|
ED Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
6174326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$629.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.93
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$454.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$349.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$335.96
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$370.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$643.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$622.93
|
| Rate for Payer: HFN Commercial |
$643.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$559.94
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$643.93
|
| Rate for Payer: Quartz Beloit One Network |
$342.96
|
| Rate for Payer: Quartz Commercial |
$454.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$384.96
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$518.41
|
|
|
ED Insertion of temporary indweling bladder catheter, complicated
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
6219975
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.36 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.36
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
ED Insertion of temporary indweling bladder catheter, complicated
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 51703
|
| Hospital Charge Code |
6219975
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.24 |
| Max. Negotiated Rate |
$173.18 |
| Rate for Payer: Aetna Commercial |
$169.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.77
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$173.18
|
| Rate for Payer: Health EOS Commercial |
$167.53
|
| Rate for Payer: HFN Commercial |
$173.18
|
| Rate for Payer: Multiplan Commercial |
$150.59
|
| Rate for Payer: Preferred Network Access Commercial |
$173.18
|
| Rate for Payer: Quartz Beloit One Network |
$92.24
|
| Rate for Payer: Quartz Commercial |
$112.94
|
| Rate for Payer: WEA Trust Commercial |
$103.53
|
| Rate for Payer: WPS Commercial |
$139.42
|
|
|
ED Insertion of Temporary Indwelling Bladder Catheter
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6174093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
ED Insertion of Temporary Indwelling Bladder Catheter
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
6174093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.35 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.35
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$130.47
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
ED Insertion PICC w/o IMG GDN 5 yr/>
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
6181648
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.05 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.05
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$381.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
ED Insertion PICC w/o IMG GDN 5 yr/>
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
6181648
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.92 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
ED Introduction any hemostatic agent or pack for spontaneous/traumatic non-OB vag hemorrhage
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
6173478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.34 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$212.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.34
|
| Rate for Payer: Anthem Medicare Advantage |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| 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 |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| 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 |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| 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 |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| 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 |
$113.83
|
| Rate for Payer: Wellcare Medicare |
$212.76
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
ED Introduction any hemostatic agent or pack for spontaneous/traumatic non-OB vag hemorrhage
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
6173478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$124.18
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
ED Intubation
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
6173475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| 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 |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| 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 |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| 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 |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| 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 |
$187.62
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
ED Intubation
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
6173475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
ED Iridotomy/Iridectomy by Laser Surgery
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
6174418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$725.67 |
| Max. Negotiated Rate |
$1,362.48 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$888.58
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
ED Iridotomy/Iridectomy by Laser Surgery
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
6174418
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,332.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.63
|
| Rate for Payer: Aetna Managed Medicare |
$578.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.86
|
| Rate for Payer: Anthem Medicare Advantage |
$578.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$578.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$578.81
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cash Price |
$427.20
|
| Rate for Payer: Cigna Commercial |
$1,362.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$578.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$578.81
|
| Rate for Payer: Health EOS Commercial |
$1,318.05
|
| Rate for Payer: HFN Commercial |
$1,362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,153.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$578.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$578.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$578.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$578.81
|
| Rate for Payer: Multiplan Commercial |
$1,184.77
|
| Rate for Payer: NAPHCARE Commercial |
$868.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.48
|
| Rate for Payer: Quartz Beloit One Network |
$725.67
|
| Rate for Payer: Quartz Commercial |
$962.62
|
| Rate for Payer: Quartz Medicare Advantage |
$578.81
|
| Rate for Payer: The Alliance Commercial |
$2,315.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$578.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$814.53
|
| Rate for Payer: Wellcare Medicare |
$578.81
|
| Rate for Payer: WPS Commercial |
$1,096.91
|
|
|
ED Irrigation Corpora Cavernosa Priapism
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
6181647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.17
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
ED Irrigation Corpora Cavernosa Priapism
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
6181647
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
ED Lacrimal Closure by plug, each
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 68761
|
| Hospital Charge Code |
6174436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.19 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$334.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Anthem Medicare Advantage |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.04
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.04
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.04
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$501.06
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| Rate for Payer: Quartz Medicare Advantage |
$334.04
|
| Rate for Payer: The Alliance Commercial |
$1,336.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$334.04
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
ED Lacrimal Closure by plug, each
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 68761
|
| Hospital Charge Code |
6174436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
ED Lacrimal Closure by plug, each BILAT
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 68761 50
|
| Hospital Charge Code |
6174437
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Aetna Managed Medicare |
$228.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.52
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: NAPHCARE Commercial |
$489.22
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$529.98
|
| Rate for Payer: Quartz Medicare Advantage |
$489.22
|
| Rate for Payer: The Alliance Commercial |
$407.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
ED Lacrimal Closure by plug, each BILAT
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 68761 50
|
| Hospital Charge Code |
6174437
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$489.22
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
ED Laryngoscopy, Diagnostic
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
6173889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$190.94
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
ED Laryngoscopy, Diagnostic
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
6173889
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.76 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Aetna Managed Medicare |
$210.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.76
|
| Rate for Payer: Anthem Medicare Advantage |
$210.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.06
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.06
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$781.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.06
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$315.09
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$206.86
|
| Rate for Payer: Quartz Medicare Advantage |
$210.06
|
| Rate for Payer: The Alliance Commercial |
$840.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.06
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: Wellcare Medicare |
$210.06
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
ED Laryngoscopy with Operating Microscope or Telescope
|
Facility
|
IP
|
$1,478.00
|
|
|
Service Code
|
CPT 31536
|
| Hospital Charge Code |
6173888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$753.19 |
| Max. Negotiated Rate |
$1,414.15 |
| Rate for Payer: Aetna Commercial |
$1,383.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.67
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$1,414.15
|
| Rate for Payer: Health EOS Commercial |
$1,368.04
|
| Rate for Payer: HFN Commercial |
$1,414.15
|
| Rate for Payer: Multiplan Commercial |
$1,229.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,414.15
|
| Rate for Payer: Quartz Beloit One Network |
$753.19
|
| Rate for Payer: Quartz Commercial |
$922.27
|
| Rate for Payer: WEA Trust Commercial |
$845.42
|
| Rate for Payer: WPS Commercial |
$1,138.50
|
|
|
ED Laryngoscopy with Operating Microscope or Telescope
|
Facility
|
OP
|
$1,478.00
|
|
|
Service Code
|
CPT 31536
|
| Hospital Charge Code |
6173888
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$15,694.68 |
| Rate for Payer: Aetna Commercial |
$1,383.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.92
|
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.82
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cash Price |
$443.40
|
| Rate for Payer: Cigna Commercial |
$1,414.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Health EOS Commercial |
$1,368.04
|
| Rate for Payer: HFN Commercial |
$1,414.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: Multiplan Commercial |
$1,229.70
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,414.15
|
| Rate for Payer: Quartz Beloit One Network |
$753.19
|
| Rate for Payer: Quartz Commercial |
$999.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$15,694.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$845.42
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
| Rate for Payer: WPS Commercial |
$1,138.50
|
|
|
ED Laryngoscopy w/removal foreign body
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
6173545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.24 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$411.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Anthem Medicare Advantage |
$411.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$411.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$411.61
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$411.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$411.61
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,531.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$411.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$411.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$411.61
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$617.42
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$411.61
|
| Rate for Payer: The Alliance Commercial |
$1,646.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$411.61
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: Wellcare Medicare |
$411.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
ED Laryngoscopy w/removal foreign body
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
6173545
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
