|
ED Exploration Penetrating Wound SPX Extremity
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
6210438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$1,066.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,019.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$770.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$592.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.80
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.05
|
| 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 |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$1,090.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$1,054.65
|
| Rate for Payer: HFN Commercial |
$1,090.20
|
| 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 |
$948.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.20
|
| Rate for Payer: Quartz Beloit One Network |
$580.65
|
| Rate for Payer: Quartz Commercial |
$770.25
|
| 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 |
$651.75
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$877.73
|
|
|
ED Exploration Penetrating Wound SPX Extremity
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
6210438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$580.65 |
| Max. Negotiated Rate |
$1,090.20 |
| Rate for Payer: Aetna Commercial |
$1,066.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,019.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$628.05
|
| Rate for Payer: Cash Price |
$355.50
|
| Rate for Payer: Cigna Commercial |
$1,090.20
|
| Rate for Payer: Health EOS Commercial |
$1,054.65
|
| Rate for Payer: HFN Commercial |
$1,090.20
|
| Rate for Payer: Multiplan Commercial |
$948.00
|
| Rate for Payer: NAPHCARE Commercial |
$711.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.20
|
| Rate for Payer: Quartz Beloit One Network |
$580.65
|
| Rate for Payer: Quartz Commercial |
$711.00
|
| Rate for Payer: WEA Trust Commercial |
$651.75
|
| Rate for Payer: WPS Commercial |
$877.73
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by forceps only
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
6174424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by forceps only
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
6174424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.96 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.96
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| 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 |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| 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 |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| 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 |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| 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 |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
6174425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.48 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,151.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
ED Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
6174425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Different Lids
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
6174422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.24 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,151.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Different Lids
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
6174422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Same Lid
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
6174421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.96 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.96
|
| Rate for Payer: Anthem Medicare Advantage |
$1,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,000.70
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,000.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,000.70
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,722.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,000.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,000.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,000.70
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,501.05
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,000.70
|
| Rate for Payer: The Alliance Commercial |
$4,002.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,000.70
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: Wellcare Medicare |
$1,000.70
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
ED Eyelids; Excision of Chalazion, Multiple Same Lid
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
6174421
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
ED Eyelids; Excision of Chalazion, Single
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
6174420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.12
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.16
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$314.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$304.38
|
| Rate for Payer: HFN Commercial |
$314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$314.64
|
| Rate for Payer: Quartz Beloit One Network |
$167.58
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,151.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$188.10
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$253.32
|
|
|
ED Eyelids; Excision of Chalazion, Single
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
6174420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.58 |
| Max. Negotiated Rate |
$314.64 |
| Rate for Payer: Aetna Commercial |
$307.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.26
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna Commercial |
$314.64
|
| Rate for Payer: Health EOS Commercial |
$304.38
|
| Rate for Payer: HFN Commercial |
$314.64
|
| Rate for Payer: Multiplan Commercial |
$273.60
|
| Rate for Payer: NAPHCARE Commercial |
$205.20
|
| Rate for Payer: Preferred Network Access Commercial |
$314.64
|
| Rate for Payer: Quartz Beloit One Network |
$167.58
|
| Rate for Payer: Quartz Commercial |
$205.20
|
| Rate for Payer: WEA Trust Commercial |
$188.10
|
| Rate for Payer: WPS Commercial |
$253.32
|
|
|
ED Fine Needle Aspiration Without Imaging
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
6173135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.88
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
ED Fine Needle Aspiration Without Imaging
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
6173135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
ED Fitting And Insertion Of Pessary
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
6174398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.24 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$196.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Anthem Medicare Advantage |
$196.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$196.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$196.96
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$196.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$196.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$196.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$196.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$196.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.44
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$196.96
|
| Rate for Payer: The Alliance Commercial |
$787.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.96
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$196.96
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
ED Fitting And Insertion Of Pessary
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
6174398
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
ED Fluoro Central Venous Access Dev Placement
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
6181794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
ED Fluoro Central Venous Access Dev Placement
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
6181794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$50.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$107.40
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
ED Foreskin Manipulation including Lysis Of Prepubital Adhesions & Stretching
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
6174109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
ED Foreskin Manipulation including Lysis Of Prepubital Adhesions & Stretching
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
6174109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| 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 |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| 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 |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| 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 |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| 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 |
$66.55
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
ED GASTRIC INTUBATION & ASPIRATION W/PHYS SKILL/LAVAGE
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
6177977
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.52
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
ED GASTRIC INTUBATION & ASPIRATION W/PHYS SKILL/LAVAGE
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 43753
|
| Hospital Charge Code |
6177977
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
ED Gastrointestinal Tract Imaging, Intraluminal
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
6174449
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,752.82 |
| Max. Negotiated Rate |
$5,168.56 |
| Rate for Payer: Aetna Commercial |
$5,056.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,831.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,977.54
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cigna Commercial |
$5,168.56
|
| Rate for Payer: Health EOS Commercial |
$5,000.02
|
| Rate for Payer: HFN Commercial |
$5,168.56
|
| Rate for Payer: Multiplan Commercial |
$4,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,168.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,752.82
|
| Rate for Payer: Quartz Commercial |
$3,370.80
|
| Rate for Payer: WEA Trust Commercial |
$3,089.90
|
| Rate for Payer: WPS Commercial |
$4,161.25
|
|
|
ED Gastrointestinal Tract Imaging, Intraluminal
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
6174449
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,168.56 |
| Rate for Payer: Aetna Commercial |
$5,056.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,831.48
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,651.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,809.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,696.64
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,977.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cash Price |
$1,685.40
|
| Rate for Payer: Cigna Commercial |
$5,168.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,143.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$5,000.02
|
| Rate for Payer: HFN Commercial |
$5,168.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$4,494.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$5,168.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,752.82
|
| Rate for Payer: Quartz Commercial |
$3,651.70
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,089.90
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$4,161.25
|
|
|
ED Glossectomy; Less Than One-Half Tongue
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
CPT 41120
|
| Hospital Charge Code |
6174077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.91
|
|
