|
EDEMA GLOVES 3/4 FINGER (OPEN) #55659501
|
Facility
|
OP
|
$394.00
|
|
| Hospital Charge Code |
2970249
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$114.73 |
| Max. Negotiated Rate |
$376.98 |
| Rate for Payer: Aetna Commercial |
$368.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.39
|
| Rate for Payer: Aetna Managed Medicare |
$114.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.17
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$376.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.31
|
| Rate for Payer: Health EOS Commercial |
$364.69
|
| Rate for Payer: HFN Commercial |
$376.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.32
|
| Rate for Payer: Multiplan Commercial |
$327.81
|
| Rate for Payer: NAPHCARE Commercial |
$245.86
|
| Rate for Payer: Preferred Network Access Commercial |
$376.98
|
| Rate for Payer: Quartz Beloit One Network |
$200.78
|
| Rate for Payer: Quartz Commercial |
$266.34
|
| Rate for Payer: Quartz Medicare Advantage |
$245.86
|
| Rate for Payer: The Alliance Commercial |
$204.88
|
| Rate for Payer: WEA Trust Commercial |
$225.37
|
| Rate for Payer: WPS Commercial |
$303.50
|
|
|
EDEMA GLOVES 3/4 FINGER (OPEN) #55659501
|
Facility
|
IP
|
$394.00
|
|
| Hospital Charge Code |
2970249
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$200.78 |
| Max. Negotiated Rate |
$376.98 |
| Rate for Payer: Aetna Commercial |
$368.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.17
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$376.98
|
| Rate for Payer: Health EOS Commercial |
$364.69
|
| Rate for Payer: HFN Commercial |
$376.98
|
| Rate for Payer: Multiplan Commercial |
$327.81
|
| Rate for Payer: Preferred Network Access Commercial |
$376.98
|
| Rate for Payer: Quartz Beloit One Network |
$200.78
|
| Rate for Payer: Quartz Commercial |
$245.86
|
| Rate for Payer: WEA Trust Commercial |
$225.37
|
| Rate for Payer: WPS Commercial |
$303.50
|
|
|
ED Endocervical Curettage
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
6174402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
ED Endocervical Curettage
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
6174402
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.75 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$969.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.75
|
| Rate for Payer: Anthem Medicare Advantage |
$969.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$969.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$969.30
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$969.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$969.30
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,605.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$969.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$969.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$969.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$969.30
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.95
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$969.30
|
| Rate for Payer: The Alliance Commercial |
$3,877.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.30
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: Wellcare Medicare |
$969.30
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
ED Endometrial Aspiration
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
6174407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$234.62
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
ED Endometrial Aspiration
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
6174407
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$212.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.70
|
| Rate for Payer: Anthem Medicare Advantage |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$212.76
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$212.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$212.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$791.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$212.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$212.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$212.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| Rate for Payer: Quartz Medicare Advantage |
$212.76
|
| Rate for Payer: The Alliance Commercial |
$851.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.76
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: Wellcare Medicare |
$212.76
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
ED Esophageal Motility Study With Interpretation
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
6174448
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$672.67 |
| Max. Negotiated Rate |
$1,262.98 |
| Rate for Payer: Aetna Commercial |
$1,235.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.58
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,262.98
|
| Rate for Payer: Health EOS Commercial |
$1,221.79
|
| Rate for Payer: HFN Commercial |
$1,262.98
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.98
|
| Rate for Payer: Quartz Beloit One Network |
$672.67
|
| Rate for Payer: Quartz Commercial |
$823.68
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
ED Esophageal Motility Study With Interpretation
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
6174448
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,570.82 |
| Rate for Payer: Aetna Commercial |
$1,235.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$892.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.94
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,262.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$1,221.79
|
| Rate for Payer: HFN Commercial |
$1,262.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.98
|
| Rate for Payer: Quartz Beloit One Network |
$672.67
|
| Rate for Payer: Quartz Commercial |
$892.32
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
ED Esophagogastroduodenoscopy, flexible, transoral; w/ biopsy, single or multiple
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
6172943
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$756.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.60
