|
ED Incision And Drainage Of Bartholin's Gland Abscess
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
6173477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$196.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.00
|
| Rate for Payer: Anthem Medicare Advantage |
$196.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| 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 |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$196.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$196.96
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| 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 |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$295.44
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| 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 |
$151.25
|
| Rate for Payer: Wellcare Medicare |
$196.96
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
ED Incision And Drainage Of Bartholin's Gland Abscess
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
6173477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
ED Incision and drainage of pilonidal cyst; complicated
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
6172922
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$244.02 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$448.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.28
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$458.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$443.22
|
| Rate for Payer: HFN Commercial |
$458.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$398.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$458.16
|
| Rate for Payer: Quartz Beloit One Network |
$244.02
|
| Rate for Payer: Quartz Commercial |
$323.70
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$373.50
|
| Rate for Payer: WEA Trust Commercial |
$273.90
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$368.87
|
|
|
ED Incision and drainage of pilonidal cyst; complicated
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
6172922
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$244.02 |
| Max. Negotiated Rate |
$458.16 |
| Rate for Payer: Aetna Commercial |
$448.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.94
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$458.16
|
| Rate for Payer: Health EOS Commercial |
$443.22
|
| Rate for Payer: HFN Commercial |
$458.16
|
| Rate for Payer: Multiplan Commercial |
$398.40
|
| Rate for Payer: NAPHCARE Commercial |
$298.80
|
| Rate for Payer: Preferred Network Access Commercial |
$458.16
|
| Rate for Payer: Quartz Beloit One Network |
$244.02
|
| Rate for Payer: Quartz Commercial |
$298.80
|
| Rate for Payer: WEA Trust Commercial |
$273.90
|
| Rate for Payer: WPS Commercial |
$368.87
|
|
|
ED Incision And Drainage Of Pilonidal Cyst, Simple
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
6173136
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
ED Incision And Drainage Of Pilonidal Cyst, Simple
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
6173136
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$583.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$410.00
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
ED Incision And Drainage Of Vulva Or Perineal Abscess
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
6174390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.53 |
| Max. Negotiated Rate |
$549.24 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.41
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$549.24
|
| Rate for Payer: Health EOS Commercial |
$531.33
|
| Rate for Payer: HFN Commercial |
$549.24
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: NAPHCARE Commercial |
$358.20
|
| Rate for Payer: Preferred Network Access Commercial |
$549.24
|
| Rate for Payer: Quartz Beloit One Network |
$292.53
|
| Rate for Payer: Quartz Commercial |
$358.20
|
| Rate for Payer: WEA Trust Commercial |
$328.35
|
| Rate for Payer: WPS Commercial |
$442.20
|
|
|
ED Incision And Drainage Of Vulva Or Perineal Abscess
|
Facility
|
OP
|
$597.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
6174390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$537.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.42
|
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.56
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.09
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cash Price |
$179.10
|
| Rate for Payer: Cigna Commercial |
$549.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Health EOS Commercial |
$531.33
|
| Rate for Payer: HFN Commercial |
$549.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$317.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$317.09
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Preferred Network Access Commercial |
$549.24
|
| Rate for Payer: Quartz Beloit One Network |
$292.53
|
| Rate for Payer: Quartz Commercial |
$388.05
|
| Rate for Payer: Quartz Medicare Advantage |
$317.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.09
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$328.35
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
| Rate for Payer: WPS Commercial |
$442.20
|
|
|
ED Incision and drainage, perianal abscess, superficial
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
6172944
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$358.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.28
|
| Rate for Payer: Aetna Managed Medicare |
$903.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.36
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$366.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.36
|
| Rate for Payer: Health EOS Commercial |
$354.22
|
| Rate for Payer: HFN Commercial |
$366.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.36
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.04
|
| Rate for Payer: Preferred Network Access Commercial |
$366.16
|
| Rate for Payer: Quartz Beloit One Network |
$195.02
|
| Rate for Payer: Quartz Commercial |
$258.70
|
| Rate for Payer: Quartz Medicare Advantage |
$903.36
|
| Rate for Payer: The Alliance Commercial |
$3,613.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.36
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$218.90
|
| Rate for Payer: Wellcare Medicare |
$903.36
|
| Rate for Payer: WPS Commercial |
$294.80
|
|
|
ED Incision and drainage, perianal abscess, superficial
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
6172944
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.02 |
| Max. Negotiated Rate |
$366.16 |
| Rate for Payer: Aetna Commercial |
$358.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.94
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$366.16
|
| Rate for Payer: Health EOS Commercial |
$354.22
|
| Rate for Payer: HFN Commercial |
$366.16
|
| Rate for Payer: Multiplan Commercial |
$318.40
|
| Rate for Payer: NAPHCARE Commercial |
$238.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.16
|
| Rate for Payer: Quartz Beloit One Network |
$195.02
|
| Rate for Payer: Quartz Commercial |
