|
ED Repair, complex (trunk) 1.1-2.5cm
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
6173167
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.70 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.70
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
ED Repair, complex (trunk) 2.6-7.5cm
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
6173168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
ED Repair, complex (trunk) 2.6-7.5cm
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
6173168
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
ED Repair, complex (trunk) each additional <= 5cm
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
6173169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
ED Repair, complex (trunk) each additional <= 5cm
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
6173169
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$55.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.42
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$117.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$117.94
|
| Rate for Payer: The Alliance Commercial |
$227.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
ED Repair lip, full thickness; vermilion only
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
6173864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
ED Repair lip, full thickness; vermilion only
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
6173864
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$567.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$676.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$499.20
|
| Rate for Payer: Anthem Medicare Advantage |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$567.58
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$567.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$567.58
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,111.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$567.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$567.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$567.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$567.58
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$851.37
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$567.58
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$567.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: Wellcare Medicare |
$567.58
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
ED Repair Of Blepharoptosis: Levator Resection Or Advancement, Exteranl Approach
|
Facility
|
OP
|
$4,473.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
6174428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$4,186.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,000.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,023.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,325.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,232.92
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,465.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cigna Commercial |
$4,279.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$4,140.21
|
| Rate for Payer: HFN Commercial |
$4,279.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: Multiplan Commercial |
$3,721.54
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,279.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.44
|
| Rate for Payer: Quartz Commercial |
$3,023.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,558.56
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$3,445.55
|
|
|
ED Repair Of Blepharoptosis: Levator Resection Or Advancement, Exteranl Approach
|
Facility
|
IP
|
$4,473.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
6174428
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,279.44 |
| Max. Negotiated Rate |
$4,279.77 |
| Rate for Payer: Aetna Commercial |
$4,186.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,000.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,465.52
|
| Rate for Payer: Cash Price |
$1,341.90
|
| Rate for Payer: Cigna Commercial |
$4,279.77
|
| Rate for Payer: Health EOS Commercial |
$4,140.21
|
| Rate for Payer: HFN Commercial |
$4,279.77
|
| Rate for Payer: Multiplan Commercial |
$3,721.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,279.77
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.44
|
| Rate for Payer: Quartz Commercial |
$2,791.15
|
| Rate for Payer: WEA Trust Commercial |
$2,558.56
|
| Rate for Payer: WPS Commercial |
$3,445.55
|
|
|
ED Repair of Ectropion, Extensive
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
6174429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,473.25 |
| Max. Negotiated Rate |
$2,766.11 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,803.98
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
ED Repair of Ectropion, Extensive
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
CPT 67917
|
| Hospital Charge Code |
6174429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,954.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,503.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,443.19
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,954.32
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
ED Repair Of Entropion,Extensive
|
Facility
|
OP
|
$3,837.00
|
|
|
Service Code
|
CPT 67924
|
| Hospital Charge Code |
6174430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$3,591.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,431.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,593.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,995.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,915.43
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,671.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$3,551.53
|
| Rate for Payer: HFN Commercial |
$3,671.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: Multiplan Commercial |
$3,192.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,671.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,955.34
|
| Rate for Payer: Quartz Commercial |
$2,593.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,194.76
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$2,955.64
|
|
|
ED Repair Of Entropion,Extensive
|
Facility
|
IP
|
$3,837.00
|
|
|
Service Code
|
CPT 67924
|
| Hospital Charge Code |
6174430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,955.34 |
| Max. Negotiated Rate |
$3,671.24 |
| Rate for Payer: Aetna Commercial |
$3,591.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,431.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.95
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,671.24
|
| Rate for Payer: Health EOS Commercial |
$3,551.53
|
| Rate for Payer: HFN Commercial |
$3,671.24
|
| Rate for Payer: Multiplan Commercial |
$3,192.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,671.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,955.34
|
| Rate for Payer: Quartz Commercial |
$2,394.29
|
| Rate for Payer: WEA Trust Commercial |
$2,194.76
|
| Rate for Payer: WPS Commercial |
$2,955.64
|
|
|
ED Repair of laceration 2.5 cm /<; floor of mouth &/or anterior two-thirds of tongue
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
6172942
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
ED Repair of laceration 2.5 cm /<; floor of mouth &/or anterior two-thirds of tongue
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
6172942
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$203.17 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$470.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$275.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$203.17
|
| Rate for Payer: Anthem Medicare Advantage |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| 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 |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$470.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$470.13
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| 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 |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| 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 |