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| 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 |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| 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 |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| 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 |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$756.44
|
| 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 |
$640.07
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
ED Esophagogastroduodenoscopy, flexible, transoral; w/ biopsy, single or multiple
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
6172943
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.24 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$698.26
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
ED Esophagogastroduodenoscopy, Flexible, transoral; w/conrol of bleeding, any method
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
6243713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Commercial |
$1,172.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$847.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$625.50
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.65
|
| 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 |
$375.90
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cigna Commercial |
$1,198.87
|
| 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 |
$1,159.78
|
| Rate for Payer: HFN Commercial |
$1,198.87
|
| 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 |
$1,042.50
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.87
|
| Rate for Payer: Quartz Beloit One Network |
$638.53
|
| Rate for Payer: Quartz Commercial |
$847.03
|
| 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 |
$716.72
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
| Rate for Payer: WPS Commercial |
$965.19
|
|
|
ED Esophagogastroduodenoscopy, Flexible, transoral; w/conrol of bleeding, any method
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
6243713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$638.53 |
| Max. Negotiated Rate |
$1,198.87 |
| Rate for Payer: Aetna Commercial |
$1,172.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.65
|
| Rate for Payer: Cash Price |
$375.90
|
| Rate for Payer: Cigna Commercial |
$1,198.87
|
| Rate for Payer: Health EOS Commercial |
$1,159.78
|
| Rate for Payer: HFN Commercial |
$1,198.87
|
| Rate for Payer: Multiplan Commercial |
$1,042.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.87
|
| Rate for Payer: Quartz Beloit One Network |
$638.53
|
| Rate for Payer: Quartz Commercial |
$781.87
|
| Rate for Payer: WEA Trust Commercial |
$716.72
|
| Rate for Payer: WPS Commercial |
$965.19
|
|
|
ED Evacuation of a subungual Hematoma
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
6172926
|
|
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 Evacuation of a subungual Hematoma
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
6172926
|
|
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 |
$140.02
|
| 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 |
$140.02
|
| 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 |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| 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 |
$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 |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| 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 |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| 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 |
$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 |
$85.80
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
ED Excision, Destruction with simple repair
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
6174073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Commercial |
$686.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.91
|
| Rate for Payer: Anthem Medicare Advantage |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$701.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Health EOS Commercial |
$678.46
|
| Rate for Payer: HFN Commercial |
$701.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Preferred Network Access Commercial |
$701.33
|
| Rate for Payer: Quartz Beloit One Network |
$373.54
|
| Rate for Payer: Quartz Commercial |
$495.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
ED Excision, Destruction with simple repair
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 40812
|
| Hospital Charge Code |
6174073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.54 |
| Max. Negotiated Rate |
$701.33 |
| Rate for Payer: Aetna Commercial |
$686.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.03
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$701.33
|
| Rate for Payer: Health EOS Commercial |
$678.46
|
| Rate for Payer: HFN Commercial |
$701.33
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: Preferred Network Access Commercial |
$701.33
|
| Rate for Payer: Quartz Beloit One Network |
$373.54
|
| Rate for Payer: Quartz Commercial |
$457.39
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
ED Excision of benign oral lesion 0.6-1.0cm
|
Facility
|
OP
|
$676.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
6174079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.26 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$632.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$604.61
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$456.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$351.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$337.46
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$249.26
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$646.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$249.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$249.26
|
| Rate for Payer: Health EOS Commercial |
$625.71
|
| Rate for Payer: HFN Commercial |
$646.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$249.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$249.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$249.26
|
| Rate for Payer: Multiplan Commercial |
$562.43
