|
SWEA 69210 Removal impacted cerumen (separate procedure), 1 or both ears
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
3148052
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
SWEA 69210 Removal impacted cerumen (separate procedure), 1 or both ears
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
3148052
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
SWEA 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
3148092
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$624.00
|
| Rate for Payer: United Healthcare PPO |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
SWEA 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
3148092
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
SWEA 99212 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3148122
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
SWEA 99212 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3148122
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: United Healthcare PPO |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
SWEA 99213 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
3148123
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.08
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$309.12
|
| Rate for Payer: Health EOS Commercial |
$299.04
|
| Rate for Payer: HFN Commercial |
$309.12
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: NAPHCARE Commercial |
$201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$309.12
|
| Rate for Payer: Quartz Beloit One Network |
$164.64
|
| Rate for Payer: Quartz Commercial |
$201.60
|
| Rate for Payer: WEA Trust Commercial |
$184.80
|
| Rate for Payer: WPS Commercial |
$248.88
|
|
|
SWEA 99213 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
3148123
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.96
|
| Rate for Payer: Aetna Managed Medicare |
$94.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.08
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$309.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Health EOS Commercial |
$299.04
|
| Rate for Payer: HFN Commercial |
$309.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: NAPHCARE Commercial |
$201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$309.12
|
| Rate for Payer: Quartz Beloit One Network |
$164.64
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: Quartz Medicare Advantage |
$201.60
|
| Rate for Payer: The Alliance Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare PPO |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$184.80
|
| Rate for Payer: WPS Commercial |
$248.88
|
|
|
SWEA 99214 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
3148124
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
SWEA 99214 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
3148124
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: United Healthcare PPO |
$413.25
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
SWEA 99215 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
OP
|
$738.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
3148125
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$664.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.68
|
| Rate for Payer: Aetna Managed Medicare |
$206.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.14
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$678.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Health EOS Commercial |
$656.82
|
| Rate for Payer: HFN Commercial |
$678.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.50
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: NAPHCARE Commercial |
$442.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.96
|
| Rate for Payer: Quartz Beloit One Network |
$361.62
|
| Rate for Payer: Quartz Commercial |
$479.70
|
| Rate for Payer: Quartz Medicare Advantage |
$442.80
|
| Rate for Payer: The Alliance Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare PPO |
$553.50
|
| Rate for Payer: WEA Trust Commercial |
$405.90
|
| Rate for Payer: WPS Commercial |
$546.64
|
|
|
SWEA 99215 Office or other outpatient visit for the evaluation and management of an establi
|
Facility
|
IP
|
$738.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
3148125
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$361.62 |
| Max. Negotiated Rate |
$678.96 |
| Rate for Payer: Aetna Commercial |
$664.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.14
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$678.96
|
| Rate for Payer: Health EOS Commercial |
$656.82
|
| Rate for Payer: HFN Commercial |
$678.96
|
| Rate for Payer: Multiplan Commercial |
$590.40
|
| Rate for Payer: NAPHCARE Commercial |
$442.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.96
|
| Rate for Payer: Quartz Beloit One Network |
$361.62
|
| Rate for Payer: Quartz Commercial |
$442.80
|
| Rate for Payer: WEA Trust Commercial |
$405.90
|
| Rate for Payer: WPS Commercial |
$546.64
|
|
|
SWEA 99291 Critical care, evaluation and management of the critically ill or critically inj
|
Facility
|
IP
|
$1,568.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
3147612
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$768.32 |
| Max. Negotiated Rate |
$1,442.56 |
| Rate for Payer: Aetna Commercial |
$1,411.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$831.04
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cigna Commercial |
$1,442.56
|
| Rate for Payer: Health EOS Commercial |
$1,395.52
|
| Rate for Payer: HFN Commercial |
$1,442.56
|
| Rate for Payer: Multiplan Commercial |
$1,254.40
|
| Rate for Payer: NAPHCARE Commercial |
$940.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.56
|
| Rate for Payer: Quartz Beloit One Network |
$768.32
|
| Rate for Payer: Quartz Commercial |
$940.80
|
| Rate for Payer: WEA Trust Commercial |
$862.40
|
| Rate for Payer: WPS Commercial |
$1,161.42
|
|
|
SWEA 99291 Critical care, evaluation and management of the critically ill or critically inj
|
Facility
|
OP
|
$1,568.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
3147612
