|
ED Application of Short Leg Cast
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
6173878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.73
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$231.19
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
|
ED Application of short leg splint (calf to foot)
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
6172929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
ED Application of short leg splint (calf to foot)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
6172929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
ED Application of Walking Cast
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
6173879
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
ED Application of Walking Cast
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
6173879
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.24
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
ED Application Skin Substitute Graft
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
6174789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.10 |
| Max. Negotiated Rate |
$708.03 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.89
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$708.03
|
| Rate for Payer: Health EOS Commercial |
$684.94
|
| Rate for Payer: HFN Commercial |
$708.03
|
| Rate for Payer: Multiplan Commercial |
$615.68
|
| Rate for Payer: Preferred Network Access Commercial |
$708.03
|
| Rate for Payer: Quartz Beloit One Network |
$377.10
|
| Rate for Payer: Quartz Commercial |
$461.76
|
| Rate for Payer: WEA Trust Commercial |
$423.28
|
| Rate for Payer: WPS Commercial |
$570.02
|
|
|
ED Application Skin Substitute Graft
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
6174789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.86
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$500.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$369.41
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$708.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$684.94
|
| Rate for Payer: HFN Commercial |
$708.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: Multiplan Commercial |
$615.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$708.03
|
| Rate for Payer: Quartz Beloit One Network |
$377.10
|
| Rate for Payer: Quartz Commercial |
$500.24
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$423.28
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$570.02
|
|
|
ED Application Skin Substitute Graft, ea add'l 25sq cm
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
6174790
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$59.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.90
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$127.92
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$138.58
|
| Rate for Payer: Quartz Medicare Advantage |
$127.92
|
| Rate for Payer: The Alliance Commercial |
$84.41
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
ED Application Skin Substitute Graft, ea add'l 25sq cm
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
6174790
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
ED Arterial catheterization or cannulation for sampling, monitoring or transfusion
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6173813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.52
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$160.91
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
ED Arterial catheterization or cannulation for sampling, monitoring or transfusion
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
6173813
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
ED Arterial Puncture
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
6173812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
ED Arterial Puncture
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
6173812
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
ED Arthrocentesis, Aspiration and/or Injection; Major Joint or Bursa
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
6172927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$373.15 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.97
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: Health EOS Commercial |
$360.98
|
| Rate for Payer: HFN Commercial |
$373.15
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: Preferred Network Access Commercial |
$373.15
|
| Rate for Payer: Quartz Beloit One Network |
$198.74
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: WPS Commercial |
$300.42
|
|
|
ED Arthrocentesis, Aspiration and/or Injection; Major Joint or Bursa
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
6172927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.69 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$365.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$348.82
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.69
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna Commercial |
$373.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$360.98
|
| Rate for Payer: HFN Commercial |
$373.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$324.48
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$373.15
|
| Rate for Payer: Quartz Beloit One Network |
$198.74
|
| Rate for Payer: Quartz Commercial |
$263.64
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$223.08
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$300.42
|
|
|
ED Arthrocentesis, Aspiration and/or Injection; Medium Joint or Bursa
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
6173873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.40
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$80.44
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
ED Arthrocentesis, Aspiration and/or Injection; Medium Joint or Bursa
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
6173873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$74.26
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
ED Arthrocentesis, Aspiration and/or Injection Small Joint or Bursa
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
6173872
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.67 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$278.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.67
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$278.51
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
ED Arthrocentesis, Aspiration and/or Injection Small Joint or Bursa
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
6173872
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$257.09
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
ED Arthrocentesis, Aspiratn &/or injectn, major joint or bursa; w/ US guide & permannt record/reprt
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
6243349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.55 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$360.67
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
ED Arthrocentesis, Aspiratn &/or injectn, major joint or bursa; w/ US guide & permannt record/reprt
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
6243349
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.54 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.54
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$390.73
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
ED Aspiration of bladder; with insertion of suprapubic catheter
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
6219974
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
ED Aspiration of bladder; with insertion of suprapubic catheter
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
6219974
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cash Price |
$277.50
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
| Rate for Payer: WPS Commercial |
$712.53
|
|
|
ED Aspiration or Injection of Ganglion Cyst
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
6173874
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.39 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.39
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$95.32
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
ED Aspiration or Injection of Ganglion Cyst
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 20612
|
| Hospital Charge Code |
6173874
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$87.98
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
