|
Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
1190822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$408.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.00
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| Rate for Payer: HFN Commercial |
$408.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.43
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$408.50
|
| Rate for Payer: Quartz Beloit One Network |
$189.20
|
| Rate for Payer: Quartz Commercial |
$245.10
|
| Rate for Payer: The Alliance Commercial |
$215.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
DRAINAGE OF ARM BURSA 23931
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
3013802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$280.22 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna Commercial |
$687.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$687.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.40
|
| Rate for Payer: Health EOS Commercial |
$658.84
|
| Rate for Payer: HFN Commercial |
$687.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$532.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$532.57
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.80
|
| Rate for Payer: Quartz Beloit One Network |
$318.56
|
| Rate for Payer: Quartz Commercial |
$412.68
|
| Rate for Payer: The Alliance Commercial |
$362.00
|
| Rate for Payer: United Healthcare Medicaid |
$280.22
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
DRAINAGE OF ARM LESION 23930
|
Professional
|
Both
|
$1,034.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
3013801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$261.53 |
| Max. Negotiated Rate |
$982.30 |
| Rate for Payer: Aetna Commercial |
$982.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$889.24
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$982.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$620.40
|
| Rate for Payer: Health EOS Commercial |
$940.94
|
| Rate for Payer: HFN Commercial |
$982.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$712.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$712.28
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: Preferred Network Access Commercial |
$982.30
|
| Rate for Payer: Quartz Beloit One Network |
$454.96
|
| Rate for Payer: Quartz Commercial |
$589.38
|
| Rate for Payer: The Alliance Commercial |
$517.00
|
| Rate for Payer: United Healthcare Medicaid |
$261.53
|
| Rate for Payer: WEA Trust Commercial |
$568.70
|
| Rate for Payer: WPS Commercial |
$765.88
|
|
|
DRAINAGE OF EYE 65800
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
3015224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.80
|
| Rate for Payer: Health EOS Commercial |
$407.68
|
| Rate for Payer: HFN Commercial |
$425.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$303.40
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Preferred Network Access Commercial |
$425.60
|
| Rate for Payer: Quartz Beloit One Network |
$197.12
|
| Rate for Payer: Quartz Commercial |
$255.36
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
DRAINAGE OF EYE 65815
|
Professional
|
Both
|
$1,543.00
|
|
|
Service Code
|
CPT 65815
|
| Hospital Charge Code |
3015226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.31 |
| Max. Negotiated Rate |
$1,602.44 |
| Rate for Payer: Aetna Commercial |
$1,465.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.98
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,465.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$925.80
|
| Rate for Payer: Health EOS Commercial |
$1,404.13
|
| Rate for Payer: HFN Commercial |
$1,465.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.44
|
| Rate for Payer: Multiplan Commercial |
$1,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.85
|
| Rate for Payer: Quartz Beloit One Network |
$678.92
|
| Rate for Payer: Quartz Commercial |
$879.51
|
| Rate for Payer: The Alliance Commercial |
$771.50
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$848.65
|
| Rate for Payer: WPS Commercial |
$1,142.90
|
|
|
DRAINAGE OF FINGER ABSCESS 26010
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
3013923
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: HFN Commercial |
$637.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$468.71
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
DRAINAGE OF FINGER ABSCESS 26011
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
3013924
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.79 |
| Max. Negotiated Rate |
$1,417.40 |
| Rate for Payer: Aetna Commercial |
$1,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.12
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$1,417.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.20
|
| Rate for Payer: Health EOS Commercial |
$1,357.72
|
| Rate for Payer: HFN Commercial |
$1,417.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$619.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$619.23
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.40
|
| Rate for Payer: Quartz Beloit One Network |
$656.48
|
| Rate for Payer: Quartz Commercial |
$850.44
|
| Rate for Payer: The Alliance Commercial |
$746.00
|
| Rate for Payer: United Healthcare Medicaid |
$158.79
|
| Rate for Payer: WEA Trust Commercial |
$820.60
|
| Rate for Payer: WPS Commercial |
