|
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 |
$31.31 |
| Max. Negotiated Rate |
$513.35 |
| Rate for Payer: Aetna Commercial |
$424.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$114.08
|
| Rate for Payer: Anthem Medicare Advantage |
$114.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.08
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$424.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$406.95
|
| Rate for Payer: HFN Commercial |
$424.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$171.12
|
| Rate for Payer: Preferred Network Access Commercial |
$424.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.77
|
| Rate for Payer: Quartz Commercial |
$254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$114.08
|
| Rate for Payer: The Alliance Commercial |
$484.83
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.08
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$513.35
|
|
|
DRAINAGE OF ARM BURSA 23931
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
3013802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.78 |
| Max. Negotiated Rate |
$715.31 |
| Rate for Payer: Aetna Commercial |
$715.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$152.78
|
| Rate for Payer: Anthem Medicare Advantage |
$152.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$152.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$152.78
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$715.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.78
|
| Rate for Payer: Health EOS Commercial |
$685.19
|
| Rate for Payer: HFN Commercial |
$715.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$553.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$152.78
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$229.16
|
| Rate for Payer: Preferred Network Access Commercial |
$715.31
|
| Rate for Payer: Quartz Beloit One Network |
$331.30
|
| Rate for Payer: Quartz Commercial |
$429.19
|
| Rate for Payer: Quartz Medicare Advantage |
$152.78
|
| Rate for Payer: The Alliance Commercial |
$649.30
|
| Rate for Payer: United Healthcare Medicaid |
$291.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$687.49
|
|
|
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 |
$194.81 |
| Max. Negotiated Rate |
$1,021.59 |
| Rate for Payer: Aetna Commercial |
$1,021.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.81
|
| Rate for Payer: Aetna Managed Medicare |
$194.81
|
| Rate for Payer: Anthem Medicare Advantage |
$194.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.81
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$1,021.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.81
|
| Rate for Payer: Health EOS Commercial |
$978.58
|
| Rate for Payer: HFN Commercial |
$1,021.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$740.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$740.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.81
|
| Rate for Payer: Multiplan Commercial |
$860.29
|
| Rate for Payer: NAPHCARE Commercial |
$292.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,021.59
|
| Rate for Payer: Quartz Beloit One Network |
$473.16
|
| Rate for Payer: Quartz Commercial |
$612.96
|
| Rate for Payer: Quartz Medicare Advantage |
$194.81
|
| Rate for Payer: The Alliance Commercial |
$827.95
|
| Rate for Payer: United Healthcare Medicaid |
$271.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.81
|
| Rate for Payer: WEA Trust Commercial |
$591.45
|
| Rate for Payer: WPS Commercial |
$876.66
|
|
|
DRAINAGE OF EYE 65800
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
3015224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$442.62 |
| Rate for Payer: Aetna Commercial |
$442.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.69
|
| Rate for Payer: Aetna Managed Medicare |
$70.35
|
| Rate for Payer: Anthem Medicare Advantage |
$70.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.35
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$442.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.35
|
| Rate for Payer: Health EOS Commercial |
$423.99
|
| Rate for Payer: HFN Commercial |
$442.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$315.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.35
|
| Rate for Payer: Multiplan Commercial |
$372.74
|
| Rate for Payer: NAPHCARE Commercial |
$105.52
|
| Rate for Payer: Preferred Network Access Commercial |
$442.62
|
| Rate for Payer: Quartz Beloit One Network |
$205.00
|
| Rate for Payer: Quartz Commercial |
$265.57
|
| Rate for Payer: Quartz Medicare Advantage |
$70.35
|
| Rate for Payer: The Alliance Commercial |
$298.97
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.35
|
| Rate for Payer: WEA Trust Commercial |
$256.26
|
| Rate for Payer: WPS Commercial |
$316.56
|
|
|
DRAINAGE OF EYE 65815
|
Professional
|
Both
|
$1,543.00
|
|
|
Service Code
|
CPT 65815
|
| Hospital Charge Code |
3015226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$1,836.62 |
| Rate for Payer: Aetna Commercial |
$1,524.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,380.06
|
| Rate for Payer: Aetna Managed Medicare |
$408.14
|
| Rate for Payer: Anthem Medicare Advantage |
$408.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$408.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$408.14
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cash Price |
$462.90
|
| Rate for Payer: Cigna Commercial |
$1,524.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.14
|
| Rate for Payer: Health EOS Commercial |
$1,460.30
|
| Rate for Payer: HFN Commercial |
