|
ED Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
6173863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$402.58 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
ED Closed treatment of shoulder dislocation, with manipulation; w/o anesthesia
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
6172918
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.19 |
| Max. Negotiated Rate |
$766.40 |
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$499.82
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
ED Closed treatment of shoulder dislocation, with manipulation; w/o anesthesia
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
6172918
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$749.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$716.41
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$541.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.86
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$441.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$766.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Health EOS Commercial |
$741.41
|
| Rate for Payer: HFN Commercial |
$766.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: Multiplan Commercial |
$666.43
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$766.40
|
| Rate for Payer: Quartz Beloit One Network |
$408.19
|
| Rate for Payer: Quartz Commercial |
$541.48
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$458.17
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$617.01
|
|
|
ED Closed treatment of trimalleolar ankle fracture; with manipulation
|
Facility
|
OP
|
$2,286.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
6174071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$2,139.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,044.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,545.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,188.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.17
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$2,187.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Health EOS Commercial |
$2,115.92
|
| Rate for Payer: HFN Commercial |
$2,187.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: Multiplan Commercial |
$1,901.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,164.95
|
| Rate for Payer: Quartz Commercial |
$1,545.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,307.59
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$1,760.91
|
|
|
ED Closed treatment of trimalleolar ankle fracture; with manipulation
|
Facility
|
IP
|
$2,286.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
6174071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,164.95 |
| Max. Negotiated Rate |
$2,187.24 |
| Rate for Payer: Aetna Commercial |
$2,139.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,044.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.04
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$2,187.24
|
| Rate for Payer: Health EOS Commercial |
$2,115.92
|
| Rate for Payer: HFN Commercial |
$2,187.24
|
| Rate for Payer: Multiplan Commercial |
$1,901.95
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,164.95
|
| Rate for Payer: Quartz Commercial |
$1,426.46
|
| Rate for Payer: WEA Trust Commercial |
$1,307.59
|
| Rate for Payer: WPS Commercial |
$1,760.91
|
|
|
ED Closed Treatment of ulnar fracture, proximal end; with manipulation
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
6230218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$708.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$511.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$393.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$377.89
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$724.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Health EOS Commercial |
$700.68
|
| Rate for Payer: HFN Commercial |
$724.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: Multiplan Commercial |
$629.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$724.30
|
| Rate for Payer: Quartz Beloit One Network |
$385.77
|
| Rate for Payer: Quartz Commercial |
$511.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$433.00
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$583.12
|
|
|
ED Closed Treatment of ulnar fracture, proximal end; with manipulation
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
6230218
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.77 |
| Max. Negotiated Rate |
$724.30 |
| Rate for Payer: Aetna Commercial |
$708.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.26
|
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Cigna Commercial |
$724.30
|
| Rate for Payer: Health EOS Commercial |
$700.68
|
| Rate for Payer: HFN Commercial |
$724.30
|
| Rate for Payer: Multiplan Commercial |
$629.82
|
| Rate for Payer: Preferred Network Access Commercial |
$724.30
|
| Rate for Payer: Quartz Beloit One Network |
$385.77
|
| Rate for Payer: Quartz Commercial |
$472.37
|
| Rate for Payer: WEA Trust Commercial |
$433.00
|
| Rate for Payer: WPS Commercial |
$583.12
|
|
|
ED Closed Treatment, Radial & Ulnar Shaft Fractures with manipulation
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
6182859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
ED Closed Treatment, Radial & Ulnar Shaft Fractures with manipulation
|
Facility
|
IP
|
$988.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
6182859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
ED Closed TX Nasal Bone FX W/MNPJ w/o Stabilization
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
6210174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,531.49 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.90
|
| Rate for Payer: Anthem Medicare Advantage |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| 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 |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$718.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| 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 |
$624.83
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$507.68
|
| 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 |
$429.57
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
ED Closed TX Nasal Bone FX W/MNPJ w/o Stabilization
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
6210174
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$382.71 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$718.56
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$468.62
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
ED Closure of Laceration, Vestibule of Mouth; 2.5 cm or less
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
6174795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
ED Closure of Laceration, Vestibule of Mouth; 2.5 cm or less
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
6174795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| 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 |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| 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 |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| 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 |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| 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 |
$190.48
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
