|
ED Biopsy: Oropharynx
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT 42800
|
| Hospital Charge Code |
6174082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
ED Biopsy, Prostate needle or punch
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
6174389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$51,915.80 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$276.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.48
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$276.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$51,915.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
ED Biopsy, Prostate needle or punch
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
6174389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$391.92 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$255.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$255.60
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
ED Biopsy, Vestibule of Mouth
|
Facility
IP
|
$515.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
6174072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.35 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| Rate for Payer: Health EOS Commercial |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$309.00
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$309.00
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
ED Biopsy, Vestibule of Mouth
|
Facility
OP
|
$515.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
6174072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.20 |
| Max. Negotiated Rate |
$5,812.20 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Aetna Managed Medicare |
$543.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.20
|
| Rate for Payer: Anthem Medicare Advantage |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.83
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$543.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$543.83
|
| Rate for Payer: Health EOS Commercial |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,023.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$543.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$543.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$543.83
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$815.74
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$334.75
|
| Rate for Payer: Quartz Medicare Advantage |
$543.83
|
| Rate for Payer: The Alliance Commercial |
$5,812.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$543.83
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: Wellcare Medicare |
$543.83
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
ED Bladder Instillation of Anticarcinogenic Agent
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
6174095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$178.20
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
ED Bladder Instillation of Anticarcinogenic Agent
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
6174095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$19,720.32 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$193.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.56
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$193.05
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$19,720.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
ED Bladder Irrigation, lavage
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
6174091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.92
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$150.88
|
| Rate for Payer: Health EOS Commercial |
$145.96
|
| Rate for Payer: HFN Commercial |
$150.88
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: NAPHCARE Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.88
|
| Rate for Payer: Quartz Beloit One Network |
$80.36
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: WEA Trust Commercial |
$90.20
|
| Rate for Payer: WPS Commercial |
$121.47
|
|
|
ED Bladder Irrigation, lavage
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
6174091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$13,185.36 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.04
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.72
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$150.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$145.96
|
| Rate for Payer: HFN Commercial |
$150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$150.88
|
| Rate for Payer: Quartz Beloit One Network |
$80.36
|
| Rate for Payer: Quartz Commercial |
$106.60
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$13,185.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$90.20
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$121.47
|
|
|
ED Blepharotomy, Drainage Of Abscess Eyelid
|
Facility
OP
|
$367.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
6174419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$5,247.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$5,247.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
ED Blepharotomy, Drainage Of Abscess Eyelid
|
Facility
IP
|
$367.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
6174419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
ED Bone Marrow, Aspiration Only
|
Facility
OP
|
$282.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
6173894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.36
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$259.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$183.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
ED Bone Marrow, Aspiration Only
|
Facility
IP
|
$282.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
6173894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$259.44 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$259.44
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$169.20
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$169.20
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
ED Bone Marrow Bipsy, Needle or Trocar
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
6173895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.63 |
| Max. Negotiated Rate |
$356.04 |
| Rate for Payer: Aetna Commercial |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.11
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$356.04
|
| Rate for Payer: Health EOS Commercial |
$344.43
|
| Rate for Payer: HFN Commercial |
$356.04
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: NAPHCARE Commercial |
$232.20
|
| Rate for Payer: Preferred Network Access Commercial |
$356.04
|
| Rate for Payer: Quartz Beloit One Network |
$189.63
|
| Rate for Payer: Quartz Commercial |
$232.20
|
| Rate for Payer: WEA Trust Commercial |
$212.85
|
| Rate for Payer: WPS Commercial |
$286.65
|
|
|
ED Bone Marrow Bipsy, Needle or Trocar
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
6173895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$348.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$251.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.76
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$356.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$344.43
|
| Rate for Payer: HFN Commercial |
$356.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$356.04
|
| Rate for Payer: Quartz Beloit One Network |
$189.63
|
| Rate for Payer: Quartz Commercial |
$251.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$212.85
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$286.65
|
|
|
ED CANTHOTOMY SEPARATE PROCEDURE
|
Facility
OP
|
$684.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
6209815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$8,592.12 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.32
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$629.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$608.76
|
| Rate for Payer: HFN Commercial |
$629.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$629.28
|
| Rate for Payer: Quartz Beloit One Network |
$335.16
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
ED CANTHOTOMY SEPARATE PROCEDURE
|
Facility
IP
|
$684.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
6209815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$629.28 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$629.28
|
| Rate for Payer: Health EOS Commercial |
$608.76
|
| Rate for Payer: HFN Commercial |
$629.28
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: NAPHCARE Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$629.28
|
| Rate for Payer: Quartz Beloit One Network |
$335.16
|
| Rate for Payer: Quartz Commercial |
$410.40
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
ED Cardioversion, elective arrhythmia; external
|
Facility
IP
|
$519.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
6172949
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
ED Cardioversion, elective arrhythmia; external
|
Facility
OP
|
$519.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
6172949
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.12 |
| Max. Negotiated Rate |
$2,393.00 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Aetna Managed Medicare |
$643.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.12
|
| Rate for Payer: Anthem Medicare Advantage |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$643.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$643.28
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$643.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$643.28
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,393.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$643.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$643.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$643.28
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$964.92
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| Rate for Payer: Quartz Medicare Advantage |
$643.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$643.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: Wellcare Medicare |
$643.28
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
ED Cautery Of Cervix
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
6174403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$178.20
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
ED Cautery Of Cervix
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
6174403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$19,919.20 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$193.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$193.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$19,919.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
ED Change of Cystostomy Tube; Complicated
|
Facility
OP
|
$697.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
6174094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.56
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$641.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
| Rate for Payer: Health EOS Commercial |
$620.33
|
| Rate for Payer: HFN Commercial |
$641.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Preferred Network Access Commercial |
$641.24
|
| Rate for Payer: Quartz Beloit One Network |
$341.53
|
| Rate for Payer: Quartz Commercial |
$453.05
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
ED Change of Cystostomy Tube; Complicated
|
Facility
IP
|
$697.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
6174094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.53 |
| Max. Negotiated Rate |
$641.24 |
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$641.24
|
| Rate for Payer: Health EOS Commercial |
$620.33
|
| Rate for Payer: HFN Commercial |
$641.24
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: NAPHCARE Commercial |
$418.20
|
| Rate for Payer: Preferred Network Access Commercial |
$641.24
|
| Rate for Payer: Quartz Beloit One Network |
$341.53
|
| Rate for Payer: Quartz Commercial |
$418.20
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
ED Change of Cystostomy Tube; simple
|
Facility
IP
|
$324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
6172945
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$194.40
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
|
ED Change of Cystostomy Tube; simple
|
Facility
OP
|
$324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
6172945
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.52 |
| Max. Negotiated Rate |
$7,762.64 |
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.64
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$210.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$155.52
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$298.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$288.36
|
| Rate for Payer: HFN Commercial |
$298.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$259.20
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$298.08
|
| Rate for Payer: Quartz Beloit One Network |
$158.76
|
| Rate for Payer: Quartz Commercial |
$210.60
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$7,762.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$178.20
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$239.99
|
|