$1,524.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,666.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,666.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$408.14
|
| Rate for Payer: Multiplan Commercial |
$1,283.78
|
| Rate for Payer: NAPHCARE Commercial |
$612.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.48
|
| Rate for Payer: Quartz Beloit One Network |
$706.08
|
| Rate for Payer: Quartz Commercial |
$914.69
|
| Rate for Payer: Quartz Medicare Advantage |
$408.14
|
| Rate for Payer: The Alliance Commercial |
$1,734.58
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$408.14
|
| Rate for Payer: WEA Trust Commercial |
$882.60
|
| Rate for Payer: WPS Commercial |
$1,836.62
|
|
|
DRAINAGE OF FINGER ABSCESS 26010
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
3013923
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$662.95 |
| Rate for Payer: Aetna Commercial |
$662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Aetna Managed Medicare |
$140.37
|
| Rate for Payer: Anthem Medicare Advantage |
$140.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.37
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.37
|
| Rate for Payer: Health EOS Commercial |
$635.03
|
| Rate for Payer: HFN Commercial |
$662.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.37
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: NAPHCARE Commercial |
$210.55
|
| Rate for Payer: Preferred Network Access Commercial |
$662.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.05
|
| Rate for Payer: Quartz Commercial |
$397.77
|
| Rate for Payer: Quartz Medicare Advantage |
$140.37
|
| Rate for Payer: The Alliance Commercial |
$596.57
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.37
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$631.66
|
|
|
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 |
$165.14 |
| Max. Negotiated Rate |
$1,474.10 |
| Rate for Payer: Aetna Commercial |
$1,474.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.44
|
| Rate for Payer: Aetna Managed Medicare |
$175.17
|
| Rate for Payer: Anthem Medicare Advantage |
$175.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$175.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$175.17
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$1,474.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.17
|
| Rate for Payer: Health EOS Commercial |
$1,412.03
|
| Rate for Payer: HFN Commercial |
$1,474.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$644.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$644.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$175.17
|
| Rate for Payer: Multiplan Commercial |
$1,241.34
|
| Rate for Payer: NAPHCARE Commercial |
$262.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,474.10
|
| Rate for Payer: Quartz Beloit One Network |
$682.74
|
| Rate for Payer: Quartz Commercial |
$884.46
|
| Rate for Payer: Quartz Medicare Advantage |
$175.17
|
| Rate for Payer: The Alliance Commercial |
$744.46
|
| Rate for Payer: United Healthcare Medicaid |
$165.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.17
|
| Rate for Payer: WEA Trust Commercial |
$853.42
|
| Rate for Payer: WPS Commercial |
$788.25
|
|
|
DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 26011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 26010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
|
|
DRAINAGE OF GUM LESION 41800
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
3014619
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$829.30 |
| Rate for Payer: Aetna Commercial |
$279.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Aetna Managed Medicare |
$184.29
|
| Rate for Payer: Anthem Medicare Advantage |
$184.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.29
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$279.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.29
|
| Rate for Payer: Health EOS Commercial |
$267.83
|
| Rate for Payer: HFN Commercial |
$279.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$550.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$550.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.29
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: NAPHCARE Commercial |
$276.43
|
| Rate for Payer: Preferred Network Access Commercial |
$279.60
|
| Rate for Payer: Quartz Beloit One Network |
$129.50
|
| Rate for Payer: Quartz Commercial |
$167.76
|
| Rate for Payer: Quartz Medicare Advantage |
$184.29
|
| Rate for Payer: The Alliance Commercial |
$783.22
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.29
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$829.30
|
|
|
DRAINAGE OF MOUTH LESION 40800
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
3014604
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$511.24 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$113.61
|
| Rate for Payer: Anthem Medicare Advantage |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.61
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.61
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.61
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$170.41
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$113.61
|
| Rate for Payer: The Alliance Commercial |
$482.84
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.61
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$511.24
|
|
|
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 |
$140.16 |
| Max. Negotiated Rate |
$1,074.94 |
| Rate for Payer: Aetna Commercial |