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$646.80
|
| Rate for Payer: Quartz Beloit One Network |
$344.49
|
| Rate for Payer: Quartz Commercial |
$456.98
|
| Rate for Payer: Quartz Medicare Advantage |
$249.26
|
| Rate for Payer: The Alliance Commercial |
$997.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$386.67
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$520.72
|
|
|
ED Excision of benign oral lesion 0.6-1.0cm
|
Facility
|
IP
|
$676.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
6174079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$344.49 |
| Max. Negotiated Rate |
$646.80 |
| Rate for Payer: Aetna Commercial |
$632.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$604.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.61
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$646.80
|
| Rate for Payer: Health EOS Commercial |
$625.71
|
| Rate for Payer: HFN Commercial |
$646.80
|
| Rate for Payer: Multiplan Commercial |
$562.43
|
| Rate for Payer: Preferred Network Access Commercial |
$646.80
|
| Rate for Payer: Quartz Beloit One Network |
$344.49
|
| Rate for Payer: Quartz Commercial |
$421.82
|
| Rate for Payer: WEA Trust Commercial |
$386.67
|
| Rate for Payer: WPS Commercial |
$520.72
|
|
|
ED Excision Of Lesion; Eyelid Repair
|
Facility
|
IP
|
$780.00
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
6174426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$397.49 |
| Max. Negotiated Rate |
$746.30 |
| Rate for Payer: Aetna Commercial |
$730.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.94
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: Health EOS Commercial |
$721.97
|
| Rate for Payer: HFN Commercial |
$746.30
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: Preferred Network Access Commercial |
$746.30
|
| Rate for Payer: Quartz Beloit One Network |
$397.49
|
| Rate for Payer: Quartz Commercial |
$486.72
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$600.83
|
|
|
ED Excision Of Lesion; Eyelid Repair
|
Facility
|
OP
|
$780.00
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
6174426
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$730.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,049.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.38
|
| Rate for Payer: Anthem Medicare Advantage |
$1,049.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,049.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,049.10
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$746.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,049.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,049.10
|
| Rate for Payer: Health EOS Commercial |
$721.97
|
| Rate for Payer: HFN Commercial |
$746.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,902.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,049.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,049.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,049.10
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.65
|
| Rate for Payer: Preferred Network Access Commercial |
$746.30
|
| Rate for Payer: Quartz Beloit One Network |
$397.49
|
| Rate for Payer: Quartz Commercial |
$527.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,049.10
|
| Rate for Payer: The Alliance Commercial |
$4,196.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,049.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: Wellcare Medicare |
$1,049.10
|
| Rate for Payer: WPS Commercial |
$600.83
|
|
|
ED Excision Of Lesion; Eyelid Repair Margin
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
CPT 67961
|
| Hospital Charge Code |
6174432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
ED Excision Of Lesion; Eyelid Repair Margin
|
Facility
|
OP
|
$2,440.00
|
|
|
Service Code
|
CPT 67961
|
| Hospital Charge Code |
6174432
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
ED Excision Of Lesion Of Tongue With Closure; Anterior Two-Thirds
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
6174076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Commercial |
$707.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.17
|
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$511.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$393.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$377.40
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$723.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Health EOS Commercial |
$699.75
|
| Rate for Payer: HFN Commercial |
$723.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: Multiplan Commercial |
$628.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Preferred Network Access Commercial |
$723.34
|
| Rate for Payer: Quartz Beloit One Network |
$385.26
|
| Rate for Payer: Quartz Commercial |
$511.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$432.43
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
| Rate for Payer: WPS Commercial |
$582.35
|
|
|
ED Excision Of Lesion Of Tongue With Closure; Anterior Two-Thirds
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 41112
|
| Hospital Charge Code |
6174076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.26 |
| Max. Negotiated Rate |
$723.34 |
| Rate for Payer: Aetna Commercial |
$707.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.71
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna Commercial |
$723.34
|
| Rate for Payer: Health EOS Commercial |
$699.75
|
| Rate for Payer: HFN Commercial |
$723.34
|
| Rate for Payer: Multiplan Commercial |
$628.99
|
| Rate for Payer: Preferred Network Access Commercial |
$723.34
|
| Rate for Payer: Quartz Beloit One Network |
$385.26
|
| Rate for Payer: Quartz Commercial |
$471.74
|
| Rate for Payer: WEA Trust Commercial |
$432.43
|
| Rate for Payer: WPS Commercial |
$582.35
|
|
|
ED Excision of Lesion of Tongue Without Closure
|
Facility
|
OP
|
$721.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
6174074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$487.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$374.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$359.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$487.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
