|
ED CPAP Ventilation CPAP Initiation & Mgmt
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
6181649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.00
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Cryocautery Of Cervix, Initial Or Repeat
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6174404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.00
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Cryocautery Of Cervix, Initial Or Repeat
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
6174404
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.40
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.09
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$317.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$317.09
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$198.25
|
| Rate for Payer: Quartz Medicare Advantage |
$317.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6181630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.08
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
ED CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 30905
|
| Hospital Charge Code |
6181630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
ED Cystourethroscopy
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
6174097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.32
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
| 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 |
$721.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$509.60
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$2,700.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
ED Cystourethroscopy
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
6174097
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$470.40
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
ED Cystourethroscopy With Dilation Of Stricture
|
Facility
|
IP
|
$838.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6174098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.62 |
| Max. Negotiated Rate |
$770.96 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.14
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$770.96
|
| Rate for Payer: Health EOS Commercial |
$745.82
|
| Rate for Payer: HFN Commercial |
$770.96
|
| Rate for Payer: Multiplan Commercial |
$670.40
|
| Rate for Payer: NAPHCARE Commercial |
$502.80
|
| Rate for Payer: Preferred Network Access Commercial |
$770.96
|
| Rate for Payer: Quartz Beloit One Network |
$410.62
|
| Rate for Payer: Quartz Commercial |
$502.80
|
| Rate for Payer: WEA Trust Commercial |
$460.90
|
| Rate for Payer: WPS Commercial |
$620.71
|
|
|
ED Cystourethroscopy With Dilation Of Stricture
|
Facility
|
OP
|
$838.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
6174098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$754.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$544.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.24
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cash Price |
$251.40
|
| Rate for Payer: Cigna Commercial |
$770.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$745.82
|
| Rate for Payer: HFN Commercial |
$770.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$670.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$770.96
|
| Rate for Payer: Quartz Beloit One Network |
$410.62
|
| Rate for Payer: Quartz Commercial |
$544.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$460.90
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$620.71
|
|
|
ED Cystourethroscopy With Removal of Ureteral Stent
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
6174099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
ED Cystourethroscopy With Removal of Ureteral Stent
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
6174099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
ED Debridement, Masoidectomy Cavity, simple
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6174444
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ED Debridement, Masoidectomy Cavity, simple
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 69220
|
| Hospital Charge Code |
6174444
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ED Debridement of Nails, 1-5
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
6174787
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
ED Debridement of Nails, 1-5
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
6174787
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
ED Debridement of Nails, >5
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
6174788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
ED Debridement of Nails, >5
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
6174788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
ED Debridement of Open Wound; 20 sq cm or less
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
6174451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.00
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Debridement of Open Wound; 20 sq cm or less
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
6174451
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$274.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.40
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$280.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$271.45
|
| Rate for Payer: HFN Commercial |
$280.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$280.60
|
| Rate for Payer: Quartz Beloit One Network |
$149.45
|
| Rate for Payer: Quartz Commercial |
$198.25
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$167.75
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$225.91
|
|
|
ED Debridement of partial thickness burn; initial or subsequent, less than 5% BSA
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
6172914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
ED Debridement of partial thickness burn; initial or subsequent, less than 5% BSA
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 16020
|
| Hospital Charge Code |
6172914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.48
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
ED Debridement Open Wound Each Additional 20 sq cm
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
6196740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.13 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
ED Debridement Open Wound Each Additional 20 sq cm
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
6196740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.55
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$284.05
|
| Rate for Payer: Quartz Medicare Advantage |
$262.20
|
| Rate for Payer: The Alliance Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
ED Declotting or Thrombolytic Agent of Implnted Vascular Access Device or Catheter
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
6173892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
ED Declotting or Thrombolytic Agent of Implnted Vascular Access Device or Catheter
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
6173892
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$23.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: The Alliance Commercial |
$1,338.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
