|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) <= 2.5cm
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
6173154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 2.6-7.5cm
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
6172932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 2.6-7.5cm
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
6172932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) >30.0cm
|
Facility
OP
|
$1,015.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
6173157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$659.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$507.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.20
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$537.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cigna Commercial |
$933.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$903.35
|
| Rate for Payer: HFN Commercial |
$933.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$933.80
|
| Rate for Payer: Quartz Beloit One Network |
$497.35
|
| Rate for Payer: Quartz Commercial |
$659.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$558.25
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$751.81
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) >30.0cm
|
Facility
IP
|
$1,015.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
6173157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.35 |
| Max. Negotiated Rate |
$933.80 |
| Rate for Payer: Aetna Commercial |
$913.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$537.95
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cigna Commercial |
$933.80
|
| Rate for Payer: Health EOS Commercial |
$903.35
|
| Rate for Payer: HFN Commercial |
$933.80
|
| Rate for Payer: Multiplan Commercial |
$812.00
|
| Rate for Payer: NAPHCARE Commercial |
$609.00
|
| Rate for Payer: Preferred Network Access Commercial |
$933.80
|
| Rate for Payer: Quartz Beloit One Network |
$497.35
|
| Rate for Payer: Quartz Commercial |
$609.00
|
| Rate for Payer: WEA Trust Commercial |
$558.25
|
| Rate for Payer: WPS Commercial |
$751.81
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 7.6-12.5cm
|
Facility
IP
|
$370.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
6172933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$340.40 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$222.00
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$222.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 7.6-12.5cm
|
Facility
OP
|
$370.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
6172933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.60
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$240.50
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
ED Ligation or Biopsy; Temporal Artery
|
Facility
IP
|
$841.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
6173893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$412.09 |
| Max. Negotiated Rate |
$773.72 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$504.60
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
ED Ligation or Biopsy; Temporal Artery
|
Facility
OP
|
$841.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
6173893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.68
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$546.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
ED Long Arm Split
|
Facility
IP
|
$166.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
6173473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$99.60
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$99.60
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
ED Long Arm Split
|
Facility
OP
|
$166.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
6173473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$10,829.40 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Aetna Managed Medicare |
$155.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.68
|
| Rate for Payer: Anthem Medicare Advantage |
$155.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.74
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.74
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.74
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$233.61
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$107.90
|
| Rate for Payer: Quartz Medicare Advantage |
$155.74
|
| Rate for Payer: The Alliance Commercial |
$10,829.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.74
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: Wellcare Medicare |
$155.74
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
ED Loop Electrode Excision
|
Facility
OP
|
$982.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
6174405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$11,495.25 |
| Rate for Payer: Aetna Commercial |
$883.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$844.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$638.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$471.36
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$903.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Health EOS Commercial |
$873.98
|
| Rate for Payer: HFN Commercial |
$903.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Preferred Network Access Commercial |
$903.44
|
| Rate for Payer: Quartz Beloit One Network |
$481.18
|
| Rate for Payer: Quartz Commercial |
$638.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$8,905.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$540.10
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
| Rate for Payer: WPS Commercial |
$727.37
|
|
|
ED Loop Electrode Excision
|
Facility
IP
|
$982.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
6174405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.18 |
| Max. Negotiated Rate |
$903.44 |
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Aetna Commercial |
$883.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.46
|
| Rate for Payer: Cigna Commercial |
$903.44
|
| Rate for Payer: Health EOS Commercial |
$873.98
|
| Rate for Payer: HFN Commercial |
$903.44
|
| Rate for Payer: Multiplan Commercial |
$785.60
|
| Rate for Payer: NAPHCARE Commercial |
$589.20
|
| Rate for Payer: Preferred Network Access Commercial |
$903.44
|
| Rate for Payer: Quartz Beloit One Network |
$481.18
|
| Rate for Payer: Quartz Commercial |
$589.20
|
| Rate for Payer: WEA Trust Commercial |
$540.10
|
| Rate for Payer: WPS Commercial |
$727.37
|
|
|
ED LUMBAR PUNCTURE W/FLUORO OR CT
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
6174410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$5,812.20 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$683.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| Rate for Payer: Anthem Medicare Advantage |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$683.53
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$683.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$683.53
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$683.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$683.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$683.53
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.30
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$683.53
|
| Rate for Payer: The Alliance Commercial |
$5,812.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: Wellcare Medicare |
$683.53
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ED LUMBAR PUNCTURE W/FLUORO OR CT
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
6174410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ED Measurement of Post-Voiding residual Urine by Ultrasound
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
6174792
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
ED Measurement of Post-Voiding residual Urine by Ultrasound
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
6174792
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
ED Myringotomy Incision With Aspiration Or Inflation
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
6174445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.56 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$241.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Anthem Medicare Advantage |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$241.43
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$241.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$241.43
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$241.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$241.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$362.14
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$241.43
|
| Rate for Payer: The Alliance Commercial |
$220.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$241.43
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: Wellcare Medicare |
$241.43
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
ED Myringotomy Incision With Aspiration Or Inflation
|
Facility
IP
|
$447.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
6174445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
ED Nasal Endoscopy, diagnostic
|
Facility
OP
|
$416.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
6173884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.78 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$195.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$270.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.68
|
| Rate for Payer: Anthem Medicare Advantage |
$195.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.78
|
| 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 |
$382.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$195.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$195.78
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$195.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$195.78
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$293.67
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$270.40
|
| Rate for Payer: Quartz Medicare Advantage |
$195.78
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.78
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: Wellcare Medicare |
$195.78
|
| Rate for Payer: WPS Commercial |
$308.13
|
|
|
ED Nasal Endoscopy, diagnostic
|
Facility
IP
|
$416.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
6173884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$382.72 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$382.72
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$308.13
|
|
|
ED Nasal Hemorrahage
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
6173886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
ED Nasal Hemorrahage
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
6173886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.88 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
ED Nasal/Sinus Endoscopy With Debridement
|
Facility
IP
|
$696.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
6173885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.04 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$417.60
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$417.60
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
ED Nasal/Sinus Endoscopy With Debridement
|
Facility
OP
|
$696.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
6173885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$452.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.08
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
