|
ED Incision and removal of foreign body, subcutaneous tissues; simple
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
6173470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; simple
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
6173470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| 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 |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| 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 |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| 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 |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| 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 |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
ED Incision Of Conjunctiva, Drainage Of Cyst
|
Facility
OP
|
$491.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
6174433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.68
|
| Rate for Payer: Anthem Medicare Advantage |
$1,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| 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 |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| 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 |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| 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 |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,501.05
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$319.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,000.70
|
| Rate for Payer: The Alliance Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,000.70
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: Wellcare Medicare |
$1,000.70
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
ED Incision Of Conjunctiva, Drainage Of Cyst
|
Facility
IP
|
$491.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
6174433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$451.72 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$294.60
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$294.60
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
ED Incision Thrombosed Hemorrhoid External
|
Facility
OP
|
$348.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
6179157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.04 |
| Max. Negotiated Rate |
$35,109.64 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$35,109.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
ED Incision Thrombosed Hemorrhoid External
|
Facility
IP
|
$348.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
6179157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
ED Injection, anesthetic agent and/or steroid, other perpheral nerve branch
|
Facility
IP
|
$330.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6173811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$303.60 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$198.00
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
ED Injection, anesthetic agent and/or steroid, other perpheral nerve branch
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6173811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$41,927.24 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Aetna Managed Medicare |
$683.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$683.53
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$683.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$683.53
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$683.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$683.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$683.53
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.30
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$214.50
|
| Rate for Payer: Quartz Medicare Advantage |
$683.53
|
| Rate for Payer: The Alliance Commercial |
$41,927.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: Wellcare Medicare |
$683.53
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
ED Injection of Anesthetic agent/steroid greater occipital nerve
|
Facility
OP
|
$614.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
6182858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ED Injection of Anesthetic agent/steroid greater occipital nerve
|
Facility
IP
|
$614.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
6182858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ED Injection of anesthetic agent, trigeminal nerve, ea branch
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
6172910
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
ED Injection of anesthetic agent, trigeminal nerve, ea branch
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
6172910
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.84 |
| Max. Negotiated Rate |
$6,103.72 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$6,103.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
ED Injection of Tendon Sheath or Ligament; Single
|
Facility
IP
|
$329.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
6173870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$197.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
ED Injection of Tendon Sheath or Ligament; Single
|
Facility
OP
|
$329.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
6173870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.92
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| 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 |
$302.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$213.85
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
ED Injection(s); Single or Multiple Trigger Points
|
Facility
OP
|
$329.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
6173871
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.92
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| 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 |
$302.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$213.85
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$2.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
ED Injection(s); Single or Multiple Trigger Points
|
Facility
IP
|
$329.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
6173871
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$197.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
ED Injection Therapeutic, Carpal Tunnel
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
6173869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$48.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
ED Injection Therapeutic, Carpal Tunnel
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
6173869
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
ED Insertion Of Intrauterine Device
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
6174408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
ED Insertion Of Intrauterine Device
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
6174408
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$71.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: The Alliance Commercial |
$1,024.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
ED Insertion Of Non-Biodegradable Drug Delivery Implant
|
Facility
OP
|
$197.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
6173148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.56 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| 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 |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| 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 |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
ED Insertion Of Non-Biodegradable Drug Delivery Implant
|
Facility
IP
|
$197.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
6173148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
ED Insertion of Non-Indwelling Bladder Catheter
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6174092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.84 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.84
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| 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 |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| 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 |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| 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 |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$102.70
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
ED Insertion of Non-Indwelling Bladder Catheter
|
Facility
IP
|
$158.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
6174092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
ED Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older
|
Facility
OP
|
$673.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
6174326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$125,383.92 |
| Rate for Payer: Aetna Commercial |
$605.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$437.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$323.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$619.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$598.97
|
| Rate for Payer: HFN Commercial |
$619.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$619.16
|
| Rate for Payer: Quartz Beloit One Network |
$329.77
|
| Rate for Payer: Quartz Commercial |
$437.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$125,383.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
