|
ED I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Facility
|
OP
|
$1,432.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
6181611
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$12,227.57 |
| Rate for Payer: Aetna Commercial |
$1,340.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,280.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,056.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$968.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$744.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$714.85
|
| Rate for Payer: Anthem Medicare Advantage |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,056.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,056.89
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cigna Commercial |
$1,370.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,056.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,056.89
|
| Rate for Payer: Health EOS Commercial |
$1,325.46
|
| Rate for Payer: HFN Commercial |
$1,370.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,371.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,056.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,056.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,056.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,056.89
|
| Rate for Payer: Multiplan Commercial |
$1,191.42
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.14
|
| Rate for Payer: Quartz Beloit One Network |
$729.75
|
| Rate for Payer: Quartz Commercial |
$968.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,056.89
|
| Rate for Payer: The Alliance Commercial |
$12,227.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,056.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$819.10
|
| Rate for Payer: Wellcare Medicare |
$3,056.89
|
| Rate for Payer: WPS Commercial |
$1,103.07
|
|
|
ED I&D of hematoma, seroma or fluid collection
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
6172925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.21 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| 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 |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| 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 |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| 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 |
$209.92
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
ED I&D of hematoma, seroma or fluid collection
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
6172925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
ED I&D of hematoma, seroma or fluid collection, Extended
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 10140 22
|
| Hospital Charge Code |
6173138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.84 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$127.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.94
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$296.76
|
| Rate for Payer: Quartz Medicare Advantage |
$273.94
|
| Rate for Payer: The Alliance Commercial |
$228.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
ED I&D of hematoma, seroma or fluid collection, Extended
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 10140 22
|
| Hospital Charge Code |
6173138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.71 |
| Max. Negotiated Rate |
$420.04 |
| Rate for Payer: Aetna Commercial |
$410.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.98
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$420.04
|
| Rate for Payer: Health EOS Commercial |
$406.34
|
| Rate for Payer: HFN Commercial |
$420.04
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Preferred Network Access Commercial |
$420.04
|
| Rate for Payer: Quartz Beloit One Network |
$223.71
|
| Rate for Payer: Quartz Commercial |
$273.94
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$338.16
|
|
|
ED I&D scrotal abcess
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
6173476
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.03 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.03
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| 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 |
$174.90
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| 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 |
$485.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$394.11
|
| 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 |
$333.48
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
ED I&D scrotal abcess
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
6173476
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$363.79
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
ED Incisional Biopsy Skin Ea Sep/Additional Lesion
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
6173145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
ED Incisional Biopsy Skin Ea Sep/Additional Lesion
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
6173145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$97.51
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
ED Incisional Biopsy Skin Single Lesion
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
6173144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$205.71 |
| Rate for Payer: Aetna Commercial |
$201.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.51
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$205.71
|
| Rate for Payer: Health EOS Commercial |
$199.00
|
| Rate for Payer: HFN Commercial |
$205.71
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: Preferred Network Access Commercial |
$205.71
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: WPS Commercial |
$165.61
|
|
|
ED Incisional Biopsy Skin Single Lesion
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
6173144
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$201.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.33
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$205.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$199.00
|
| Rate for Payer: HFN Commercial |
$205.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$205.71
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$145.34
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$165.61
|
|
|
ED Incision and Drainage Abscess: Peritonsillar
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
6174081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.16 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.16
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| 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 |
$126.30
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| 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 |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| 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 |
$350.27
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$284.60
|
| 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 |
$240.81
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
ED Incision and Drainage Abscess: Peritonsillar
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
6174081
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$262.70
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
ED Incision And Drainage Of Bartholin's Gland Abscess
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
