|
ED Strapping of Toes
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
6173881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$36.19
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
ED Subconjunctival Injection
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
6174434
|
|
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 |
$470.13
|
| 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 |
$470.13
|
| 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 |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$470.13
|
| 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 |
$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 |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| 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 |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| 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 |
$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 |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
ED Subconjunctival Injection
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
6174434
|
|
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 Suture Of Recent Wound, Eyelid
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
6174431
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| 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 |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| 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 |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| 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 |
$575.43
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ED Suture Of Recent Wound, Eyelid
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
6174431
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ED Tangential Biopsy Skin Ea Sep/Add Lesion
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
6173141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$69.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
ED Tangential Biopsy Skin Ea Sep/Add Lesion
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
6173141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
ED Tangential Biopsy Skin Single Lesion
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
6173140
|
|
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 Tangential Biopsy Skin Single Lesion
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
6173140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$201.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.33
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.51
|
| 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 |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$205.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$199.00
|
| Rate for Payer: HFN Commercial |
$205.71
|
| 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 |
$178.88
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$205.71
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$145.34
|
| 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 |
$122.98
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$165.61
|
|
|
ED Thoracentesis Needle/Cath Pleura w/Imaging
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
6222227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,078.82 |
| Max. Negotiated Rate |
$2,025.55 |
| Rate for Payer: Aetna Commercial |
$1,981.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.89
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$2,025.55
|
| Rate for Payer: Health EOS Commercial |
$1,959.50
|
| Rate for Payer: HFN Commercial |
$2,025.55
|
| Rate for Payer: Multiplan Commercial |
$1,761.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.82
|
| Rate for Payer: Quartz Commercial |
$1,321.01
|
| Rate for Payer: WEA Trust Commercial |
$1,210.92
|
| Rate for Payer: WPS Commercial |
$1,630.73
|
|
|
ED Thoracentesis Needle/Cath Pleura w/Imaging
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
6222227
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,981.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.44
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,100.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.81
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.89
|
| 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 |
$635.10
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$2,025.55
|
| 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 |
$1,959.50
|
| Rate for Payer: HFN Commercial |
$2,025.55
|
| 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 |
$1,761.34
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.82
|
| Rate for Payer: Quartz Commercial |
$1,431.09
|
| 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 |
$1,210.92
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$1,630.73
|
|
|
ED Trabeculoplasty By Laser; 1 or more sessions
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 65855
|
| Hospital Charge Code |
6174415
|
|
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 Trabeculoplasty By Laser; 1 or more sessions
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 65855
|
| Hospital Charge Code |
6174415
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$578.81
|
| 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 |
$578.81
|
| 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 |
$578.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$578.81
|
| 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 |
$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 |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| 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 |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$868.22
|
| 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 |
$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 |
$572.00
|
| Rate for Payer: Wellcare Medicare |
$578.81
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
ED Trabeculoplasty By Laser; 1 or more sessions BILAT
|
Facility
|
IP
|
$2,000.00
|
|
|
Service Code
|
CPT 65855 50
|
| Hospital Charge Code |
6174416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,019.20 |
| Max. Negotiated Rate |
$1,913.60 |
| Rate for Payer: Aetna Commercial |
$1,872.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,788.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,102.40
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,913.60
|
| Rate for Payer: Health EOS Commercial |
$1,851.20
|
| Rate for Payer: HFN Commercial |
$1,913.60
|
| Rate for Payer: Multiplan Commercial |
$1,664.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,913.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.20
|
| Rate for Payer: Quartz Commercial |
$1,248.00
|
| Rate for Payer: WEA Trust Commercial |
$1,144.00
|
| Rate for Payer: WPS Commercial |
$1,540.60
|
|
|
ED Trabeculoplasty By Laser; 1 or more sessions BILAT
|
Facility
|
OP
|
$2,000.00
|
|
|
Service Code
|
CPT 65855 50
|
| Hospital Charge Code |
6174416
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Commercial |
$1,872.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,788.80
|
| Rate for Payer: Aetna Managed Medicare |
$582.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,352.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$998.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,102.40