$1,074.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$973.11
|
| Rate for Payer: Aetna Managed Medicare |
$184.75
|
| Rate for Payer: Anthem Medicare Advantage |
$184.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.75
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$1,074.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.75
|
| Rate for Payer: Health EOS Commercial |
$1,029.68
|
| Rate for Payer: HFN Commercial |
$1,074.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$704.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$704.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.75
|
| Rate for Payer: Multiplan Commercial |
$905.22
|
| Rate for Payer: NAPHCARE Commercial |
$277.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,074.94
|
| Rate for Payer: Quartz Beloit One Network |
$497.87
|
| Rate for Payer: Quartz Commercial |
$644.97
|
| Rate for Payer: Quartz Medicare Advantage |
$184.75
|
| Rate for Payer: The Alliance Commercial |
$785.17
|
| Rate for Payer: United Healthcare Medicaid |
$140.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.75
|
| Rate for Payer: WEA Trust Commercial |
$622.34
|
| Rate for Payer: WPS Commercial |
$831.36
|
|
|
DRAINAGE OF NOSE LESION 30000
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
3014348
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$528.58 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$107.50
|
| Rate for Payer: Anthem Medicare Advantage |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.50
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$413.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.50
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$161.26
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: Quartz Medicare Advantage |
$107.50
|
| Rate for Payer: The Alliance Commercial |
$456.90
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.50
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$483.77
|
|
|
DRAINAGE OF NOSE LESION 30020
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
3014349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.14 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$108.50
|
| Rate for Payer: Anthem Medicare Advantage |
$108.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.50
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.50
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$415.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.50
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$162.75
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: Quartz Medicare Advantage |
$108.50
|
| Rate for Payer: The Alliance Commercial |
$461.14
|
| Rate for Payer: United Healthcare Medicaid |
$39.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.50
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$488.26
|
|
|
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 |
$204.63 |
| Max. Negotiated Rate |
$2,380.09 |
| Rate for Payer: Aetna Commercial |
$2,380.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,154.61
|
| Rate for Payer: Aetna Managed Medicare |
$468.05
|
| Rate for Payer: Anthem Medicare Advantage |
$468.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$468.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$468.05
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna Commercial |
$2,380.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.05
|
| Rate for Payer: Health EOS Commercial |
$2,279.88
|
| Rate for Payer: HFN Commercial |
$2,380.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,812.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$468.05
|
| Rate for Payer: Multiplan Commercial |
$2,004.29
|
| Rate for Payer: NAPHCARE Commercial |
$702.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.36
|
| Rate for Payer: Quartz Commercial |
$1,428.06
|
| Rate for Payer: Quartz Medicare Advantage |
$468.05
|
| Rate for Payer: The Alliance Commercial |
$1,989.22
|
| Rate for Payer: United Healthcare Medicaid |
$204.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$468.05
|
| Rate for Payer: WEA Trust Commercial |
$1,377.95
|
| Rate for Payer: WPS Commercial |
$2,106.23
|
|
|
DRAINAGE OF PILONIDAL CYST 10081
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
3013504
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.77 |
| Max. Negotiated Rate |
$759.77 |
| Rate for Payer: Anthem Medicare Advantage |
$160.77
|
| Rate for Payer: Aetna Commercial |
$759.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.79
|
| Rate for Payer: Aetna Managed Medicare |
$160.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$160.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$160.77
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$759.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.77
|
| Rate for Payer: Health EOS Commercial |
$727.78
|
| Rate for Payer: HFN Commercial |
$759.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$595.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$595.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$160.77
|
| Rate for Payer: Multiplan Commercial |
$639.81
|
| Rate for Payer: NAPHCARE Commercial |
$241.16
|
| Rate for Payer: Preferred Network Access Commercial |
$759.77
|
| Rate for Payer: Quartz Beloit One Network |
$351.89
|
| Rate for Payer: Quartz Commercial |
$455.86
|
| Rate for Payer: Quartz Medicare Advantage |
$160.77
|
| Rate for Payer: The Alliance Commercial |
$683.29
|
| Rate for Payer: United Healthcare Medicaid |
$217.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$160.77
|
| Rate for Payer: WEA Trust Commercial |