6173477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$212.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.28
|
| Rate for Payer: Anthem Medicare Advantage |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| 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 |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$212.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$212.76
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| 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 |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| 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 |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$212.76
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
ED Incision And Drainage Of Bartholin's Gland Abscess
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
6173477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
ED Incision and drainage of pilonidal cyst; complicated
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
6172922
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$466.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.41
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$476.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$460.95
|
| Rate for Payer: HFN Commercial |
$476.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$414.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$476.49
|
| Rate for Payer: Quartz Beloit One Network |
$253.78
|
| Rate for Payer: Quartz Commercial |
$336.65
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$284.86
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$383.61
|
|
|
ED Incision and drainage of pilonidal cyst; complicated
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
6172922
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$476.49 |
| Rate for Payer: Aetna Commercial |
$466.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.50
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$476.49
|
| Rate for Payer: Health EOS Commercial |
$460.95
|
| Rate for Payer: HFN Commercial |
$476.49
|
| Rate for Payer: Multiplan Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$476.49
|
| Rate for Payer: Quartz Beloit One Network |
$253.78
|
| Rate for Payer: Quartz Commercial |
$310.75
|
| Rate for Payer: WEA Trust Commercial |
$284.86
|
| Rate for Payer: WPS Commercial |
$383.61
|
|
|
ED Incision And Drainage Of Pilonidal Cyst, Simple
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
6173136
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$267.70
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$308.88
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
ED Incision And Drainage Of Pilonidal Cyst, Simple
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
6173136
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$378.89 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$247.10
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
ED Incision And Drainage Of Vulva Or Perineal Abscess
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
6174390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$298.02 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$558.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.96
|
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.02
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.07
|
| 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 |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$571.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Health EOS Commercial |
$552.58
|
| Rate for Payer: HFN Commercial |
$571.21
|
| 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 |
$496.70
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Preferred Network Access Commercial |
$571.21
|
| Rate for Payer: Quartz Beloit One Network |
$304.23
|
| Rate for Payer: Quartz Commercial |
$403.57
|
| 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 |
$341.48
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
| Rate for Payer: WPS Commercial |
$459.87
|
|
|
ED Incision And Drainage Of Vulva Or Perineal Abscess
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
6174390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.23 |
| Max. Negotiated Rate |
$571.21 |
| Rate for Payer: Aetna Commercial |
$558.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.07
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$571.21
|
| Rate for Payer: Health EOS Commercial |
$552.58
|
| Rate for Payer: HFN Commercial |
$571.21
|
| Rate for Payer: Multiplan Commercial |
$496.70
|
| Rate for Payer: Preferred Network Access Commercial |
$571.21
|
| Rate for Payer: Quartz Beloit One Network |
$304.23
|
| Rate for Payer: Quartz Commercial |
$372.53
|
| Rate for Payer: WEA Trust Commercial |
$341.48
|
| Rate for Payer: WPS Commercial |
$459.87
|
|
|
ED Incision and drainage, perianal abscess, superficial
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
6172944
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$380.81 |
| Rate for Payer: Aetna Commercial |
$372.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.38
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$380.81
|
| Rate for Payer: Health EOS Commercial |
$368.39
|
| Rate for Payer: HFN Commercial |
$380.81
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: Preferred Network Access Commercial |
$380.81
|
| Rate for Payer: Quartz Beloit One Network |
$202.82
|
| Rate for Payer: Quartz Commercial |
$248.35
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: WPS Commercial |
$306.58
|
|
|
ED Incision and drainage, perianal abscess, superficial
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
6172944
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.68 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$372.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.68
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.38
|
| 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 |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$380.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Health EOS Commercial |
$368.39
|
| Rate for Payer: HFN Commercial |
$380.81
|
| 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 |
$331.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Preferred Network Access Commercial |
$380.81
|
| Rate for Payer: Quartz Beloit One Network |
$202.82
|
| Rate for Payer: Quartz Commercial |
$269.05
|
| 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 |
$227.66
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
| Rate for Payer: WPS Commercial |
$306.58
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; complicated
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
6173137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.50
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| 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 |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| 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 |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$425.88
|
| 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 |
$360.36
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; complicated
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
6173137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$393.12
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
