|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6174100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.87
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$110.86
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6174101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.08 |
| Max. Negotiated Rate |
$157.87 |
| Rate for Payer: Aetna Commercial |
$154.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.95
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| Rate for Payer: Health EOS Commercial |
$152.72
|
| Rate for Payer: HFN Commercial |
$157.87
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: Preferred Network Access Commercial |
$157.87
|
| Rate for Payer: Quartz Beloit One Network |
$84.08
|
| Rate for Payer: Quartz Commercial |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6174101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$154.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.37
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.95
|
| 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 |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$157.87
|
| 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 |
$152.72
|
| Rate for Payer: HFN Commercial |
$157.87
|
| 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 |
$137.28
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$157.87
|
| Rate for Payer: Quartz Beloit One Network |
$84.08
|
| Rate for Payer: Quartz Commercial |
$111.54
|
| 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 |
$94.38
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
ED Drainage External Auditory Canal, Abscess
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6174442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
ED Drainage External Auditory Canal, Abscess
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6174442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.10 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.10
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Complicated
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6174441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$226.51
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Complicated
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6174441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$188.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.21
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$245.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6174440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.68 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6174440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
ED Drainage of Abscess, Cyst, Hematoma from Dentoalveiolar structures
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6180613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$276.43
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
ED Drainage of Abscess, Cyst, Hematoma from Dentoalveiolar structures
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6180613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.15
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| 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 |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| 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 |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| 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 |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$299.47
|
| 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 |
$253.40
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
ED Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6172941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$398.03 |
| Rate for Payer: Aetna Commercial |
$389.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.30
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$398.03
|
| Rate for Payer: Health EOS Commercial |
$385.05
|
| Rate for Payer: HFN Commercial |
$398.03
|
| Rate for Payer: Multiplan Commercial |
$346.11
|
| Rate for Payer: Preferred Network Access Commercial |
$398.03
|
| Rate for Payer: Quartz Beloit One Network |
$211.99
|
| Rate for Payer: Quartz Commercial |
$259.58
|
| Rate for Payer: WEA Trust Commercial |
$237.95
|
| Rate for Payer: WPS Commercial |
$320.44
|
|
|
ED Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6172941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.67 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$389.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.07
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$281.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$207.67
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$398.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$385.05
|
| Rate for Payer: HFN Commercial |
$398.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$346.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$398.03
|
| Rate for Payer: Quartz Beloit One Network |
$211.99
|
| Rate for Payer: Quartz Commercial |
$281.22
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$237.95
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$320.44
|
|
|
ED Drainage of Finger Abscess
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
6175423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.45
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
ED Drainage of Finger Abscess
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
6175423
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
ED Drainage of Peritoneal abscess/ localized peritonitis, exclusive of appendical abscess, open
|
Facility
|
OP
|
$2,397.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
6224194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,509.25 |
| Rate for Payer: Aetna Commercial |
$2,243.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,143.88
|
| Rate for Payer: Aetna Managed Medicare |
$698.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,620.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,246.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,321.23
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,293.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,218.66
|
| Rate for Payer: HFN Commercial |
$2,293.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,869.66
|
| Rate for Payer: Multiplan Commercial |
$1,994.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,293.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.51
|
| Rate for Payer: Quartz Commercial |
$1,620.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.73
|
| Rate for Payer: The Alliance Commercial |
$5,509.25
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,371.08
|
| Rate for Payer: WPS Commercial |
$1,846.41
|
|
|
ED Drainage of Peritoneal abscess/ localized peritonitis, exclusive of appendical abscess, open
|
Facility
|
IP
|
$2,397.00
|
|
|
Service Code
|
CPT 49020
|
| Hospital Charge Code |
6224194
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,221.51 |
| Max. Negotiated Rate |
$2,293.45 |
| Rate for Payer: Aetna Commercial |
$2,243.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,143.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,321.23
|
| Rate for Payer: Cash Price |
$719.10
|
| Rate for Payer: Cigna Commercial |
$2,293.45
|
| Rate for Payer: Health EOS Commercial |
$2,218.66
|
| Rate for Payer: HFN Commercial |
$2,293.45
|
| Rate for Payer: Multiplan Commercial |
$1,994.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,293.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.51
|
| Rate for Payer: Quartz Commercial |
$1,495.73
|
| Rate for Payer: WEA Trust Commercial |
$1,371.08
|
| Rate for Payer: WPS Commercial |
$1,846.41
|
|
|
ED Dressings and/or debridement of partial-thickness burns, initial or subsequest; large
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
6250430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$329.71 |
| Max. Negotiated Rate |
$619.05 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$403.73
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
ED Dressings and/or debridement of partial-thickness burns, initial or subsequest; large
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
6250430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$605.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.68
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$437.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$336.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.98
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$619.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$598.86
|
| Rate for Payer: HFN Commercial |
$619.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$538.30
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$619.05
|
| Rate for Payer: Quartz Beloit One Network |
$329.71
|
| Rate for Payer: Quartz Commercial |
$437.37
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$370.08
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$498.38
|
|
|
ED DRESSINGS &/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, MEDIUM
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
6210127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
ED DRESSINGS &/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; WITHOUT ANESTHESIA, MEDIUM
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 16025
|
| Hospital Charge Code |
6210127
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$156.75 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
ED EGD Flexible Foreign Body Removal
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
6209954
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$521.32 |
| Max. Negotiated Rate |
$978.81 |
| Rate for Payer: Aetna Commercial |
$957.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.88
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$978.81
|
| Rate for Payer: Health EOS Commercial |
$946.89
|
| Rate for Payer: HFN Commercial |
$978.81
|
| Rate for Payer: Multiplan Commercial |
$851.14
|
| Rate for Payer: Preferred Network Access Commercial |
$978.81
|
| Rate for Payer: Quartz Beloit One Network |
$521.32
|
| Rate for Payer: Quartz Commercial |
$638.35
|
| Rate for Payer: WEA Trust Commercial |
$585.16
|
| Rate for Payer: WPS Commercial |
$788.02
|
|
|
ED EGD Flexible Foreign Body Removal
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
6209954
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$957.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$691.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.68
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.88
|
| 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 |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$978.81
|
| 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 |
$946.89
|
| Rate for Payer: HFN Commercial |
$978.81
|
| 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 |
$851.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$978.81
|
| Rate for Payer: Quartz Beloit One Network |
$521.32
|
| Rate for Payer: Quartz Commercial |
$691.55
|
| 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 |
$585.16
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$788.02
|
|
|
ED EGD Percutaneous Placement Gastronomy Tube
|
Facility
|
OP
|
$1,084.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
6181645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
ED EGD Percutaneous Placement Gastronomy Tube
|
Facility
|
IP
|
$1,084.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
6181645
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
