|
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 |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$452.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.46
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$641.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Health EOS Commercial |
$620.15
|
| Rate for Payer: HFN Commercial |
$641.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$641.06
|
| Rate for Payer: Quartz Beloit One Network |
$341.43
|
| Rate for Payer: Quartz Commercial |
$452.92
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
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 |
$171.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
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 |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
SWEA 29515 Application of short leg splint (calf to foot)
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
3147885
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$166.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
SWEA 29515 Application of short leg splint (calf to foot)
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
3147885
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
SWEA 41800 Drainage of abscess, cyst, hematoma from dentoalveolar structures
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
3147963
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.84
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$559.05
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SWEA 41800 Drainage of abscess, cyst, hematoma from dentoalveolar structures
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
3147963
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$791.27 |
| Rate for Payer: Aetna Commercial |
$774.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.84
|
| Rate for Payer: Cash Price |
$248.10
|
| Rate for Payer: Cigna Commercial |
$791.27
|
| Rate for Payer: Health EOS Commercial |
$765.47
|
| Rate for Payer: HFN Commercial |
$791.27
|
| Rate for Payer: Multiplan Commercial |
$688.06
|
| Rate for Payer: Preferred Network Access Commercial |
$791.27
|
| Rate for Payer: Quartz Beloit One Network |
$421.44
|
| Rate for Payer: Quartz Commercial |
$516.05
|
| Rate for Payer: WEA Trust Commercial |
$473.04
|
| Rate for Payer: WPS Commercial |
$637.04
|
|
|
SWEA 42809 REMOVAL OF FOREIGN BODY FROM PHARYNX
|
Facility
|
IP
|
$804.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
3147969
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$409.72 |
| Max. Negotiated Rate |
$769.27 |
| Rate for Payer: Aetna Commercial |
$752.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.16
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$769.27
|
| Rate for Payer: Health EOS Commercial |
$744.18
|
| Rate for Payer: HFN Commercial |
$769.27
|
| Rate for Payer: Multiplan Commercial |
$668.93
|
| Rate for Payer: Preferred Network Access Commercial |
$769.27
|
| Rate for Payer: Quartz Beloit One Network |
$409.72
|
| Rate for Payer: Quartz Commercial |
$501.70
|
| Rate for Payer: WEA Trust Commercial |
$459.89
|
| Rate for Payer: WPS Commercial |
$619.32
|
|
|
SWEA 42809 REMOVAL OF FOREIGN BODY FROM PHARYNX
|
Facility
|
OP
|
$804.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
3147969
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$401.36 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$752.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$719.10
|
| Rate for Payer: Aetna Managed Medicare |
$470.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$543.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$401.36
|
| Rate for Payer: Anthem Medicare Advantage |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$443.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$470.13
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cigna Commercial |
$769.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$470.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$470.13
|
| Rate for Payer: Health EOS Commercial |
$744.18
|
| Rate for Payer: HFN Commercial |
$769.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,748.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$470.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$470.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$470.13
|
| Rate for Payer: Multiplan Commercial |
$668.93
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| Rate for Payer: Preferred Network Access Commercial |
$769.27
|
| Rate for Payer: Quartz Beloit One Network |
$409.72
|
| Rate for Payer: Quartz Commercial |
$543.50
|
| Rate for Payer: Quartz Medicare Advantage |
$470.13
|
| Rate for Payer: The Alliance Commercial |
$1,880.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: WEA Trust Commercial |
$459.89
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
| Rate for Payer: WPS Commercial |
$619.32
|
|
|
SWEA 69000 Drainage external ear, abscess or hematoma; simple
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
3148047
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$373.90 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$701.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.91
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$506.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$389.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$373.90
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$716.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$693.27
|
| Rate for Payer: HFN Commercial |
$716.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$623.17
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$716.64
|
| Rate for Payer: Quartz Beloit One Network |
$381.69
|
| Rate for Payer: Quartz Commercial |
$506.32
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: WEA Trust Commercial |
$428.43
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$576.95
|
|
|
SWEA 69000 Drainage external ear, abscess or hematoma; simple
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
3148047
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$381.69 |
| Max. Negotiated Rate |
$716.64 |
| Rate for Payer: Aetna Commercial |
$701.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.85
|
| Rate for Payer: Cash Price |
$224.70
|
| Rate for Payer: Cigna Commercial |
$716.64
|
| Rate for Payer: Health EOS Commercial |
$693.27
|
| Rate for Payer: HFN Commercial |
$716.64
|
| Rate for Payer: Multiplan Commercial |
$623.17
|
| Rate for Payer: Preferred Network Access Commercial |
$716.64
|
| Rate for Payer: Quartz Beloit One Network |
$381.69
|
| Rate for Payer: Quartz Commercial |
$467.38
|
| Rate for Payer: WEA Trust Commercial |
$428.43
|
| Rate for Payer: WPS Commercial |
$576.95
|
|
|
