|
ED Excision of Lesion of Tongue Without Closure
|
Facility
IP
|
$721.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
6174074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
|
ED Excision of Lesion or Tumor (except listed above) dentalalveolar structures; without repair
|
Facility
OP
|
$383.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
6174078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.84 |
| Max. Negotiated Rate |
$12,270.48 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.84
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$248.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,270.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
ED Excision of Lesion or Tumor (except listed above) dentalalveolar structures; without repair
|
Facility
IP
|
$383.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
6174078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.67 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$229.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$229.80
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
ED Excision of Multiple External Papillae or tags, anus
|
Facility
OP
|
$409.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
6174086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$196.32 |
| Max. Negotiated Rate |
$19,720.32 |
| Rate for Payer: Aetna Commercial |
$368.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,775.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$265.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.32
|
| Rate for Payer: Anthem Medicare Advantage |
$2,775.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,775.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,775.24
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$376.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,775.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,775.24
|
| Rate for Payer: Health EOS Commercial |
$364.01
|
| Rate for Payer: HFN Commercial |
$376.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,323.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,775.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,775.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,775.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,775.24
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$376.28
|
| Rate for Payer: Quartz Beloit One Network |
$200.41
|
| Rate for Payer: Quartz Commercial |
$265.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.24
|
| Rate for Payer: The Alliance Commercial |
$19,720.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,775.24
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: Wellcare Medicare |
$2,775.24
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
ED Excision of Multiple External Papillae or tags, anus
|
Facility
IP
|
$409.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
6174086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.41 |
| Max. Negotiated Rate |
$376.28 |
| Rate for Payer: Aetna Commercial |
$368.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.77
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$376.28
|
| Rate for Payer: Health EOS Commercial |
$364.01
|
| Rate for Payer: HFN Commercial |
$376.28
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: NAPHCARE Commercial |
$245.40
|
| Rate for Payer: Preferred Network Access Commercial |
$376.28
|
| Rate for Payer: Quartz Beloit One Network |
$200.41
|
| Rate for Payer: Quartz Commercial |
$245.40
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
ED Excision of nail & nail matrix, partial or complete for permanent removal
|
Facility
IP
|
$621.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
6172930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$372.60
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
ED Excision of nail & nail matrix, partial or complete for permanent removal
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
6172930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.08 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.08
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| 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 |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| 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 |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| 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 |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$403.65
|
| 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 |
$341.55
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
ED Excision Of Sublingual Salivary Cyst
|
Facility
IP
|
$890.00
|
|
|
Service Code
|
CPT 42408
|
| Hospital Charge Code |
6174080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$818.80 |
| Rate for Payer: Aetna Commercial |
$801.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.70
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$818.80
|
| Rate for Payer: Health EOS Commercial |
$792.10
|
| Rate for Payer: HFN Commercial |
$818.80
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: NAPHCARE Commercial |
$534.00
|
| Rate for Payer: Preferred Network Access Commercial |
$818.80
|
| Rate for Payer: Quartz Beloit One Network |
$436.10
|
| Rate for Payer: Quartz Commercial |
$534.00
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
ED Excision Of Sublingual Salivary Cyst
|
Facility
OP
|
$890.00
|
|
|
Service Code
|
CPT 42408
|
| Hospital Charge Code |
6174080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,270.48 |
| Rate for Payer: Aetna Commercial |
$801.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$765.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$578.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$445.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.20
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$818.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Health EOS Commercial |
$792.10
|
| Rate for Payer: HFN Commercial |
$818.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Preferred Network Access Commercial |
$818.80
|
| Rate for Payer: Quartz Beloit One Network |
$436.10
|
| Rate for Payer: Quartz Commercial |
$578.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,270.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
ED Excision of Thrombosed Hemorrhoid, external
|
Facility
OP
|
$422.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
6174087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.56 |
| Max. Negotiated Rate |
$39,231.04 |
| Rate for Payer: Aetna Commercial |
$379.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$274.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.56
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$388.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$375.58
|
| Rate for Payer: HFN Commercial |
$388.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$337.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$388.24
|
| Rate for Payer: Quartz Beloit One Network |
$206.78
|
| Rate for Payer: Quartz Commercial |
$274.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$39,231.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$232.10
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$312.58
|
|
|
ED Excision of Thrombosed Hemorrhoid, external
|
Facility
IP
|
$422.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
6174087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.78 |
| Max. Negotiated Rate |
$388.24 |
| Rate for Payer: Aetna Commercial |
$379.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.66
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$388.24
|
| Rate for Payer: Health EOS Commercial |
$375.58
|
| Rate for Payer: HFN Commercial |
$388.24
|
| Rate for Payer: Multiplan Commercial |
$337.60
|
| Rate for Payer: NAPHCARE Commercial |
$253.20
|
| Rate for Payer: Preferred Network Access Commercial |
