|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial
|
Facility
OP
|
$164.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6174100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$18,956.40 |
| 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 |
$18,956.40
|
| 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 Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent
|
Facility
IP
|
$165.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6174101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent
|
Facility
OP
|
$165.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6174101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$39,231.04 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.20
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| 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 |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| 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 |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| 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 |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$107.25
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$39,231.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
ED Drainage External Auditory Canal, Abscess
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6174442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
ED Drainage External Auditory Canal, Abscess
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6174442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$510.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Complicated
|
Facility
IP
|
$363.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6174441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.87 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$217.80
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$217.80
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Complicated
|
Facility
OP
|
$363.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6174441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$7,499.60 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.24
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| 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 |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| 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 |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| 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 |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$235.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$7,499.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Facility
OP
|
$404.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6174440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$0.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Facility
IP
|
$404.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6174440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
ED Drainage of Abscess, Cyst, Hematoma from Dentoalveiolar structures
|
Facility
OP
|
$443.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6180613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.64
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| 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 |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| 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 |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| 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 |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$287.95
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
ED Drainage of Abscess, Cyst, Hematoma from Dentoalveiolar structures
|
Facility
IP
|
$443.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6180613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.07 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$265.80
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
ED Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
|
Facility
OP
|
$416.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6172941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.68 |
| Max. Negotiated Rate |
$22,318.84 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$270.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.68
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$382.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$270.40
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$22,318.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$308.13
|
|
|
ED Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
|
Facility
IP
|
$416.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6172941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$382.72 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$382.72
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$308.13
|
|
|
ED Drainage of Finger Abscess
|
Facility
OP
|
$682.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
6175423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.36
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| 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 |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| 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 |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| 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 |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$443.30
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
ED Drainage of Finger Abscess
|
Facility
IP
|
$682.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
6175423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$627.44 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$409.20
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
|
ED Drainage of Peritoneal abscess/ localized peritonitis, exclusive of appendical abscess, open
|
Facility
IP
|
$2,397.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
6224194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,174.53 |
| Max. Negotiated Rate |
$2,205.24 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,270.41
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,205.24
|
| Rate for Payer: Health EOS Commercial |
$2,133.33
|
| Rate for Payer: HFN Commercial |
$2,205.24
|
| Rate for Payer: Multiplan Commercial |
$1,917.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,438.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.53
|
| Rate for Payer: Quartz Commercial |
$1,438.20
|
| Rate for Payer: WEA Trust Commercial |
$1,318.35
|
| Rate for Payer: WPS Commercial |
$1,775.46
|
|
|
ED Drainage of Peritoneal abscess/ localized peritonitis, exclusive of appendical abscess, open
|
Facility
OP
|
$2,397.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
6224194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,588.00 |
| Rate for Payer: Aetna Commercial |
$2,157.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.42
|
| Rate for Payer: Aetna Managed Medicare |
$671.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,558.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,270.41
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,205.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$2,133.33
|
| Rate for Payer: HFN Commercial |
$2,205.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.75
|
| Rate for Payer: Multiplan Commercial |
$1,917.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,438.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.53
|
| Rate for Payer: Quartz Commercial |
$1,558.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,438.20
|
| Rate for Payer: The Alliance Commercial |
$9,588.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,318.35
|
| Rate for Payer: WPS Commercial |
$1,775.46
|
|
|
ED Dressings and/or debridement of partial-thickness burns, initial or subsequest; large
|
Facility
OP
|
$647.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
6250430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.56
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$420.55
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
ED Dressings and/or debridement of partial-thickness burns, initial or subsequest; large
|
Facility
IP
|
$647.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
6250430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$388.20
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
ED DRESSINGS &/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, MEDIUM
|
Facility
OP
|
$314.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
6210127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.72 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| 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 |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| 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 |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| 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 |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
ED DRESSINGS &/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, MEDIUM
|
Facility
IP
|
$314.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
6210127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
ED EGD Flexible Foreign Body Removal
|
Facility
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
6209954
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$7,251.96 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$879.78
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.04
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$664.95
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$7,251.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
ED EGD Flexible Foreign Body Removal
|
Facility
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
6209954
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$501.27 |
| Max. Negotiated Rate |
$941.16 |
| Rate for Payer: Aetna Commercial |
$920.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.19
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$941.16
|
| Rate for Payer: Health EOS Commercial |
$910.47
|
| Rate for Payer: HFN Commercial |
$941.16
|
| Rate for Payer: Multiplan Commercial |
$818.40
|
| Rate for Payer: NAPHCARE Commercial |
$613.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.16
|
| Rate for Payer: Quartz Beloit One Network |
$501.27
|
| Rate for Payer: Quartz Commercial |
$613.80
|
| Rate for Payer: WEA Trust Commercial |
$562.65
|
| Rate for Payer: WPS Commercial |
$757.74
|
|
|
ED EGD Percutaneous Placement Gastronomy Tube
|
Facility
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
6181645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$14,595.84 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$14,595.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
ED EGD Percutaneous Placement Gastronomy Tube
|
Facility
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
6181645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