SWEA 69200 Removal foreign body from external auditory canal; without general anesthesia
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
3148051
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$220.15 |
| Max. Negotiated Rate |
$413.34 |
| Rate for Payer: Aetna Commercial |
$404.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.12
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: Health EOS Commercial |
$399.86
|
| Rate for Payer: HFN Commercial |
$413.34
|
| Rate for Payer: Multiplan Commercial |
$359.42
|
| Rate for Payer: Preferred Network Access Commercial |
$413.34
|
| Rate for Payer: Quartz Beloit One Network |
$220.15
|
| Rate for Payer: Quartz Commercial |
$269.57
|
| Rate for Payer: WEA Trust Commercial |
$247.10
|
| Rate for Payer: WPS Commercial |
$332.77
|
|
|
SWEA 69200 Removal foreign body from external auditory canal; without general anesthesia
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
3148051
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$404.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.38
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$292.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.65
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$413.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$399.86
|
| Rate for Payer: HFN Commercial |
$413.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$359.42
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$413.34
|
| Rate for Payer: Quartz Beloit One Network |
$220.15
|
| Rate for Payer: Quartz Commercial |
$292.03
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$247.10
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$332.77
|
|
|
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 |
$62.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
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 |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
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 |
$33.36 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$45.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$97.34
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$97.34
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: United Healthcare PPO |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
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 |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
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 |
$76.00 |
| Max. Negotiated Rate |
$606.32 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.49
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$122.47
|
| Rate for Payer: United Healthcare PPO |
$203.58
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
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 |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
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 |
$97.84 |
| Max. Negotiated Rate |
$606.32 |
| Rate for Payer: Aetna Commercial |
$314.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.52
|
| Rate for Payer: Aetna Managed Medicare |
$97.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.20
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$321.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.49
|
| Rate for Payer: Health EOS Commercial |
$311.00
|
| Rate for Payer: HFN Commercial |
$321.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.08
|
| Rate for Payer: Multiplan Commercial |
$279.55
|
| Rate for Payer: NAPHCARE Commercial |
$209.66
|
| Rate for Payer: Preferred Network Access Commercial |
$321.48
|
| Rate for Payer: Quartz Beloit One Network |
$171.23
|
| Rate for Payer: Quartz Commercial |
$227.14
|
| Rate for Payer: Quartz Medicare Advantage |
$209.66
|
| Rate for Payer: The Alliance Commercial |
$228.43
|
| Rate for Payer: United Healthcare PPO |
$262.08
|
| Rate for Payer: WEA Trust Commercial |
$192.19
|
| Rate for Payer: WPS Commercial |
$258.82
|
|
|
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 |
$171.23 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$314.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.20
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cigna Commercial |
$321.48
|
| Rate for Payer: Health EOS Commercial |
$311.00
|
| Rate for Payer: HFN Commercial |
$321.48
|
| Rate for Payer: Multiplan Commercial |
$279.55
|
| Rate for Payer: Preferred Network Access Commercial |
$321.48
|
| Rate for Payer: Quartz Beloit One Network |
$171.23
|
| Rate for Payer: Quartz Commercial |
$209.66
|
| Rate for Payer: WEA Trust Commercial |
$192.19
|
| Rate for Payer: WPS Commercial |
$258.82
|
|
|
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 |
$108.49 |
| Max. Negotiated Rate |
$606.32 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.49
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$335.34
|
| Rate for Payer: United Healthcare PPO |
$429.78
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
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 |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
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 |
$108.49 |
| Max. Negotiated Rate |
$706.12 |
| Rate for Payer: Aetna Commercial |
$690.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Aetna Managed Medicare |
$214.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.79
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$706.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.49
|
| Rate for Payer: Health EOS Commercial |
$683.09
|
| Rate for Payer: HFN Commercial |
$706.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$575.64
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: NAPHCARE Commercial |
$460.51
|
| Rate for Payer: Preferred Network Access Commercial |
$706.12
|
| Rate for Payer: Quartz Beloit One Network |
$376.08
|
| Rate for Payer: Quartz Commercial |
$498.89
|
| Rate for Payer: Quartz Medicare Advantage |
$460.51
|
| Rate for Payer: The Alliance Commercial |
$497.87
|
| Rate for Payer: United Healthcare PPO |
$575.64
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$568.48
|
|
|
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 |
$376.08 |
| Max. Negotiated Rate |
$706.12 |
| Rate for Payer: Aetna Commercial |
$690.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.79
|
| Rate for Payer: Cash Price |
$221.40
|
| Rate for Payer: Cigna Commercial |
$706.12
|
| Rate for Payer: Health EOS Commercial |
$683.09
|
| Rate for Payer: HFN Commercial |
$706.12
|
| Rate for Payer: Multiplan Commercial |
$614.02
|
| Rate for Payer: Preferred Network Access Commercial |
$706.12
|
| Rate for Payer: Quartz Beloit One Network |
$376.08
|
| Rate for Payer: Quartz Commercial |
$460.51
|
| Rate for Payer: WEA Trust Commercial |
$422.14
|
| Rate for Payer: WPS Commercial |
$568.48
|
|
