|
ED Removal of Foreign Body: Conjunctival Imbedded
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
6174412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$205.71 |
| Rate for Payer: Aetna Commercial |
$201.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.51
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$205.71
|
| Rate for Payer: Health EOS Commercial |
$199.00
|
| Rate for Payer: HFN Commercial |
$205.71
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: Preferred Network Access Commercial |
$205.71
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: WPS Commercial |
$165.61
|
|
|
ED Removal of Foreign Body: Cornea
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
6174413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
ED Removal of Foreign Body: Cornea
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
6174413
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
ED Removal of foreign body, external eye; corneal, w/o slit lamp
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
6172947
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
ED Removal of foreign body, external eye; corneal, w/o slit lamp
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
6172947
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.36 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$470.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.36
|
| Rate for Payer: Anthem Medicare Advantage |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$470.13
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$470.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$470.13
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,748.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$470.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$470.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$470.13
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$470.13
|
| Rate for Payer: The Alliance Commercial |
$1,880.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
ED Removal of Foreign Body: External Eye Superficial
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
6172921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.89
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
ED Removal of Foreign Body: External Eye Superficial
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
6172921
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$83.62
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
ED Removal of Foreign Body from External Auditory Canal
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
6172915
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.74
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$216.32
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
ED Removal of Foreign Body from External Auditory Canal
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
6172915
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
ED Removal of foreign body in muscle or tendon; simple
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
6173868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.24
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| 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 |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| 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 |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$221.05
|
| 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 |
$187.04
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
ED Removal of foreign body in muscle or tendon; simple
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
6173868
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.64 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$204.05
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
ED Removal of Foreign Body; Intranasal
|
Facility
|
OP
|
$4,435.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
6173883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,998.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,306.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,213.95
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,998.06
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
ED Removal of Foreign Body; Intranasal
|
Facility
|
IP
|
$4,435.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
6173883
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,260.08 |
| Max. Negotiated Rate |
$4,243.41 |
| Rate for Payer: Aetna Commercial |
$4,151.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.57
|
| Rate for Payer: Cash Price |
$1,330.50
|
| Rate for Payer: Cigna Commercial |
$4,243.41
|
| Rate for Payer: Health EOS Commercial |
$4,105.04
|
| Rate for Payer: HFN Commercial |
$4,243.41
|
| Rate for Payer: Multiplan Commercial |
$3,689.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,260.08
|
| Rate for Payer: Quartz Commercial |
$2,767.44
|
| Rate for Payer: WEA Trust Commercial |
$2,536.82
|
| Rate for Payer: WPS Commercial |
$3,416.28
|
|
|
ED Removal Of Intrauterine Device
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
6174409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
ED Removal Of Intrauterine Device
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
6174409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
ED Removal Of Non-Biodegradable Drug Delivery Implant
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
6173149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$470.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$606.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.40
|
| Rate for Payer: Anthem Medicare Advantage |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$470.13
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$470.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$470.13
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,748.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$470.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$470.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$470.13
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$470.13
|
| Rate for Payer: The Alliance Commercial |
$1,880.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare PPO |
$136.50
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
ED Removal Of Non-Biodegradable Drug Delivery Implant
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
6173149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
ED Removal Of Skin Tags 15 Or Less
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
6174957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.25 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.25
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$214.29
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
ED Removal Of Skin Tags 15 Or Less
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
6174957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$197.81
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
ED Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peri
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
6173891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.59 |
| Max. Negotiated Rate |
$556.86 |
| Rate for Payer: Aetna Commercial |
$544.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$320.80
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$556.86
|
| Rate for Payer: Health EOS Commercial |
$538.70
|
| Rate for Payer: HFN Commercial |
$556.86
|
| Rate for Payer: Multiplan Commercial |
$484.22
|
| Rate for Payer: Preferred Network Access Commercial |
$556.86
|
| Rate for Payer: Quartz Beloit One Network |
$296.59
|
| Rate for Payer: Quartz Commercial |
$363.17
|
| Rate for Payer: WEA Trust Commercial |
$332.90
|
| Rate for Payer: WPS Commercial |
$448.31
|
|
|
ED Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peri
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
6173891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.53 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$544.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$393.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$302.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$290.53
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$320.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$556.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$538.70
|
| Rate for Payer: HFN Commercial |
$556.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$484.22
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$556.86
|
| Rate for Payer: Quartz Beloit One Network |
$296.59
|
| Rate for Payer: Quartz Commercial |
$393.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$332.90
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$448.31
|
|
|
ED Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
6173890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
ED Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
6173890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$206.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.17
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
ED Removal Subcutaneous Cardiac Monitor
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
6195196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.16 |
| Max. Negotiated Rate |
$713.77 |
| Rate for Payer: Aetna Commercial |
$698.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$667.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.20
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$713.77
|
| Rate for Payer: Health EOS Commercial |
$690.50
|
| Rate for Payer: HFN Commercial |
$713.77
|
| Rate for Payer: Multiplan Commercial |
$620.67
|
| Rate for Payer: Preferred Network Access Commercial |
$713.77
|
| Rate for Payer: Quartz Beloit One Network |
$380.16
|
| Rate for Payer: Quartz Commercial |
$465.50
|
| Rate for Payer: WEA Trust Commercial |
$426.71
|
| Rate for Payer: WPS Commercial |
$574.64
|
|
|
ED Removal Subcutaneous Cardiac Monitor
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
6195196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$698.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$667.22
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$387.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.40
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$713.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$690.50
|
| Rate for Payer: HFN Commercial |
$713.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$620.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$713.77
|
| Rate for Payer: Quartz Beloit One Network |
$380.16
|
| Rate for Payer: Quartz Commercial |
$504.30
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$426.71
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$574.64
|
|
