|
ED Excision of Lesion of Tongue Without Closure
|
Facility
|
IP
|
$721.00
|
|
|
Service Code
|
CPT 41010
|
| Hospital Charge Code |
6174074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.42 |
| Max. Negotiated Rate |
$689.85 |
| Rate for Payer: Aetna Commercial |
$674.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.42
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$689.85
|
| Rate for Payer: Health EOS Commercial |
$667.36
|
| Rate for Payer: HFN Commercial |
$689.85
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: Preferred Network Access Commercial |
$689.85
|
| Rate for Payer: Quartz Beloit One Network |
$367.42
|
| Rate for Payer: Quartz Commercial |
$449.90
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$555.39
|
|
|
ED Excision of Lesion or Tumor (except listed above) dentalalveolar structures; without repair
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
6174078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
ED Excision of Lesion or Tumor (except listed above) dentalalveolar structures; without repair
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 41825
|
| Hospital Charge Code |
6174078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.19 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.19
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| 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 |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| 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 |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$258.91
|
| 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 |
$219.08
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
ED Excision of Multiple External Papillae or tags, anus
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
6174086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.17 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$276.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.17
|
| Rate for Payer: Anthem Medicare Advantage |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$391.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Health EOS Commercial |
$378.57
|
| Rate for Payer: HFN Commercial |
$391.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: Multiplan Commercial |
$340.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Preferred Network Access Commercial |
$391.33
|
| Rate for Payer: Quartz Beloit One Network |
$208.43
|
| Rate for Payer: Quartz Commercial |
$276.48
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$233.95
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
| Rate for Payer: WPS Commercial |
$315.05
|
|
|
ED Excision of Multiple External Papillae or tags, anus
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 46230
|
| Hospital Charge Code |
6174086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$208.43 |
| Max. Negotiated Rate |
$391.33 |
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.44
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$391.33
|
| Rate for Payer: Health EOS Commercial |
$378.57
|
| Rate for Payer: HFN Commercial |
$391.33
|
| Rate for Payer: Multiplan Commercial |
$340.29
|
| Rate for Payer: Preferred Network Access Commercial |
$391.33
|
| Rate for Payer: Quartz Beloit One Network |
$208.43
|
| Rate for Payer: Quartz Commercial |
$255.22
|
| Rate for Payer: WEA Trust Commercial |
$233.95
|
| Rate for Payer: WPS Commercial |
$315.05
|
|
|
ED Excision of nail & nail matrix, partial or complete for permanent removal
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
6172930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$316.46 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| Rate for Payer: Health EOS Commercial |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$387.50
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
ED Excision of nail & nail matrix, partial or complete for permanent removal
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
6172930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.00
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| 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 |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| 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 |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| 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 |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$419.80
|
| 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 |
$355.21
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
ED Excision Of Sublingual Salivary Cyst
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 42408
|
| Hospital Charge Code |
6174080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Commercial |
$833.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.29
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.57
|
| 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 |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$851.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Health EOS Commercial |
$823.78
|
| Rate for Payer: HFN Commercial |
$851.55
|
| 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 |
$740.48
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Preferred Network Access Commercial |
$851.55
|
| Rate for Payer: Quartz Beloit One Network |
$453.54
|
| Rate for Payer: Quartz Commercial |
$601.64
|
| 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 |
$509.08
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
| Rate for Payer: WPS Commercial |
$685.57
|
|
|
ED Excision Of Sublingual Salivary Cyst
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 42408
|
| Hospital Charge Code |
6174080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$453.54 |
| Max. Negotiated Rate |
$851.55 |
| Rate for Payer: Aetna Commercial |
$833.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.57
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$851.55
|
| Rate for Payer: Health EOS Commercial |
$823.78
|
| Rate for Payer: HFN Commercial |
$851.55
|