$388.24
|
| Rate for Payer: Quartz Beloit One Network |
$206.78
|
| Rate for Payer: Quartz Commercial |
$253.20
|
| Rate for Payer: WEA Trust Commercial |
$232.10
|
| Rate for Payer: WPS Commercial |
$312.58
|
|
|
ED Excision Of Vaginal Cyst Or Tumor
|
Facility
IP
|
$833.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
6174397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.17 |
| Max. Negotiated Rate |
$766.36 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.49
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$766.36
|
| Rate for Payer: Health EOS Commercial |
$741.37
|
| Rate for Payer: HFN Commercial |
$766.36
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: NAPHCARE Commercial |
$499.80
|
| Rate for Payer: Preferred Network Access Commercial |
$766.36
|
| Rate for Payer: Quartz Beloit One Network |
$408.17
|
| Rate for Payer: Quartz Commercial |
$499.80
|
| Rate for Payer: WEA Trust Commercial |
$458.15
|
| Rate for Payer: WPS Commercial |
$617.00
|
|
|
ED Excision Of Vaginal Cyst Or Tumor
|
Facility
OP
|
$833.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
6174397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.38
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.84
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$766.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Health EOS Commercial |
$741.37
|
| Rate for Payer: HFN Commercial |
$766.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Preferred Network Access Commercial |
$766.36
|
| Rate for Payer: Quartz Beloit One Network |
$408.17
|
| Rate for Payer: Quartz Commercial |
$541.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$458.15
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
| Rate for Payer: WPS Commercial |
$617.00
|
|
|
ED Exploration Penetrating Wound SPX Extremity
|
Facility
IP
|
$1,185.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
6210438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$580.65 |
| Max. Negotiated Rate |
$1,090.20 |
| Rate for Payer: Aetna Commercial |
$1,066.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.05
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$1,090.20
|
| Rate for Payer: Health EOS Commercial |
$1,054.65
|
| Rate for Payer: HFN Commercial |
$1,090.20
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: NAPHCARE Commercial |
$711.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.20
|
| Rate for Payer: Quartz Beloit One Network |
$580.65
|
| Rate for Payer: Quartz Commercial |
$711.00
|
| Rate for Payer: WEA Trust Commercial |
$651.75
|
| Rate for Payer: WPS Commercial |
$877.73
|
|
|
ED Exploration Penetrating Wound SPX Extremity
|
Facility
OP
|
$1,185.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
6210438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$13,358,312.72 |
| Rate for Payer: Aetna Commercial |
$1,066.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,019.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$770.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$592.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.80
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.05
|
| 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 |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$1,090.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$1,054.65
|
| Rate for Payer: HFN Commercial |
$1,090.20
|
| 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 |
$948.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.20
|
| Rate for Payer: Quartz Beloit One Network |
$580.65
|
| Rate for Payer: Quartz Commercial |
$770.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$13,358,312.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$651.75
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$877.73
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by forceps only
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
6174424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.96 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.96
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| 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 |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| 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 |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| 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 |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$763.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by forceps only
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
6174424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
6174425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$69.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Facility
IP
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
6174425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Different Lids
|
Facility
OP
|
$588.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
6174422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.52 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$5.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Different Lids
|
Facility
IP
|
$588.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
6174422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Same Lid
|
Facility
IP
|
$602.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
6174421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Same Lid
|
Facility
OP
|
$602.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
6174421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.96
|
| Rate for Payer: Anthem Medicare Advantage |
$1,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,000.70
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,000.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,000.70
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,722.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,000.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,000.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,000.70
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,501.05
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,000.70
|
| Rate for Payer: The Alliance Commercial |
$5.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,000.70
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: Wellcare Medicare |
$1,000.70
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
ED Eyelids; Excision of Chalazion, Single
|
Facility
IP
|
$342.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
6174420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.58 |
| Max. Negotiated Rate |
$314.64 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.26
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$314.64
|
| Rate for Payer: Health EOS Commercial |
$304.38
|
| Rate for Payer: HFN Commercial |
$314.64
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: NAPHCARE Commercial |
$205.20
|
| Rate for Payer: Preferred Network Access Commercial |
$314.64
|
| Rate for Payer: Quartz Beloit One Network |
$167.58
|
| Rate for Payer: Quartz Commercial |
$205.20
|
| Rate for Payer: WEA Trust Commercial |
$188.10
|
| Rate for Payer: WPS Commercial |
$253.32
|
|
|
ED Eyelids; Excision of Chalazion, Single
|
Facility
OP
|
$342.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
6174420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.12
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.16
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$314.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$304.38
|
| Rate for Payer: HFN Commercial |
$314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$314.64
|
| Rate for Payer: Quartz Beloit One Network |
$167.58
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$48.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$188.10
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$253.32
|
|
