|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) <= 2.5cm
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
6173154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.16 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 2.6-7.5cm
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
6172932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.16 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 2.6-7.5cm
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
6172932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) >30.0cm
|
Facility
|
OP
|
$1,015.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
6173157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$950.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$907.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$686.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$527.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$506.69
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$559.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cigna Commercial |
$971.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$939.48
|
| Rate for Payer: HFN Commercial |
$971.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$844.48
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$971.15
|
| Rate for Payer: Quartz Beloit One Network |
$517.24
|
| Rate for Payer: Quartz Commercial |
$686.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$580.58
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$781.85
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) >30.0cm
|
Facility
|
IP
|
$1,015.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
6173157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$517.24 |
| Max. Negotiated Rate |
$971.15 |
| Rate for Payer: Aetna Commercial |
$950.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$907.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$559.47
|
| Rate for Payer: Cash Price |
$304.50
|
| Rate for Payer: Cigna Commercial |
$971.15
|
| Rate for Payer: Health EOS Commercial |
$939.48
|
| Rate for Payer: HFN Commercial |
$971.15
|
| Rate for Payer: Multiplan Commercial |
$844.48
|
| Rate for Payer: Preferred Network Access Commercial |
$971.15
|
| Rate for Payer: Quartz Beloit One Network |
$517.24
|
| Rate for Payer: Quartz Commercial |
$633.36
|
| Rate for Payer: WEA Trust Commercial |
$580.58
|
| Rate for Payer: WPS Commercial |
$781.85
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 7.6-12.5cm
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
6172933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
ED Layer closure of wounds (scalp, axillae, trunk, extremities) 7.6-12.5cm
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
6172933
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.70 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.70
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$250.12
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
ED Ligation or Biopsy; Temporal Artery
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
6173893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.57 |
| Max. Negotiated Rate |
$804.67 |
| Rate for Payer: Aetna Commercial |
$787.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.56
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$804.67
|
| Rate for Payer: Health EOS Commercial |
$778.43
|
| Rate for Payer: HFN Commercial |
$804.67
|
| Rate for Payer: Multiplan Commercial |
$699.71
|
| Rate for Payer: Preferred Network Access Commercial |
$804.67
|
| Rate for Payer: Quartz Beloit One Network |
$428.57
|
| Rate for Payer: Quartz Commercial |
$524.78
|
| Rate for Payer: WEA Trust Commercial |
$481.05
|
| Rate for Payer: WPS Commercial |
$647.82
|
|
|
ED Ligation or Biopsy; Temporal Artery
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
6173893
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$787.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$419.83
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.56
|
| 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 |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$804.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$778.43
|
| Rate for Payer: HFN Commercial |
$804.67
|
| 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 |
$699.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$804.67
|
| Rate for Payer: Quartz Beloit One Network |
$428.57
|
| Rate for Payer: Quartz Commercial |
$568.52
|
| 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 |
$481.05
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$647.82
|
|
|
ED Long Arm Split
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
6173473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
ED Long Arm Split
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
6173473
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$112.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.87
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$112.22
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
ED Loop Electrode Excision
|
Facility
|
IP
|
$982.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
6174405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$500.43 |
| Max. Negotiated Rate |
$939.58 |
| Rate for Payer: Aetna Commercial |
$919.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.28
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$939.58
|
| Rate for Payer: Health EOS Commercial |
$908.94
|
| Rate for Payer: HFN Commercial |
$939.58
|
| Rate for Payer: Multiplan Commercial |
$817.02
|
| Rate for Payer: Preferred Network Access Commercial |
$939.58
|
| Rate for Payer: Quartz Beloit One Network |
$500.43
|
| Rate for Payer: Quartz Commercial |
$612.77
|
| Rate for Payer: WEA Trust Commercial |
$561.70
|
| Rate for Payer: WPS Commercial |
$756.43
|
|
|
ED Loop Electrode Excision
|
Facility
|
OP
|
$982.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
6174405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Commercial |
$919.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.30
|
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.21
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cash Price |
$294.60
|
| Rate for Payer: Cigna Commercial |
$939.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Health EOS Commercial |
$908.94
|
| Rate for Payer: HFN Commercial |
$939.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: Multiplan Commercial |
$817.02
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Preferred Network Access Commercial |
$939.58
|
| Rate for Payer: Quartz Beloit One Network |
$500.43
|
| Rate for Payer: Quartz Commercial |
$663.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$561.70
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
| Rate for Payer: WPS Commercial |
$756.43
|
|
|
ED LUMBAR PUNCTURE W/FLUORO OR CT
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
6174410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.31 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$742.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Anthem Medicare Advantage |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$742.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$742.86
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$742.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$742.86
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,763.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$742.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$742.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$742.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$742.86
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,114.29
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$742.86
|
| Rate for Payer: The Alliance Commercial |
$2,971.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$742.86
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: Wellcare Medicare |
$742.86
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ED LUMBAR PUNCTURE W/FLUORO OR CT
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 62328
|
| Hospital Charge Code |
6174410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ED Measurement of Post-Voiding residual Urine by Ultrasound
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
6174792
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
ED Measurement of Post-Voiding residual Urine by Ultrasound
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
6174792
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
ED Myringotomy Incision With Aspiration Or Inflation
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
6174445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$223.14 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.14
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| 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 |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$249.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$249.26
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| 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 |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| 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 |
$255.68
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
ED Myringotomy Incision With Aspiration Or Inflation
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
6174445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
ED Nasal Endoscopy, diagnostic
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
6173884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.99 |
| Max. Negotiated Rate |
$398.03 |
| Rate for Payer: Aetna Commercial |
$389.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.30
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$398.03
|
| Rate for Payer: Health EOS Commercial |
$385.05
|
| Rate for Payer: HFN Commercial |
$398.03
|
| Rate for Payer: Multiplan Commercial |
$346.11
|
| Rate for Payer: Preferred Network Access Commercial |
$398.03
|
| Rate for Payer: Quartz Beloit One Network |
$211.99
|
| Rate for Payer: Quartz Commercial |
$259.58
|
| Rate for Payer: WEA Trust Commercial |
$237.95
|
| Rate for Payer: WPS Commercial |
$320.44
|
|
|
ED Nasal Endoscopy, diagnostic
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
6173884
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.67 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$389.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.07
|
| Rate for Payer: Aetna Managed Medicare |
$210.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$281.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$207.67
|
| Rate for Payer: Anthem Medicare Advantage |
$210.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.30
|
| 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 |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$398.03
|
| 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 |
$385.05
|
| Rate for Payer: HFN Commercial |
$398.03
|
| 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 |
$346.11
|
| Rate for Payer: NAPHCARE Commercial |
$315.09
|
| Rate for Payer: Preferred Network Access Commercial |
$398.03
|
| Rate for Payer: Quartz Beloit One Network |
$211.99
|
| Rate for Payer: Quartz Commercial |
$281.22
|
| 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 |
$237.95
|
| Rate for Payer: Wellcare Medicare |
$210.06
|
| Rate for Payer: WPS Commercial |
$320.44
|
|
|
ED Nasal Hemorrahage
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
6173886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$7,492.58 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$7,492.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
ED Nasal Hemorrahage
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
6173886
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
ED Nasal/Sinus Endoscopy With Debridement
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
6173885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$7,492.58 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$361.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.44
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$470.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$7,492.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
|
ED Nasal/Sinus Endoscopy With Debridement
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
6173885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.68 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$434.30
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
