|
ED Destruction of precancerous lesions; 15 or more lesions
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
6173181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.96 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| 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 |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| 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 |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| 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 |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| 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 |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
ED Destruction of precancerous lesions; 2-14 lesions
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
6173180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
ED Destruction of precancerous lesions; 2-14 lesions
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
6173180
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
ED Dilation Of Cervical Canal
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
6174406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.24 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.24
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
ED Dilation Of Cervical Canal
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
6174406
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
ED Dilation of Female Urethra, Initial
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
6174102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.24 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
ED Dilation of Female Urethra, Initial
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
6174102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
ED Dilation of Female Urethra, Subsequent
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
6174103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
ED Dilation of Female Urethra, Subsequent
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
6174103
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| 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 |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| 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 |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| 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 |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
ED Dilation Of Lacrimal Punctum
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
6174438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$393.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Anthem Medicare Advantage |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.82
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$393.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$393.82
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$393.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$393.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$393.82
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$590.73
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$393.82
|
| Rate for Payer: The Alliance Commercial |
$1,575.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: Wellcare Medicare |
$393.82
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
ED Dilation Of Lacrimal Punctum
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
6174438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6174100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.04
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.72
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$150.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$145.96
|
| Rate for Payer: HFN Commercial |
$150.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$150.88
|
| Rate for Payer: Quartz Beloit One Network |
$80.36
|
| Rate for Payer: Quartz Commercial |
$106.60
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$90.20
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$121.47
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
6174100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.92
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$150.88
|
| Rate for Payer: Health EOS Commercial |
$145.96
|
| Rate for Payer: HFN Commercial |
$150.88
|
| Rate for Payer: Multiplan Commercial |
$131.20
|
| Rate for Payer: NAPHCARE Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.88
|
| Rate for Payer: Quartz Beloit One Network |
$80.36
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: WEA Trust Commercial |
$90.20
|
| Rate for Payer: WPS Commercial |
$121.47
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6174101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.20
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| 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 |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| 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 |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| 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 |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$107.25
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
ED Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
6174101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
ED Drainage External Auditory Canal, Abscess
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6174442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
ED Drainage External Auditory Canal, Abscess
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
6174442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Complicated
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6174441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$177.87 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$217.80
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$217.80
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Complicated
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 69005
|
| Hospital Charge Code |
6174441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.24
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$235.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6174440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.92 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
ED Drainage External Ear Abscess Or Hematoma; Simple Incision
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
6174440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
ED Drainage of Abscess, Cyst, Hematoma from Dentoalveiolar structures
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6180613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.64
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| 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 |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| 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 |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| 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 |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$287.95
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
ED Drainage of Abscess, Cyst, Hematoma from Dentoalveiolar structures
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
6180613
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.07 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$265.80
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
ED Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6172941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$270.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.68
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| 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 |
$382.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$270.40
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$308.13
|
|
|
ED Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
6172941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$382.72 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$382.72
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$308.13
|
|