$232.80
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
ED Repair of nail bed
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
6172931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$375.58 |
| Max. Negotiated Rate |
$705.16 |
| Rate for Payer: Aetna Commercial |
$689.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.23
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$705.16
|
| Rate for Payer: Health EOS Commercial |
$682.17
|
| Rate for Payer: HFN Commercial |
$705.16
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: Preferred Network Access Commercial |
$705.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.58
|
| Rate for Payer: Quartz Commercial |
$459.89
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: WPS Commercial |
$567.71
|
|
|
ED Repair of nail bed
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
6172931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$689.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$498.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$367.91
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$705.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Health EOS Commercial |
$682.17
|
| Rate for Payer: HFN Commercial |
$705.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Preferred Network Access Commercial |
$705.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.58
|
| Rate for Payer: Quartz Commercial |
$498.21
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
| Rate for Payer: WPS Commercial |
$567.71
|
|
|
ED Revision Of Cornea
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT 65600
|
| Hospital Charge Code |
6174414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$847.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.78
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$865.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$837.67
|
| Rate for Payer: HFN Commercial |
$865.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$865.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.19
|
| Rate for Payer: Quartz Commercial |
$611.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$697.12
|
|
|
ED Revision Of Cornea
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT 65600
|
| Hospital Charge Code |
6174414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$461.19 |
| Max. Negotiated Rate |
$865.90 |
| Rate for Payer: Aetna Commercial |
$847.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.84
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$865.90
|
| Rate for Payer: Health EOS Commercial |
$837.67
|
| Rate for Payer: HFN Commercial |
$865.90
|
| Rate for Payer: Multiplan Commercial |
$752.96
|
| Rate for Payer: Preferred Network Access Commercial |
$865.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.19
|
| Rate for Payer: Quartz Commercial |
$564.72
|
| Rate for Payer: WEA Trust Commercial |
$517.66
|
| Rate for Payer: WPS Commercial |
$697.12
|
|
|
ED Serial Tonometry Exam
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 92100
|
| Hospital Charge Code |
6210139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
ED Serial Tonometry Exam
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 92100
|
| Hospital Charge Code |
6210139
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$313.04 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$32.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| 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 |
$108.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.14
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$70.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$70.51
|
| Rate for Payer: The Alliance Commercial |
$105.46
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
ED Severing Adhesions Of Anterior Segment Laser Technique
|
Facility
|
IP
|
$1,376.00
|
|
|
Service Code
|
CPT 65860
|
| Hospital Charge Code |
6174417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$701.21 |
| Max. Negotiated Rate |
$1,316.56 |
| Rate for Payer: Aetna Commercial |
$1,287.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.45
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,316.56
|
| Rate for Payer: Health EOS Commercial |
$1,273.63
|
| Rate for Payer: HFN Commercial |
$1,316.56
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.56
|
| Rate for Payer: Quartz Beloit One Network |
$701.21
|
| Rate for Payer: Quartz Commercial |
$858.62
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
ED Severing Adhesions Of Anterior Segment Laser Technique
|
Facility
|
OP
|
$1,376.00
|
|
|
Service Code
|
CPT 65860
|
| Hospital Charge Code |
6174417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Commercial |
$1,287.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.69
|
| Rate for Payer: Aetna Managed Medicare |
$578.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$930.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.90
|
| Rate for Payer: Anthem Medicare Advantage |
$578.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$578.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$578.81
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,316.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$578.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$578.81
|
| Rate for Payer: Health EOS Commercial |
$1,273.63
|
| Rate for Payer: HFN Commercial |
$1,316.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,153.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$578.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$578.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$578.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$578.81
|
| Rate for Payer: Multiplan Commercial |
$1,144.83
|
| Rate for Payer: NAPHCARE Commercial |
$868.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.56
|
| Rate for Payer: Quartz Beloit One Network |
$701.21
|
| Rate for Payer: Quartz Commercial |
$930.18
|
| Rate for Payer: Quartz Medicare Advantage |
$578.81
|
| Rate for Payer: The Alliance Commercial |
$2,315.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$578.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$787.07
|
| Rate for Payer: Wellcare Medicare |
$578.81
|
| Rate for Payer: WPS Commercial |
$1,059.93
|
|
|
ED Simple Repair F/E/E/N/L/M 12.6 cm-20.0 cm
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
6195788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.53 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$546.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.33
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.53
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.90
|
| 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 |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| 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 |
$540.55
|
| Rate for Payer: HFN Commercial |
$558.77
|
| 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 |
$485.89
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$558.77
|
| Rate for Payer: Quartz Beloit One Network |
$297.61
|
| Rate for Payer: Quartz Commercial |
$394.78
|
| 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 |
$334.05
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$449.86
|
|
|
ED Simple Repair F/E/E/N/L/M 12.6 cm-20.0 cm
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
6195788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.61 |
| Max. Negotiated Rate |
$558.77 |
| Rate for Payer: Aetna Commercial |
$546.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.90
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cigna Commercial |
$558.77
|
| Rate for Payer: Health EOS Commercial |
$540.55
|
| Rate for Payer: HFN Commercial |
$558.77
|
| Rate for Payer: Multiplan Commercial |
$485.89
|
| Rate for Payer: Preferred Network Access Commercial |
$558.77
|
| Rate for Payer: Quartz Beloit One Network |
$297.61
|
| Rate for Payer: Quartz Commercial |
$364.42
|
| Rate for Payer: WEA Trust Commercial |
$334.05
|
| Rate for Payer: WPS Commercial |
$449.86
|
|
