negotiated Rate |
$846.45 |
| Rate for Payer: Anthem Medicaid |
$813.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$813.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$813.90
|
| Rate for Payer: Dean Health Medicaid |
$813.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$813.90
|
| Rate for Payer: Managed Health Services Medicaid |
$846.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$813.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$813.90
|
| Rate for Payer: United Healthcare Medicaid |
$813.90
|
|
|
INCISE EXTERNAL HEMORRHOID 46083
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
3014825
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$462.99 |
| Rate for Payer: Aetna Commercial |
$422.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.80
|
| Rate for Payer: Aetna Managed Medicare |
$102.89
|
| Rate for Payer: Anthem Medicare Advantage |
$102.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.89
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$422.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.89
|
| Rate for Payer: Health EOS Commercial |
$405.06
|
| Rate for Payer: HFN Commercial |
$422.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.89
|
| Rate for Payer: Multiplan Commercial |
$356.10
|
| Rate for Payer: NAPHCARE Commercial |
$154.33
|
| Rate for Payer: Preferred Network Access Commercial |
$422.86
|
| Rate for Payer: Quartz Beloit One Network |
$195.85
|
| Rate for Payer: Quartz Commercial |
$253.72
|
| Rate for Payer: Quartz Medicare Advantage |
$102.89
|
| Rate for Payer: The Alliance Commercial |
$437.27
|
| Rate for Payer: United Healthcare Medicaid |
$85.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.89
|
| Rate for Payer: WEA Trust Commercial |
$244.82
|
| Rate for Payer: WPS Commercial |
$462.99
|
|
|
INCISE FINGER TENDON SHEATH 26055
|
Professional
|
Both
|
$1,493.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
3013931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.85 |
| Max. Negotiated Rate |
$1,475.08 |
| Rate for Payer: Aetna Commercial |
$1,475.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.34
|
| Rate for Payer: Aetna Managed Medicare |
$277.85
|
| Rate for Payer: Anthem Medicare Advantage |
$277.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$277.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$277.85
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,475.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.85
|
| Rate for Payer: Health EOS Commercial |
$1,412.98
|
| Rate for Payer: HFN Commercial |
$1,475.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,015.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,015.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$277.85
|
| Rate for Payer: Multiplan Commercial |
$1,242.18
|
| Rate for Payer: NAPHCARE Commercial |
$416.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,475.08
|
| Rate for Payer: Quartz Beloit One Network |
$683.20
|
| Rate for Payer: Quartz Commercial |
$885.05
|
| Rate for Payer: Quartz Medicare Advantage |
$277.85
|
| Rate for Payer: The Alliance Commercial |
$1,180.85
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$277.85
|
| Rate for Payer: WEA Trust Commercial |
$854.00
|
| Rate for Payer: WPS Commercial |
$1,250.31
|
|
|
INCISE INNER EAR 69801
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
3015282
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.54 |
| Max. Negotiated Rate |
$2,270.42 |
| Rate for Payer: Aetna Commercial |
$2,270.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,055.33
|
| Rate for Payer: Aetna Managed Medicare |
$103.54
|
| Rate for Payer: Anthem Medicare Advantage |
$103.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.54
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,270.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,566.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.54
|
| Rate for Payer: Health EOS Commercial |
$2,174.83
|
| Rate for Payer: HFN Commercial |
$2,270.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.54
|
| Rate for Payer: Multiplan Commercial |
$1,911.94
|
| Rate for Payer: NAPHCARE Commercial |
$155.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,270.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,051.56
|
| Rate for Payer: Quartz Commercial |
$1,362.25
|
| Rate for Payer: Quartz Medicare Advantage |
$103.54
|
| Rate for Payer: The Alliance Commercial |
$440.06
|
| Rate for Payer: United Healthcare Medicaid |
$1,566.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.54
|
| Rate for Payer: WEA Trust Commercial |
$1,314.46
|
| Rate for Payer: WPS Commercial |
$465.94
|
|
|
INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.80 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
|
|
Incisional Biopsy Skin Ea Sep/Additional Lesion 11107
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
5454810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$122.51 |
| Rate for Payer: Aetna Commercial |
$122.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage |
$24.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.38
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$122.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.38
|
| Rate for Payer: Health EOS Commercial |
$117.35
|
| Rate for Payer: HFN Commercial |
$122.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.38
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$36.57
|
| Rate for Payer: Preferred Network Access Commercial |
$122.51
|
| Rate for Payer: Quartz Beloit One Network |
$56.74
|
| Rate for Payer: Quartz Commercial |
$73.51
|
| Rate for Payer: Quartz Medicare Advantage |
$24.38
|
| Rate for Payer: The Alliance Commercial |
$103.60
|
| Rate for Payer: United Healthcare Medicaid |
$57.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$109.70
|
|
|
Incisional Biopsy Skin Single Lesion 11106
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
5454811
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$395.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$44.98
|
| Rate for Payer: Anthem Medicare Advantage |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.98
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.98
|
| Rate for Payer: Health EOS Commercial |
$378.56
|
| Rate for Payer: HFN Commercial |
$395.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$201.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.98
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$67.47
|
| Rate for Payer: Preferred Network Access Commercial |
$395.20
|
| Rate for Payer: Quartz Beloit One Network |
$183.04
|
| Rate for Payer: Quartz Commercial |
$237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$44.98
|
| Rate for Payer: The Alliance Commercial |
$191.16
|
| Rate for Payer: United Healthcare Medicaid |
$121.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.98
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$202.41
|
|
|
INCISION AND DRAINAGE, ABSCESS
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960129
|
|
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
|
|
|
INCISION AND DRAINAGE, ABSCESS
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960129
|
|
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
|
|
|
Incision and Drainage Abscess: Peritonsillar
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
1152810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.29 |
| Max. Negotiated Rate |
$559.31 |
| Rate for Payer: Aetna Commercial |
$404.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.81
|
| Rate for Payer: Aetna Managed Medicare |
$124.29
|
| Rate for Payer: Anthem Medicare Advantage |
$124.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.29
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$404.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.29
|
| Rate for Payer: Health EOS Commercial |
$387.08
|
| Rate for Payer: HFN Commercial |
$404.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$467.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$467.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.29
|
| Rate for Payer: Multiplan Commercial |
$340.29
|
| Rate for Payer: NAPHCARE Commercial |
$186.44
|
| Rate for Payer: Preferred Network Access Commercial |
$404.09
|
| Rate for Payer: Quartz Beloit One Network |
$187.16
|
| Rate for Payer: Quartz Commercial |
$242.46
|
| Rate for Payer: Quartz Medicare Advantage |
$124.29
|
| Rate for Payer: The Alliance Commercial |
$528.23
|
| Rate for Payer: United Healthcare Medicaid |
$126.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.29
|
| Rate for Payer: WEA Trust Commercial |
$233.95
|
| Rate for Payer: WPS Commercial |
$559.31
|
|
|
INCISION AND DRAINAGE, ANKLE/FOOT/TOE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960130
|
|
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
|
|
|
INCISION AND DRAINAGE, ANKLE/FOOT/TOE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960130
|
|
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
|
|
|
INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; SINGLE BURSAL SPACE
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 28002
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| 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 |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
INCISION AND DRAINAGE, BREAST
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960131
|
|
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
|
|
|
INCISION AND DRAINAGE, BREAST
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960131
|
|
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
|
|