ED CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
6224199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$1,234.27 |
| Rate for Payer: Aetna Commercial |
$1,207.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.05
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,234.27
|
| Rate for Payer: Health EOS Commercial |
$1,194.02
|
| Rate for Payer: HFN Commercial |
$1,234.27
|
| Rate for Payer: Multiplan Commercial |
$1,073.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.27
|
| Rate for Payer: Quartz Beloit One Network |
$657.38
|
| Rate for Payer: Quartz Commercial |
$804.96
|
| Rate for Payer: WEA Trust Commercial |
$737.88
|
| Rate for Payer: WPS Commercial |
$993.69
|
|
|
ED CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
6224199
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$1,207.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,153.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$670.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$643.97
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,234.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Health EOS Commercial |
$1,194.02
|
| Rate for Payer: HFN Commercial |
$1,234.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: Multiplan Commercial |
$1,073.28
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.27
|
| Rate for Payer: Quartz Beloit One Network |
$657.38
|
| Rate for Payer: Quartz Commercial |
$872.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$737.88
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$993.69
|
|
|
ED CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
IP
|
$866.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
6210425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$441.31 |
| Max. Negotiated Rate |
$828.59 |
| Rate for Payer: Aetna Commercial |
$810.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.34
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$828.59
|
| Rate for Payer: Health EOS Commercial |
$801.57
|
| Rate for Payer: HFN Commercial |
$828.59
|
| Rate for Payer: Multiplan Commercial |
$720.51
|
| Rate for Payer: Preferred Network Access Commercial |
$828.59
|
| Rate for Payer: Quartz Beloit One Network |
$441.31
|
| Rate for Payer: Quartz Commercial |
$540.38
|
| Rate for Payer: WEA Trust Commercial |
$495.35
|
| Rate for Payer: WPS Commercial |
$667.08
|
|
|
ED CLTX IPHAL JT DISLC W/MANJ REQ ANES
|
Facility
|
OP
|
$866.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
6210425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.34 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$810.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.55
|
| Rate for Payer: Aetna Managed Medicare |
$294.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.31
|
| Rate for Payer: Anthem Medicare Advantage |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.34
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cash Price |
$259.80
|
| Rate for Payer: Cigna Commercial |
$828.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.34
|
| Rate for Payer: Health EOS Commercial |
$801.57
|
| Rate for Payer: HFN Commercial |
$828.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.34
|
| Rate for Payer: Multiplan Commercial |
$720.51
|
| Rate for Payer: NAPHCARE Commercial |
$441.51
|
| Rate for Payer: Preferred Network Access Commercial |
$828.59
|
| Rate for Payer: Quartz Beloit One Network |
$441.31
|
| Rate for Payer: Quartz Commercial |
$585.42
|
| Rate for Payer: Quartz Medicare Advantage |
$294.34
|
| Rate for Payer: The Alliance Commercial |
$1,177.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.34
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$495.35
|
| Rate for Payer: Wellcare Medicare |
$294.34
|
| Rate for Payer: WPS Commercial |
$667.08
|
|
|
ED Colorectal Cancer Screening: Flexible Sigmoidoscopy
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
6174791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.26 |
| Max. Negotiated Rate |
$3,914.73 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.26
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$978.68
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,640.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$978.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$978.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$978.68
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$978.68
|
| Rate for Payer: The Alliance Commercial |
$3,914.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
ED Colorectal Cancer Screening: Flexible Sigmoidoscopy
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
6174791
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
ED Colposcopy Of Cervix
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
6174399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
ED Colposcopy Of Cervix
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
6174399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$212.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.23
|
| Rate for Payer: Anthem Medicare Advantage |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| 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 |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| 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 |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| 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 |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| 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 |
$192.76
|
| Rate for Payer: Wellcare Medicare |
$212.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
ED Colposcopy with Biopsy Cervix
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
6174400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$383.68 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.03
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$383.68
|
| Rate for Payer: Health EOS Commercial |
$371.17
|
| Rate for Payer: HFN Commercial |
$383.68
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: Preferred Network Access Commercial |
$383.68
|
| Rate for Payer: Quartz Beloit One Network |
$204.35
|
| Rate for Payer: Quartz Commercial |
$250.22
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
ED Colposcopy with Biopsy Cervix
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
6174400
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.18 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$271.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.18
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$383.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Health EOS Commercial |
$371.17
|
| Rate for Payer: HFN Commercial |
$383.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Preferred Network Access Commercial |
$383.68
|
| Rate for Payer: Quartz Beloit One Network |
$204.35
|
| Rate for Payer: Quartz Commercial |
$271.08
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
ED Complex Uroflometry
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6174096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$313.87
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
ED Complex Uroflometry
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
6174096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.10
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$340.03
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
