|
ED Biopsy: Oropharynx
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 42800
|
| Hospital Charge Code |
6174082
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
ED Biopsy, Prostate needle or punch
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
6174389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$265.82
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
ED Biopsy, Prostate needle or punch
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
6174389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.05 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$124.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.28
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$265.82
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$287.98
|
| Rate for Payer: Quartz Medicare Advantage |
$265.82
|
| Rate for Payer: The Alliance Commercial |
$221.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
ED Biopsy, Vestibule of Mouth
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
6174072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$482.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.62
|
| Rate for Payer: Aetna Managed Medicare |
$567.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$348.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.09
|
| Rate for Payer: Anthem Medicare Advantage |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$567.58
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$492.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$567.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$567.58
|
| Rate for Payer: Health EOS Commercial |
$476.68
|
| Rate for Payer: HFN Commercial |
$492.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,111.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$567.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$567.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$567.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$567.58
|
| Rate for Payer: Multiplan Commercial |
$428.48
|
| Rate for Payer: NAPHCARE Commercial |
$851.37
|
| Rate for Payer: Preferred Network Access Commercial |
$492.75
|
| Rate for Payer: Quartz Beloit One Network |
$262.44
|
| Rate for Payer: Quartz Commercial |
$348.14
|
| Rate for Payer: Quartz Medicare Advantage |
$567.58
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$567.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$294.58
|
| Rate for Payer: Wellcare Medicare |
$567.58
|
| Rate for Payer: WPS Commercial |
$396.70
|
|
|
ED Biopsy, Vestibule of Mouth
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
6174072
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.44 |
| Max. Negotiated Rate |
$492.75 |
| Rate for Payer: Aetna Commercial |
$482.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.87
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$492.75
|
| Rate for Payer: Health EOS Commercial |
$476.68
|
| Rate for Payer: HFN Commercial |
$492.75
|
| Rate for Payer: Multiplan Commercial |
$428.48
|
| Rate for Payer: Preferred Network Access Commercial |
$492.75
|
| Rate for Payer: Quartz Beloit One Network |
$262.44
|
| Rate for Payer: Quartz Commercial |
$321.36
|
| Rate for Payer: WEA Trust Commercial |
$294.58
|
| Rate for Payer: WPS Commercial |
$396.70
|
|
|
ED Bladder Instillation of Anticarcinogenic Agent
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
6174095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.26
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$733.82
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$733.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$733.82
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$733.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$733.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$733.82
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$733.82
|
| Rate for Payer: The Alliance Commercial |
$2,935.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$733.82
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
ED Bladder Instillation of Anticarcinogenic Agent
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
6174095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
ED Bladder Irrigation, lavage
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
6174091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$102.34
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
ED Bladder Irrigation, lavage
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
6174091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.87
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| 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 |
$156.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$110.86
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
ED Blepharotomy, Drainage Of Abscess Eyelid
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
6174419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.21 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$334.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Anthem Medicare Advantage |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.04
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.04
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.04
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$334.04
|
| Rate for Payer: The Alliance Commercial |
$1,336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: Wellcare Medicare |
$334.04
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
ED Blepharotomy, Drainage Of Abscess Eyelid
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
6174419
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
ED Bone Marrow, Aspiration Only
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
6173894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.77 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.77
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$190.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
ED Bone Marrow, Aspiration Only
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
6173894
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$175.97
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
ED Bone Marrow Bipsy, Needle or Trocar
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
6173895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.22 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$241.49
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
ED Bone Marrow Bipsy, Needle or Trocar
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 38221
|
| Hospital Charge Code |
6173895
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.19 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.19
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$261.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
ED CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
6209815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.45
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
ED CANTHOTOMY SEPARATE PROCEDURE
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
6209815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.57 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
ED Cardioversion, elective arrhythmia; external
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
6172949
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.08 |
| Max. Negotiated Rate |
$2,782.29 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$695.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Anthem Medicare Advantage |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.57
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.57
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,587.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.57
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.36
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$695.57
|
| Rate for Payer: The Alliance Commercial |
$2,782.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.57
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: Wellcare Medicare |
$695.57
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
ED Cardioversion, elective arrhythmia; external
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
6172949
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
ED Cautery Of Cervix
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
6174403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.26
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
ED Cautery Of Cervix
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 57510
|
| Hospital Charge Code |
6174403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
ED Change of Cystostomy Tube; Complicated
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
6174094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.94
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$733.82
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$733.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$733.82
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$733.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$733.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$733.82
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$471.17
|
| Rate for Payer: Quartz Medicare Advantage |
$733.82
|
| Rate for Payer: The Alliance Commercial |
$2,935.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$733.82
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
ED Change of Cystostomy Tube; Complicated
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
6174094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$666.89 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$434.93
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
ED Change of Cystostomy Tube; simple
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
6172945
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$202.18
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
ED Change of Cystostomy Tube; simple
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
6172945
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.74 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$161.74
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$219.02
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