$1,105.12
|
|
|
DRAINAGE OF GUM LESION 41800
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
3014619
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$529.22 |
| Rate for Payer: Aetna Commercial |
$268.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$268.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.80
|
| Rate for Payer: Health EOS Commercial |
$257.53
|
| Rate for Payer: HFN Commercial |
$268.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.22
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$268.85
|
| Rate for Payer: Quartz Beloit One Network |
$124.52
|
| Rate for Payer: Quartz Commercial |
$161.31
|
| Rate for Payer: The Alliance Commercial |
$141.50
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
DRAINAGE OF MOUTH LESION 40800
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
3014604
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$410.33 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.20
|
| Rate for Payer: Health EOS Commercial |
$247.52
|
| Rate for Payer: HFN Commercial |
$258.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$410.33
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.40
|
| Rate for Payer: Quartz Beloit One Network |
$119.68
|
| Rate for Payer: Quartz Commercial |
$155.04
|
| Rate for Payer: The Alliance Commercial |
$136.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
DRAINAGE OF MOUTH LESION 40801
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
CPT 40801
|
| Hospital Charge Code |
3014605
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Aetna Commercial |
$1,033.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.68
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.80
|
| Rate for Payer: Health EOS Commercial |
$990.08
|
| Rate for Payer: HFN Commercial |
$1,033.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$677.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$677.65
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,033.60
|
| Rate for Payer: Quartz Beloit One Network |
$478.72
|
| Rate for Payer: Quartz Commercial |
$620.16
|
| Rate for Payer: The Alliance Commercial |
$544.00
|
| Rate for Payer: United Healthcare Medicaid |
$134.77
|
| Rate for Payer: WEA Trust Commercial |
$598.40
|
| Rate for Payer: WPS Commercial |
$805.88
|
|
|
DRAINAGE OF NOSE LESION 30000
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
3014348
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$508.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.00
|
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: HFN Commercial |
$508.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$397.65
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$508.25
|
| Rate for Payer: Quartz Beloit One Network |
$235.40
|
| Rate for Payer: Quartz Commercial |
$304.95
|
| Rate for Payer: The Alliance Commercial |
$267.50
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
DRAINAGE OF NOSE LESION 30020
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
3014349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.63 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: United Healthcare Medicaid |
$37.63
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
DRAINAGE OF PELVIS BURSA 26991
|
Professional
|
Both
|
$2,409.00
|
|
|
Service Code
|
CPT 26991
|
| Hospital Charge Code |
3014004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.76 |
| Max. Negotiated Rate |
$2,288.55 |
| Rate for Payer: Aetna Commercial |
$2,288.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,071.74
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna Commercial |
$2,288.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,445.40
|
| Rate for Payer: Health EOS Commercial |
$2,192.19
|
| Rate for Payer: HFN Commercial |
$2,288.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,742.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,742.48
|
| Rate for Payer: Multiplan Commercial |
$1,927.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.96
|
| Rate for Payer: Quartz Commercial |
$1,373.13
|
| Rate for Payer: The Alliance Commercial |
$1,204.50
|
| Rate for Payer: United Healthcare Medicaid |
$196.76
|
| Rate for Payer: WEA Trust Commercial |
$1,324.95
|
| Rate for Payer: WPS Commercial |
$1,784.35
|
|
|
DRAINAGE OF PILONIDAL CYST 10081
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
3013504
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.03 |
| Max. Negotiated Rate |
$730.55 |
| Rate for Payer: Aetna Commercial |
$730.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.34
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$730.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.40
|
| Rate for Payer: Health EOS Commercial |
$699.79
|
| Rate for Payer: HFN Commercial |
$730.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$572.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$572.35
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: Preferred Network Access Commercial |
$730.55
|
| Rate for Payer: Quartz Beloit One Network |
$338.36
|
| Rate for Payer: Quartz Commercial |
$438.33
|
| Rate for Payer: The Alliance Commercial |
$384.50
|
| Rate for Payer: United Healthcare Medicaid |
$209.03
|
| Rate for Payer: WEA Trust Commercial |
$422.95
|
| Rate for Payer: WPS Commercial |
$569.60
|
|
|
DRAINAGE OF SALIVARY GLAND 42320
