|
ED Colposcopy Of Cervix
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
6174399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
ED Colposcopy Of Cervix
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
6174399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$212.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.23
|
| Rate for Payer: Anthem Medicare Advantage |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$212.76
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$212.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$212.76
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$791.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$212.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$212.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$212.76
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$212.76
|
| Rate for Payer: The Alliance Commercial |
$851.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.76
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: Wellcare Medicare |
$212.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
ED Colposcopy with Biopsy Cervix
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
6174400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.18 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$271.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.18
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$383.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Health EOS Commercial |
$371.17
|
| Rate for Payer: HFN Commercial |
$383.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Preferred Network Access Commercial |
$383.68
|
| Rate for Payer: Quartz Beloit One Network |
$204.35
|
| Rate for Payer: Quartz Commercial |
$271.08
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
ED Colposcopy with Biopsy Cervix
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
6174400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$383.68 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.03
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$383.68
|
| Rate for Payer: Health EOS Commercial |
$371.17
|
| Rate for Payer: HFN Commercial |
$383.68
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: Preferred Network Access Commercial |
$383.68
|
| Rate for Payer: Quartz Beloit One Network |
$204.35
|
| Rate for Payer: Quartz Commercial |
$250.22
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
ED Complex Uroflometry
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6174096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.10
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$340.03
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
ED Complex Uroflometry
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6174096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$313.87
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
ED Construction Of Intermarginal Adhesions, Tarsorrhaphy Or Canthorrhaphy
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
6174427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$1,129.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.53
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.30
|
| 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 |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,154.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$1,117.20
|
| Rate for Payer: HFN Commercial |
$1,154.86
|
| 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 |
$1,004.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.86
|
| Rate for Payer: Quartz Beloit One Network |
$615.09
|
| Rate for Payer: Quartz Commercial |
$815.93
|
| 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 |
$690.40
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$929.75
|
|
|
ED Construction Of Intermarginal Adhesions, Tarsorrhaphy Or Canthorrhaphy
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
6174427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$615.09 |
| Max. Negotiated Rate |
$1,154.86 |
| Rate for Payer: Aetna Commercial |
$1,129.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.30
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,154.86
|
| Rate for Payer: Health EOS Commercial |
$1,117.20
|
| Rate for Payer: HFN Commercial |
$1,154.86
|
| Rate for Payer: Multiplan Commercial |
$1,004.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.86
|
| Rate for Payer: Quartz Beloit One Network |
$615.09
|
| Rate for Payer: Quartz Commercial |
$753.17
|
| Rate for Payer: WEA Trust Commercial |
$690.40
|
| Rate for Payer: WPS Commercial |
$929.75
|
|
|
ED Control Nasal Hemorrahage
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
6173474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$190.94
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
ED Control Nasal Hemorrahage
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
6173474
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.76
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$206.86
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
ED Control Nasal Hemorrhage Anterior Complex
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
6196505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
ED Control Nasal Hemorrhage Anterior Complex
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 30903
|
| Hospital Charge Code |
6196505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
ED CPAP Ventilation CPAP Initiation & Mgmt
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
6181649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
ED CPAP Ventilation CPAP Initiation & Mgmt
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
6181649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.26 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.26
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
ED Cryocautery Of Cervix, Initial Or Repeat
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6174404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.26 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.26
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
ED Cryocautery Of Cervix, Initial Or Repeat
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6174404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6181630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$267.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$197.68
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$267.70
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6181630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$378.89 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$247.10
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
ED Cystourethroscopy
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
6174097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.37
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| 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 |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| 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 |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| 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 |
$652.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$529.98
|
| 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 |
$448.45
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
ED Cystourethroscopy
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
6174097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$489.22
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
ED Cystourethroscopy With Dilation Of Stricture
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6174098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Commercial |
$784.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$566.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$435.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$418.33
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$801.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Health EOS Commercial |
$775.65
|
| Rate for Payer: HFN Commercial |
$801.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: Multiplan Commercial |
$697.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Preferred Network Access Commercial |
$801.80
|
| Rate for Payer: Quartz Beloit One Network |
$427.04
|
| Rate for Payer: Quartz Commercial |
$566.49
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$479.34
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
| Rate for Payer: WPS Commercial |
$645.51
|
|
|
ED Cystourethroscopy With Dilation Of Stricture
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6174098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.04 |
| Max. Negotiated Rate |
$801.80 |
| Rate for Payer: Aetna Commercial |
$784.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.91
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$801.80
|
| Rate for Payer: Health EOS Commercial |
$775.65
|
| Rate for Payer: HFN Commercial |
$801.80
|
| Rate for Payer: Multiplan Commercial |
$697.22
|
| Rate for Payer: Preferred Network Access Commercial |
$801.80
|
| Rate for Payer: Quartz Beloit One Network |
$427.04
|
| Rate for Payer: Quartz Commercial |
$522.91
|
| Rate for Payer: WEA Trust Commercial |
$479.34
|
| Rate for Payer: WPS Commercial |
$645.51
|
|
|
ED Cystourethroscopy With Removal of Ureteral Stent
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
6174099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$575.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$442.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$424.82
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$575.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
ED Cystourethroscopy With Removal of Ureteral Stent
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
6174099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$531.02
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
ED Debridement, Masoidectomy Cavity, simple
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6174444
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