| Rate for Payer: Multiplan Commercial |
$740.48
|
| Rate for Payer: Preferred Network Access Commercial |
$851.55
|
| Rate for Payer: Quartz Beloit One Network |
$453.54
|
| Rate for Payer: Quartz Commercial |
$555.36
|
| Rate for Payer: WEA Trust Commercial |
$509.08
|
| Rate for Payer: WPS Commercial |
$685.57
|
|
|
ED Excision of Thrombosed Hemorrhoid, external
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
6174087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Commercial |
$394.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.66
|
| Rate for Payer: Anthem Medicare Advantage |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$403.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Health EOS Commercial |
$390.60
|
| Rate for Payer: HFN Commercial |
$403.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: Multiplan Commercial |
$351.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.77
|
| Rate for Payer: Quartz Beloit One Network |
$215.05
|
| Rate for Payer: Quartz Commercial |
$285.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$241.38
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
| Rate for Payer: WPS Commercial |
$325.07
|
|
|
ED Excision of Thrombosed Hemorrhoid, external
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
CPT 46320
|
| Hospital Charge Code |
6174087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.05 |
| Max. Negotiated Rate |
$403.77 |
| Rate for Payer: Aetna Commercial |
$394.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.61
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$403.77
|
| Rate for Payer: Health EOS Commercial |
$390.60
|
| Rate for Payer: HFN Commercial |
$403.77
|
| Rate for Payer: Multiplan Commercial |
$351.10
|
| Rate for Payer: Preferred Network Access Commercial |
$403.77
|
| Rate for Payer: Quartz Beloit One Network |
$215.05
|
| Rate for Payer: Quartz Commercial |
$263.33
|
| Rate for Payer: WEA Trust Commercial |
$241.38
|
| Rate for Payer: WPS Commercial |
$325.07
|
|
|
ED Excision Of Vaginal Cyst Or Tumor
|
Facility
|
OP
|
$833.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
6174397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Commercial |
$779.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$745.04
|
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$433.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$415.83
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$797.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Health EOS Commercial |
$771.02
|
| Rate for Payer: HFN Commercial |
$797.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: Multiplan Commercial |
$693.06
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Preferred Network Access Commercial |
$797.01
|
| Rate for Payer: Quartz Beloit One Network |
$424.50
|
| Rate for Payer: Quartz Commercial |
$563.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$476.48
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
| Rate for Payer: WPS Commercial |
$641.66
|
|
|
ED Excision Of Vaginal Cyst Or Tumor
|
Facility
|
IP
|
$833.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
6174397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.50 |
| Max. Negotiated Rate |
$797.01 |
| Rate for Payer: Aetna Commercial |
$779.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$745.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.15
|
| Rate for Payer: Cash Price |
$249.90
|
| Rate for Payer: Cigna Commercial |
$797.01
|
| Rate for Payer: Health EOS Commercial |
$771.02
|
| Rate for Payer: HFN Commercial |
$797.01
|
| Rate for Payer: Multiplan Commercial |
$693.06
|
| Rate for Payer: Preferred Network Access Commercial |
$797.01
|
| Rate for Payer: Quartz Beloit One Network |
$424.50
|
| Rate for Payer: Quartz Commercial |
$519.79
|
| Rate for Payer: WEA Trust Commercial |
$476.48
|
| Rate for Payer: WPS Commercial |
$641.66
|
|
|
ED Exploration Penetrating Wound SPX Extremity
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
6210438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,109.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,059.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$801.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$616.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$591.55
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.17
|
| 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 |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$1,133.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$1,096.84
|
| Rate for Payer: HFN Commercial |
$1,133.81
|
| 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 |
$985.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,133.81
|
| Rate for Payer: Quartz Beloit One Network |
$603.88
|
| Rate for Payer: Quartz Commercial |
$801.06
|
| 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 |
$677.82
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$912.81
|
|
|
ED Exploration Penetrating Wound SPX Extremity
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
6210438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.88 |
| Max. Negotiated Rate |
$1,133.81 |
| Rate for Payer: Aetna Commercial |
$1,109.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,059.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.17
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$1,133.81
|
| Rate for Payer: Health EOS Commercial |
$1,096.84
|
| Rate for Payer: HFN Commercial |
$1,133.81
|
| Rate for Payer: Multiplan Commercial |
$985.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,133.81
|
| Rate for Payer: Quartz Beloit One Network |
$603.88
|
| Rate for Payer: Quartz Commercial |
$739.44
|
| Rate for Payer: WEA Trust Commercial |
$677.82
|
| Rate for Payer: WPS Commercial |
$912.81
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by forceps only
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
6174424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by forceps only
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
