|
ED Colposcopy Of Cervix
|
Facility
OP
|
$337.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
6174399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.76 |
| Max. Negotiated Rate |
$14,735.44 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$196.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$161.76
|
| Rate for Payer: Anthem Medicare Advantage |
$196.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$196.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$196.96
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$196.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$196.96
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$196.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$196.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$196.96
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$295.44
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$196.96
|
| Rate for Payer: The Alliance Commercial |
$14,735.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.96
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: Wellcare Medicare |
$196.96
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
ED Colposcopy Of Cervix
|
Facility
IP
|
$337.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
6174399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
ED Colposcopy with Biopsy Cervix
|
Facility
OP
|
$401.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
6174400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.48 |
| Max. Negotiated Rate |
$14,735.44 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.48
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.09
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$368.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Health EOS Commercial |
$356.89
|
| Rate for Payer: HFN Commercial |
$368.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$317.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$317.09
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Preferred Network Access Commercial |
$368.92
|
| Rate for Payer: Quartz Beloit One Network |
$196.49
|
| Rate for Payer: Quartz Commercial |
$260.65
|
| Rate for Payer: Quartz Medicare Advantage |
$317.09
|
| Rate for Payer: The Alliance Commercial |
$14,735.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
ED Colposcopy with Biopsy Cervix
|
Facility
IP
|
$401.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
6174400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.49 |
| Max. Negotiated Rate |
$368.92 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.53
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$368.92
|
| Rate for Payer: Health EOS Commercial |
$356.89
|
| Rate for Payer: HFN Commercial |
$368.92
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: NAPHCARE Commercial |
$240.60
|
| Rate for Payer: Preferred Network Access Commercial |
$368.92
|
| Rate for Payer: Quartz Beloit One Network |
$196.49
|
| Rate for Payer: Quartz Commercial |
$240.60
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
ED Complex Uroflometry
|
Facility
IP
|
$503.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6174096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
ED Complex Uroflometry
|
Facility
OP
|
$503.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6174096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$241.44 |
| Max. Negotiated Rate |
$28,833.64 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$28,833.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
ED Construction Of Intermarginal Adhesions, Tarsorrhaphy Or Canthorrhaphy
|
Facility
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
6174427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$8,592.12 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.36
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| 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 |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| 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 |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$784.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$6.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
ED Construction Of Intermarginal Adhesions, Tarsorrhaphy Or Canthorrhaphy
|
Facility
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
6174427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$591.43 |
| Max. Negotiated Rate |
$1,110.44 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$724.20
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
ED Control Nasal Hemorrahage
|
Facility
IP
|
$306.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
6173474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
ED Control Nasal Hemorrahage
|
Facility
OP
|
$306.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
6173474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.88
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
ED Control Nasal Hemorrhage Anterior Complex
|
Facility
IP
|
$293.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
6196505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$175.80
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
ED Control Nasal Hemorrhage Anterior Complex
|
Facility
OP
|
$293.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
6196505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,125.32 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.64
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$190.45
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,125.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
ED CPAP Ventilation CPAP Initiation & Mgmt
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
6181649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$784.25 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.40
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$198.25
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED CPAP Ventilation CPAP Initiation & Mgmt
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
6181649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.00
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Cryocautery Of Cervix, Initial Or Repeat
|
Facility
OP
|
$305.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6174404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$19,919.20 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.40
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.09
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$317.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$317.09
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$198.25
|
| Rate for Payer: Quartz Medicare Advantage |
$317.09
|
| Rate for Payer: The Alliance Commercial |
$19,919.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Cryocautery Of Cervix, Initial Or Repeat
|
Facility
IP
|
$305.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6174404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.00
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Facility
OP
|
$396.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6181630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.08
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Facility
IP
|
$396.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6181630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
ED Cystourethroscopy
|
Facility
IP
|
$784.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
6174097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$470.40
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
ED Cystourethroscopy
|
Facility
OP
|
$784.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
6174097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$39,231.04 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.32
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| 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 |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| 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 |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| 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 |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$509.60
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$39,231.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
ED Cystourethroscopy With Dilation Of Stricture
|
Facility
IP
|
$838.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6174098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.62 |
| Max. Negotiated Rate |
$770.96 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.14
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$770.96
|
| Rate for Payer: Health EOS Commercial |
$745.82
|
| Rate for Payer: HFN Commercial |
$770.96
|
| Rate for Payer: Multiplan Commercial |
$670.40
|
| Rate for Payer: NAPHCARE Commercial |
$502.80
|
| Rate for Payer: Preferred Network Access Commercial |
$770.96
|
| Rate for Payer: Quartz Beloit One Network |
$410.62
|
| Rate for Payer: Quartz Commercial |
$502.80
|
| Rate for Payer: WEA Trust Commercial |
$460.90
|
| Rate for Payer: WPS Commercial |
$620.71
|
|
|
ED Cystourethroscopy With Dilation Of Stricture
|
Facility
OP
|
$838.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6174098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$544.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.24
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.14
|
| 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 |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$770.96
|
| 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 |
$745.82
|
| Rate for Payer: HFN Commercial |
$770.96
|
| 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 |
$670.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$770.96
|
| Rate for Payer: Quartz Beloit One Network |
$410.62
|
| Rate for Payer: Quartz Commercial |
$544.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$460.90
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$620.71
|
|
|
ED Cystourethroscopy With Removal of Ureteral Stent
|
Facility
IP
|
$851.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
6174099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
ED Cystourethroscopy With Removal of Ureteral Stent
|
Facility
OP
|
$851.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
6174099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$11,915.08 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| 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 |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| 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 |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| 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 |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$11,915.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
ED Debridement, Masoidectomy Cavity, simple
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6174444
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$255.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