$439.87
|
| Rate for Payer: WPS Commercial |
$723.48
|
|
|
DRAINAGE OF SALIVARY GLAND 42320
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
3014629
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$706.07 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$156.90
|
| Rate for Payer: Anthem Medicare Advantage |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.90
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$614.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$614.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.90
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$235.36
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: Quartz Medicare Advantage |
$156.90
|
| Rate for Payer: The Alliance Commercial |
$666.85
|
| Rate for Payer: United Healthcare Medicaid |
$91.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$706.07
|
|
|
DRAINAGE OF SCROTUM ABSCESS 55100
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
3015052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$727.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.28
|
| Rate for Payer: Aetna Managed Medicare |
$158.30
|
| Rate for Payer: Anthem Medicare Advantage |
$158.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.30
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Health EOS Commercial |
$696.55
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$578.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$578.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.30
|
| Rate for Payer: Multiplan Commercial |
$612.35
|
| Rate for Payer: NAPHCARE Commercial |
$237.45
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$336.79
|
| Rate for Payer: Quartz Commercial |
$436.30
|
| Rate for Payer: Quartz Medicare Advantage |
$158.30
|
| Rate for Payer: The Alliance Commercial |
$672.77
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.30
|
| Rate for Payer: WEA Trust Commercial |
$420.99
|
| Rate for Payer: WPS Commercial |
$712.34
|
|
|
DRAINAGE POUCH CLAMP CLOSURE 4 #18176"
|
Facility
|
OP
|
$37.00
|
|
| Hospital Charge Code |
2969906
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$10.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.53
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.86
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$23.09
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$25.01
|
| Rate for Payer: Quartz Medicare Advantage |
$23.09
|
| Rate for Payer: The Alliance Commercial |
$19.24
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
DRAINAGE POUCH CLAMP CLOSURE 4 #18176"
|
Facility
|
IP
|
$37.00
|
|
| Hospital Charge Code |
2969906
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
DRAINAGE POUCH SET COOK 500CC DOUBLE TUBE G15134
|
Facility
|
IP
|
$610.00
|
|
| Hospital Charge Code |
3940680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
DRAINAGE POUCH SET COOK 500CC DOUBLE TUBE G15134
|
Facility
|
OP
|
$610.00
|
|
| Hospital Charge Code |
3940680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
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 |
$121.85 |
| Max. Negotiated Rate |
$1,863.37 |
| Rate for Payer: Aetna Commercial |
$1,863.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,686.84
|
| Rate for Payer: Aetna Managed Medicare |
$121.85
|
| Rate for Payer: Anthem Medicare Advantage |
$121.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.85
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cash Price |
$565.80
|
| Rate for Payer: Cigna Commercial |
$1,863.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.85
|
| Rate for Payer: Health EOS Commercial |
$1,784.91
|
| Rate for Payer: HFN Commercial |
$1,863.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$504.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$504.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.85
|
| Rate for Payer: Multiplan Commercial |
$1,569.15
|
| Rate for Payer: NAPHCARE Commercial |
$182.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.37
|
| Rate for Payer: Quartz Beloit One Network |
$863.03
|
| Rate for Payer: Quartz Commercial |
$1,118.02
|
| Rate for Payer: Quartz Medicare Advantage |
$121.85
|
| Rate for Payer: The Alliance Commercial |
$517.85
|
| Rate for Payer: United Healthcare Medicaid |
$265.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.85
|
| Rate for Payer: WEA Trust Commercial |
$1,078.79
|
| Rate for Payer: WPS Commercial |
$548.31
|
|
|
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 |
$31.31 |
| Max. Negotiated Rate |
$919.83 |
| Rate for Payer: Aetna Commercial |
$919.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$832.69
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cigna Commercial |
$919.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.94
|
| Rate for Payer: Health EOS Commercial |
$881.10
|
| Rate for Payer: HFN Commercial |
$919.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.73
|
| Rate for Payer: Multiplan Commercial |
$774.59
|
| Rate for Payer: Preferred Network Access Commercial |
$919.83
|
| Rate for Payer: Quartz Beloit One Network |
$426.03
|
| Rate for Payer: Quartz Commercial |
$551.90
|
| Rate for Payer: The Alliance Commercial |
$484.12
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: WEA Trust Commercial |
$532.53
|
| Rate for Payer: WPS Commercial |
$717.15
|
|
|
DRAIN FLAT SILICONE 7MM WIDE 0070430
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
2963514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$94.64
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