6174424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$153.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$118.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.32
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| 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 |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| 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 |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| 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 |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| 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 |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
6174425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$328.22
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
6174425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.58 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$334.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.58
|
| Rate for Payer: Anthem Medicare Advantage |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.04
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.04
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.04
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$355.58
|
| Rate for Payer: Quartz Medicare Advantage |
$334.04
|
| Rate for Payer: The Alliance Commercial |
$1,336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: Wellcare Medicare |
$334.04
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Different Lids
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
6174422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.64 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.11
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$562.60
|
| Rate for Payer: Health EOS Commercial |
$544.25
|
| Rate for Payer: HFN Commercial |
$562.60
|
| Rate for Payer: Multiplan Commercial |
$489.22
|
| Rate for Payer: Preferred Network Access Commercial |
$562.60
|
| Rate for Payer: Quartz Beloit One Network |
$299.64
|
| Rate for Payer: Quartz Commercial |
$366.91
|
| Rate for Payer: WEA Trust Commercial |
$336.34
|
| Rate for Payer: WPS Commercial |
$452.94
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Different Lids
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
6174422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.53 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.91
|
| Rate for Payer: Aetna Managed Medicare |
$334.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$397.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.53
|
| Rate for Payer: Anthem Medicare Advantage |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.04
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$562.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.04
|
| Rate for Payer: Health EOS Commercial |
$544.25
|
| Rate for Payer: HFN Commercial |
$562.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.04
|
| Rate for Payer: Multiplan Commercial |
$489.22
|
| Rate for Payer: NAPHCARE Commercial |
$501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$562.60
|
| Rate for Payer: Quartz Beloit One Network |
$299.64
|
| Rate for Payer: Quartz Commercial |
$397.49
|
| Rate for Payer: Quartz Medicare Advantage |
$334.04
|
| Rate for Payer: The Alliance Commercial |
$1,336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$336.34
|
| Rate for Payer: Wellcare Medicare |
$334.04
|
| Rate for Payer: WPS Commercial |
$452.94
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Same Lid
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
6174421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Same Lid
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
6174421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.52 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$1,049.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.52
|
| Rate for Payer: Anthem Medicare Advantage |
$1,049.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| 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 |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| 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 |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| 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 |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,573.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| 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 |
$344.34
|
| Rate for Payer: Wellcare Medicare |
$1,049.10
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
ED Eyelids; Excision of Chalazion, Single
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
6174420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Aetna Managed Medicare |
$334.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.73
|
| Rate for Payer: Anthem Medicare Advantage |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.04
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.04
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.04
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: NAPHCARE Commercial |
$501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$231.19
|
| Rate for Payer: Quartz Medicare Advantage |
$334.04
|
| Rate for Payer: The Alliance Commercial |
$1,336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: Wellcare Medicare |
$334.04
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
|
ED Eyelids; Excision of Chalazion, Single
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
6174420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.28 |
| Max. Negotiated Rate |
$327.23 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.51
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$327.23
|
| Rate for Payer: Health EOS Commercial |
$316.56
|
| Rate for Payer: HFN Commercial |
$327.23
|
| Rate for Payer: Multiplan Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$327.23
|
| Rate for Payer: Quartz Beloit One Network |
$174.28
|
| Rate for Payer: Quartz Commercial |
$213.41
|
| Rate for Payer: WEA Trust Commercial |
$195.62
|
| Rate for Payer: WPS Commercial |
$263.44
|
|