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cigna Commercial |
$1,913.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Health EOS Commercial |
$1,851.20
|
| Rate for Payer: HFN Commercial |
$1,913.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,560.00
|
| Rate for Payer: Multiplan Commercial |
$1,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,913.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.20
|
| Rate for Payer: Quartz Commercial |
$1,352.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,248.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,144.00
|
| Rate for Payer: WPS Commercial |
$1,540.60
|
|
|
ED Tracheotomy Tube Change prior to Establishment of Fistula Tract
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
6173887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
ED Tracheotomy Tube Change prior to Establishment of Fistula Tract
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 31502
|
| Hospital Charge Code |
6173887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.91 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$249.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.91
|
| Rate for Payer: Anthem Medicare Advantage |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$249.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$249.26
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$249.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$249.26
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$927.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$249.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$249.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$249.26
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$373.89
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$74.36
|
| Rate for Payer: Quartz Medicare Advantage |
$249.26
|
| Rate for Payer: The Alliance Commercial |
$997.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: Wellcare Medicare |
$249.26
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
ED Transfusion, blood or blood components
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6172939
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
ED Transfusion, blood or blood components
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
6172939
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$464.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Anthem Medicare Advantage |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$464.29
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$464.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$464.29
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$464.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$464.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$464.29
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$696.43
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$464.29
|
| Rate for Payer: The Alliance Commercial |
$1,857.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.29
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: Wellcare Medicare |
$464.29
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
ED Treat Finger Fracture, each
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
6177766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$427.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.34
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$555.67
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
ED Treat Finger Fracture, each
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
6177766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$418.89 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$512.93
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
ED Treat Hip Dislocation
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
6175422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$880.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$841.63
|
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$636.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$489.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.75
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Health EOS Commercial |
$870.99
|
| Rate for Payer: HFN Commercial |
$900.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: Multiplan Commercial |
$782.91
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Preferred Network Access Commercial |
$900.35
|
| Rate for Payer: Quartz Beloit One Network |
$479.53
|
| Rate for Payer: Quartz Commercial |
$636.12
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$538.25
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
| Rate for Payer: WPS Commercial |
$724.85
|
|
|
ED Treat Hip Dislocation
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
6175422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$479.53 |
| Max. Negotiated Rate |
$900.35 |
| Rate for Payer: Aetna Commercial |
$880.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$841.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.68
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cigna Commercial |
$900.35
|
| Rate for Payer: Health EOS Commercial |
$870.99
|
| Rate for Payer: HFN Commercial |
$900.35
|
| Rate for Payer: Multiplan Commercial |
$782.91
|
| Rate for Payer: Preferred Network Access Commercial |
$900.35
|
| Rate for Payer: Quartz Beloit One Network |
$479.53
|
| Rate for Payer: Quartz Commercial |
$587.18
|
| Rate for Payer: WEA Trust Commercial |
$538.25
|
| Rate for Payer: WPS Commercial |
$724.85
|
|
|
ED Treatment Closed Elbow DIslocation Req Anes
|
Facility
|
IP
|
$770.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
6209410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.39 |
| Max. Negotiated Rate |
$736.74 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.42
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$736.74
|
| Rate for Payer: Health EOS Commercial |
$712.71
|
| Rate for Payer: HFN Commercial |
$736.74
|
| Rate for Payer: Multiplan Commercial |
$640.64
|
| Rate for Payer: Preferred Network Access Commercial |
$736.74
|
| Rate for Payer: Quartz Beloit One Network |
$392.39
|
| Rate for Payer: Quartz Commercial |
$480.48
|
| Rate for Payer: WEA Trust Commercial |
$440.44
|
| Rate for Payer: WPS Commercial |
$593.13
|
|
|
ED Treatment Closed Elbow DIslocation Req Anes
|
Facility
|
OP
|
$770.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
6209410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,768.94 |
| Rate for Payer: Aetna Commercial |
$720.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.38
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$736.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Health EOS Commercial |
$712.71
|
| Rate for Payer: HFN Commercial |
$736.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: Multiplan Commercial |
$640.64
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Preferred Network Access Commercial |
$736.74
|
| Rate for Payer: Quartz Beloit One Network |
$392.39
|
| Rate for Payer: Quartz Commercial |
$520.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$6,768.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$440.44
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
| Rate for Payer: WPS Commercial |
$593.13
|
|