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$3,508.32 |
| Rate for Payer: Aetna Commercial |
$1,411.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.48
|
| Rate for Payer: Aetna Managed Medicare |
$877.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Anthem Medicare Advantage |
$877.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$831.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$877.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$877.08
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cigna Commercial |
$1,442.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$877.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$877.08
|
| Rate for Payer: Health EOS Commercial |
$1,395.52
|
| Rate for Payer: HFN Commercial |
$1,442.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,262.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$877.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$877.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$877.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$877.08
|
| Rate for Payer: Multiplan Commercial |
$1,254.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,315.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.56
|
| Rate for Payer: Quartz Beloit One Network |
$768.32
|
| Rate for Payer: Quartz Commercial |
$1,019.20
|
| Rate for Payer: Quartz Medicare Advantage |
$877.08
|
| Rate for Payer: The Alliance Commercial |
$3,508.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$877.08
|
| Rate for Payer: United Healthcare PPO |
$1,176.00
|
| Rate for Payer: WEA Trust Commercial |
$862.40
|
| Rate for Payer: Wellcare Medicare |
$877.08
|
| Rate for Payer: WPS Commercial |
$1,161.42
|
|
|
SWEA 99292 Critical care, evaluation and management of the critically ill or critically inj
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
3147613
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$520.72 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$339.60
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
SWEA 99292 Critical care, evaluation and management of the critically ill or critically inj
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
3147613
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$2,264.00 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Aetna Managed Medicare |
$158.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.50
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$367.90
|
| Rate for Payer: Quartz Medicare Advantage |
$339.60
|
| Rate for Payer: The Alliance Commercial |
$2,264.00
|
| Rate for Payer: United Healthcare PPO |
$424.50
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
SWELL SPOT DORSAL (SM) #SP-02-S
|
Facility
|
OP
|
$269.00
|
|
| Hospital Charge Code |
2970855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
SWELL SPOT DORSAL (SM) #SP-02-S
|
Facility
|
IP
|
$269.00
|
|
| Hospital Charge Code |
2970855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$247.48 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$161.40
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
SWELL SPOTS CURVED #5609-18-03
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
2971122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$120.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.50
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$258.00
|
| Rate for Payer: The Alliance Commercial |
$1,720.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
SWELL SPOTS CURVED #5609-18-03
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
2971122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
SWELL SPOTS DORSAL (SMALL) #5609-18-01
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
2971121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$120.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.50
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$258.00
|
| Rate for Payer: The Alliance Commercial |
$1,720.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
SWELL SPOTS DORSAL (SMALL) #5609-18-01
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
2971121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
SWELL SPOTS KATINA (SMALL) #5609-18-04
|
Facility
|
IP
|
$476.00
|
|
| Hospital Charge Code |
2971283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$437.92 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.28
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$437.92
|
| Rate for Payer: Health EOS Commercial |
$423.64
|
| Rate for Payer: HFN Commercial |
$437.92
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: NAPHCARE Commercial |
$285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$437.92
|
| Rate for Payer: Quartz Beloit One Network |
$233.24
|
| Rate for Payer: Quartz Commercial |
$285.60
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
|
SWELL SPOTS KATINA (SMALL) #5609-18-04
|
Facility
|
OP
|
$476.00
|
|
| Hospital Charge Code |
2971283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$1,904.00 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Aetna Managed Medicare |
$133.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$309.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$238.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.28
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$437.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$266.37
|
| Rate for Payer: Health EOS Commercial |
$423.64
|
| Rate for Payer: HFN Commercial |
$437.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.00
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: NAPHCARE Commercial |
$285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$437.92
|
| Rate for Payer: Quartz Beloit One Network |
$233.24
|
| Rate for Payer: Quartz Commercial |
$309.40
|
| Rate for Payer: Quartz Medicare Advantage |
$285.60
|
| Rate for Payer: The Alliance Commercial |
$1,904.00
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
|
SWELL SPOTS PALMER (SM) #SP-03-S
|
Facility
|
OP
|
$269.00
|
|
| Hospital Charge Code |
2971025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