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
3014629
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.57 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: HFN Commercial |
$566.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$590.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$590.75
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: United Healthcare Medicaid |
$87.57
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
DRAINAGE OF SCROTUM ABSCESS 55100
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
3015052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$699.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.96
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$669.76
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$556.68
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$323.84
|
| Rate for Payer: Quartz Commercial |
$419.52
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$404.80
|
| Rate for Payer: WPS Commercial |
$545.16
|
|
|
DRAINAGE POUCH CLAMP CLOSURE 4 #18176"
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
2969906
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$34.04 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.20
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$22.20
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
DRAINAGE POUCH CLAMP CLOSURE 4 #18176"
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
2969906
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.36 |
| Max. Negotiated Rate |
$148.00 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Aetna Managed Medicare |
$10.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.71
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.20
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$24.05
|
| Rate for Payer: Quartz Medicare Advantage |
$22.20
|
| Rate for Payer: The Alliance Commercial |
$148.00
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
DRAINAGE POUCH SET COOK 500CC DOUBLE TUBE G15134
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
3940680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$170.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.50
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$366.00
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
DRAINAGE POUCH SET COOK 500CC DOUBLE TUBE G15134
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
3940680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
DRAIN BL W/CATH INSERTION 51102
|
Professional
|
Both
|
$1,886.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
3014968
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$255.48 |
| Max. Negotiated Rate |
$1,791.70 |
| Rate for Payer: Aetna Commercial |
$1,791.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,621.96
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,791.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,131.60
|
| Rate for Payer: Health EOS Commercial |
$1,716.26
|
| Rate for Payer: HFN Commercial |
$1,791.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$485.48
|
| Rate for Payer: Multiplan Commercial |
$1,508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.70
|
| Rate for Payer: Quartz Beloit One Network |
$829.84
|
| Rate for Payer: Quartz Commercial |
$1,075.02
|
| Rate for Payer: The Alliance Commercial |
$943.00
|
| Rate for Payer: United Healthcare Medicaid |
$255.48
|
| Rate for Payer: WEA Trust Commercial |
$1,037.30
|
| Rate for Payer: WPS Commercial |
$1,396.96
|
|
|
Drain External Ear Lesion 6900050
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
CPT 69000 50
|
| Hospital Charge Code |
4498648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.64 |
| Max. Negotiated Rate |
$884.45 |
| Rate for Payer: Aetna Commercial |
$884.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$800.66
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$884.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$465.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.60
|
| Rate for Payer: Health EOS Commercial |
$847.21
|
| Rate for Payer: HFN Commercial |
$884.45
|
| Rate for Payer: Multiplan Commercial |
$744.80
|
| Rate for Payer: Preferred Network Access Commercial |
$884.45
|
| Rate for Payer: Quartz Beloit One Network |
$409.64
|
| Rate for Payer: Quartz Commercial |
$530.67
|
| Rate for Payer: The Alliance Commercial |
$465.50
|
| Rate for Payer: WEA Trust Commercial |
$512.05
|
| Rate for Payer: WPS Commercial |
$689.59
|
|
|
DRAIN FLAT SILICONE 7MM WIDE 0070430
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2963514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
DRAIN FLAT SILICONE 7MM WIDE 0070430
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
2963514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Drain/Inject,Joint/Bursa 20600
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3426832
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$119.38 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.20
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: HFN Commercial |
$77.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.38
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: The Alliance Commercial |
$41.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.73
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
