|
SWABS SUCTION SYSTEM W/ CHG 6914
|
Facility
IP
|
$485.00
|
|
| Hospital Charge Code |
2962919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.65 |
| Max. Negotiated Rate |
$446.20 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.05
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$446.20
|
| Rate for Payer: Health EOS Commercial |
$431.65
|
| Rate for Payer: HFN Commercial |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: NAPHCARE Commercial |
$291.00
|
| Rate for Payer: Preferred Network Access Commercial |
$446.20
|
| Rate for Payer: Quartz Beloit One Network |
$237.65
|
| Rate for Payer: Quartz Commercial |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$266.75
|
| Rate for Payer: WPS Commercial |
$359.24
|
|
|
Swallow Therapy Treatment
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5184733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$369.60
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
Swallow Therapy Treatment
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5184733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$172.48 |
| Max. Negotiated Rate |
$2,464.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Aetna Managed Medicare |
$172.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.71
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$400.40
|
| Rate for Payer: Quartz Medicare Advantage |
$369.60
|
| Rate for Payer: The Alliance Commercial |
$2,464.00
|
| Rate for Payer: United Healthcare PPO |
$462.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3147641
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3147641
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
SWEA 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis
|
Facility
OP
|
$887.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3147642
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$394.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.82
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$576.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.76
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$816.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$789.43
|
| Rate for Payer: HFN Commercial |
$816.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$816.04
|
| Rate for Payer: Quartz Beloit One Network |
$434.63
|
| Rate for Payer: Quartz Commercial |
$576.55
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: WEA Trust Commercial |
$487.85
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$657.00
|
|
|
SWEA 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis
|
Facility
IP
|
$887.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3147642
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$434.63 |
| Max. Negotiated Rate |
$816.04 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.11
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$816.04
|
| Rate for Payer: Health EOS Commercial |
$789.43
|
| Rate for Payer: HFN Commercial |
$816.04
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.20
|
| Rate for Payer: Preferred Network Access Commercial |
$816.04
|
| Rate for Payer: Quartz Beloit One Network |
$434.63
|
| Rate for Payer: Quartz Commercial |
$532.20
|
| Rate for Payer: WEA Trust Commercial |
$487.85
|
| Rate for Payer: WPS Commercial |
$657.00
|
|
|
SWEA 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
OP
|
$522.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3147648
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.56
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$339.30
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
SWEA 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
IP
|
$522.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3147648
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$255.78 |
| Max. Negotiated Rate |
$480.24 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$313.20
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
IP
|
$502.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3147668
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$301.20
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
OP
|
$502.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3147668
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.96
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
SWEA 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
IP
|
$710.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
3147669
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$347.90 |
| Max. Negotiated Rate |
$653.20 |
| Rate for Payer: Aetna Commercial |
$639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.30
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$653.20
|
| Rate for Payer: Health EOS Commercial |
$631.90
|
| Rate for Payer: HFN Commercial |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: NAPHCARE Commercial |
$426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$653.20
|
| Rate for Payer: Quartz Beloit One Network |
$347.90
|
| Rate for Payer: Quartz Commercial |
$426.00
|
| Rate for Payer: WEA Trust Commercial |
$390.50
|
| Rate for Payer: WPS Commercial |
$525.90
|
|
|
SWEA 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
OP
|
$710.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
3147669
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$610.60
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.80
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$653.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$631.90
|
| Rate for Payer: HFN Commercial |
$653.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$653.20
|
| Rate for Payer: Quartz Beloit One Network |
$347.90
|
| Rate for Payer: Quartz Commercial |
$461.50
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$390.50
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$525.90
|
|
|
SWEA 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mu
|
Facility
IP
|
$517.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
3147674
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$310.20
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
SWEA 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mu
|
Facility
OP
|
$517.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
3147674
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.16
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$336.05
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
SWEA 26010 Drainage of finger abscess; simple
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
3147798
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| 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 |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
SWEA 26010 Drainage of finger abscess; simple
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
3147798
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| 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 2676554 Open treatment of distal phalangeal fracture, finger or thumb, includes internal
|
Facility
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 26765 54
|
| Hospital Charge Code |
3147819
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$9,152.00 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,967.68
|
| Rate for Payer: Aetna Managed Medicare |
$640.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.32
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,487.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,372.80
|
| Rate for Payer: The Alliance Commercial |
$9,152.00
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
SWEA 2676554 Open treatment of distal phalangeal fracture, finger or thumb, includes internal
|
Facility
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 26765 54
|
| Hospital Charge Code |
3147819
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,121.12 |
| Max. Negotiated Rate |
$2,104.96 |
| Rate for Payer: Aetna Commercial |
$2,059.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,212.64
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,104.96
|
| Rate for Payer: Health EOS Commercial |
$2,036.32
|
| Rate for Payer: HFN Commercial |
$2,104.96
|
| Rate for Payer: Multiplan Commercial |
$1,830.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,372.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,104.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,258.40
|
| Rate for Payer: WPS Commercial |
$1,694.72
|
|
|
SWEA 28190 Removal of foreign body, foot; subcutaneous
|
Facility
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3147855
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$491.04 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.04
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$664.95
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
SWEA 28190 Removal of foreign body, foot; subcutaneous
|
Facility
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3147855
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$501.27 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$613.80
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
SWEA 28490 Closed treatment of fracture great toe, phalanx or phalanges; without manipulati
|
Facility
OP
|
$670.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
3147864
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.20
|
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$435.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$321.60
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$616.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Health EOS Commercial |
$596.30
|
| Rate for Payer: HFN Commercial |
$616.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Preferred Network Access Commercial |
$616.40
|
| Rate for Payer: Quartz Beloit One Network |
$328.30
|
| Rate for Payer: Quartz Commercial |
$435.50
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
SWEA 28490 Closed treatment of fracture great toe, phalanx or phalanges; without manipulati
|
Facility
IP
|
$670.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
3147864
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$616.40 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.10
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$616.40
|
| Rate for Payer: Health EOS Commercial |
$596.30
|
| Rate for Payer: HFN Commercial |
$616.40
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: NAPHCARE Commercial |
$402.00
|
| Rate for Payer: Preferred Network Access Commercial |
$616.40
|
| Rate for Payer: Quartz Beloit One Network |
$328.30
|
| Rate for Payer: Quartz Commercial |
$402.00
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
SWEA 29105 Application of long arm splint (shoulder to hand)
|
Facility
OP
|
$355.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
3147877
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$10,829.40 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$155.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Anthem Medicare Advantage |
$155.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.74
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.74
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.74
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$233.61
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$155.74
|
| Rate for Payer: The Alliance Commercial |
$10,829.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.74
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: Wellcare Medicare |
$155.74
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
SWEA 29105 Application of long arm splint (shoulder to hand)
|
Facility
IP
|
$355.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
3147877
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