$238.80
|
| Rate for Payer: WEA Trust Commercial |
$218.90
|
| Rate for Payer: WPS Commercial |
$294.80
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; complicated
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
6173137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$302.40
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| 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 |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| 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 |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$409.50
|
| 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 |
$346.50
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; complicated
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
6173137
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; simple
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
6173470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| 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 |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| 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 |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| 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 |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| 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 |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
ED Incision and removal of foreign body, subcutaneous tissues; simple
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
6173470
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
ED Incision Of Conjunctiva, Drainage Of Cyst
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
6174433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.59 |
| Max. Negotiated Rate |
$451.72 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| Rate for Payer: Health EOS Commercial |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$294.60
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$294.60
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
ED Incision Of Conjunctiva, Drainage Of Cyst
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
6174433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.68 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$441.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.68
|
| Rate for Payer: Anthem Medicare Advantage |
$1,000.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.23
|
| 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 |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$451.72
|
| 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 |
$436.99
|
| Rate for Payer: HFN Commercial |
$451.72
|
| 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 |
$392.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,501.05
|
| Rate for Payer: Preferred Network Access Commercial |
$451.72
|
| Rate for Payer: Quartz Beloit One Network |
$240.59
|
| Rate for Payer: Quartz Commercial |
$319.15
|
| 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 |
$270.05
|
| Rate for Payer: Wellcare Medicare |
$1,000.70
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
ED Incision Thrombosed Hemorrhoid External
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
6179157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.04 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.04
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| 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 |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| 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 |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| 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 |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$226.20
|
| 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 |
$191.40
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
ED Incision Thrombosed Hemorrhoid External
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
6179157
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.52 |
| Max. Negotiated Rate |
$320.16 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.44
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$320.16
|
| Rate for Payer: Health EOS Commercial |
$309.72
|
| Rate for Payer: HFN Commercial |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: NAPHCARE Commercial |
$208.80
|
| Rate for Payer: Preferred Network Access Commercial |
$320.16
|
| Rate for Payer: Quartz Beloit One Network |
$170.52
|
| Rate for Payer: Quartz Commercial |
$208.80
|
| Rate for Payer: WEA Trust Commercial |
$191.40
|
| Rate for Payer: WPS Commercial |
$257.76
|
|
|
ED Injection, anesthetic agent and/or steroid, other perpheral nerve branch
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6173811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Aetna Managed Medicare |
$683.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$683.53
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$683.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$683.53
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,542.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$683.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$683.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$683.53
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.30
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$214.50
|
| Rate for Payer: Quartz Medicare Advantage |
$683.53
|
| Rate for Payer: The Alliance Commercial |
$2,734.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$683.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: Wellcare Medicare |
$683.53
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
ED Injection, anesthetic agent and/or steroid, other perpheral nerve branch
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
6173811
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$303.60 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$198.00
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
ED Injection of Anesthetic agent/steroid greater occipital nerve
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
6182858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ED Injection of Anesthetic agent/steroid greater occipital nerve
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
6182858
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ED Injection of anesthetic agent, trigeminal nerve, ea branch
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
6172910
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.84 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
ED Injection of anesthetic agent, trigeminal nerve, ea branch
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
6172910
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
ED Injection of Tendon Sheath or Ligament; Single
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
6173870
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.92 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.92
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$213.85
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
