|
ED Abdominal paracentesis (diagn or therap), w/ imaging guidance
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
6177678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$727.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.95
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.88
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$743.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$719.19
|
| Rate for Payer: HFN Commercial |
$743.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$646.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$743.43
|
| Rate for Payer: Quartz Beloit One Network |
$395.96
|
| Rate for Payer: Quartz Commercial |
$525.25
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$444.44
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$598.52
|
|
|
ED Abdominal paracentesis (diagn or therap), w/ imaging guidance
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
6177678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.96 |
| Max. Negotiated Rate |
$743.43 |
| Rate for Payer: Aetna Commercial |
$727.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.28
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$743.43
|
| Rate for Payer: Health EOS Commercial |
$719.19
|
| Rate for Payer: HFN Commercial |
$743.43
|
| Rate for Payer: Multiplan Commercial |
$646.46
|
| Rate for Payer: Preferred Network Access Commercial |
$743.43
|
| Rate for Payer: Quartz Beloit One Network |
$395.96
|
| Rate for Payer: Quartz Commercial |
$484.85
|
| Rate for Payer: WEA Trust Commercial |
$444.44
|
| Rate for Payer: WPS Commercial |
$598.52
|
|
|
ED Abdom paracentesis dx/ther w/o Imaging Guidance
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
6222460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.45 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$354.43
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
ED Abdom paracentesis dx/ther w/o Imaging Guidance
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
6222460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.55 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.55
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$383.97
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
ED Anorectal Manometry
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
6174450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,567.24 |
| Rate for Payer: Aetna Commercial |
$1,533.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,465.03
|
| Rate for Payer: Aetna Managed Medicare |
$476.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,107.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$851.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$817.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$902.87
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$1,567.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$953.32
|
| Rate for Payer: Health EOS Commercial |
$1,516.13
|
| Rate for Payer: HFN Commercial |
$1,567.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,277.64
|
| Rate for Payer: Multiplan Commercial |
$1,362.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,022.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,567.24
|
| Rate for Payer: Quartz Beloit One Network |
$834.72
|
| Rate for Payer: Quartz Commercial |
$1,107.29
|
| Rate for Payer: Quartz Medicare Advantage |
$1,022.11
|
| Rate for Payer: The Alliance Commercial |
$851.76
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$936.94
|
| Rate for Payer: WPS Commercial |
$1,261.75
|
|
|
ED Anorectal Manometry
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
6174450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$834.72 |
| Max. Negotiated Rate |
$1,567.24 |
| Rate for Payer: Aetna Commercial |
$1,533.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,465.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$902.87
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$1,567.24
|
| Rate for Payer: Health EOS Commercial |
$1,516.13
|
| Rate for Payer: HFN Commercial |
$1,567.24
|
| Rate for Payer: Multiplan Commercial |
$1,362.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,567.24
|
| Rate for Payer: Quartz Beloit One Network |
$834.72
|
| Rate for Payer: Quartz Commercial |
$1,022.11
|
| Rate for Payer: WEA Trust Commercial |
$936.94
|
| Rate for Payer: WPS Commercial |
$1,261.75
|
|
|
ED Anoscopy Diagnostic With Or Without Collection Of Specimen
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
6174088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.34 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.34
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| 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 |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| 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 |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| 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 |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| 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 |
$113.83
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
ED Anoscopy Diagnostic With Or Without Collection Of Specimen
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
6174088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$124.18
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
ED Application Long Leg Splint Thigh Ankle/Toes
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
6180117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
ED Application Long Leg Splint Thigh Ankle/Toes
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
6180117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
ED Application of finger splint; static
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
6172912
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| 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 |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| 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 |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| 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 |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| 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 |
$68.64
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
ED Application of finger splint; static
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
6172912
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
ED APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
6173877
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
ED APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
6173877
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
ED Application of Rigid Total Contact Leg Cast
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
6173880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.70 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.51
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.70
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$357.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$346.17
|
| Rate for Payer: HFN Commercial |
$357.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$311.17
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$357.84
|
| Rate for Payer: Quartz Beloit One Network |
$190.59
|
| Rate for Payer: Quartz Commercial |
$252.82
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$213.93
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$288.09
|
|
|
ED Application of Rigid Total Contact Leg Cast
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
6173880
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.59 |
| Max. Negotiated Rate |
$357.84 |
| Rate for Payer: Aetna Commercial |
$350.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.15
|
| Rate for Payer: Cash Price |
$112.20
|
| Rate for Payer: Cigna Commercial |
$357.84
|
| Rate for Payer: Health EOS Commercial |
$346.17
|
| Rate for Payer: HFN Commercial |
$357.84
|
| Rate for Payer: Multiplan Commercial |
$311.17
|
| Rate for Payer: Preferred Network Access Commercial |
$357.84
|
| Rate for Payer: Quartz Beloit One Network |
$190.59
|
| Rate for Payer: Quartz Commercial |
$233.38
|
| Rate for Payer: WEA Trust Commercial |
$213.93
|
| Rate for Payer: WPS Commercial |
$288.09
|
|
|
ED Application of short arm splint (forearm to hand); static
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
6172920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| 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 |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| 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 |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| 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 |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| 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 |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
ED Application of short arm splint (forearm to hand); static
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
6172920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
ED Application of Short Leg Cast
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
6173878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.73
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$231.19
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
|
ED Application of Short Leg Cast
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
6173878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.28 |
| Max. Negotiated Rate |
$327.23 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$213.41
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
|
ED Application of short leg splint (calf to foot)
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
6172929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
ED Application of short leg splint (calf to foot)
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
6172929
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
ED Application of Walking Cast
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
6173879
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
ED Application of Walking Cast
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
6173879
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.24
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
ED Application Skin Substitute Graft
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
6174789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$692.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.86
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$500.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$369.41
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cash Price |
$222.00
|
| Rate for Payer: Cigna Commercial |
$708.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$684.94
|
| Rate for Payer: HFN Commercial |
$708.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: Multiplan Commercial |
$615.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$708.03
|
| Rate for Payer: Quartz Beloit One Network |
$377.10
|
| Rate for Payer: Quartz Commercial |
$500.24
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$423.28
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$570.02
|
|
