|
ED Removal Of Intrauterine Device
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
6174409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
ED Removal Of Intrauterine Device
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
6174409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.36 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| 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 |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| 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 |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| 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 |
$86.35
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
ED Removal Of Non-Biodegradable Drug Delivery Implant
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
6173149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
ED Removal Of Non-Biodegradable Drug Delivery Implant
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 11982
|
| Hospital Charge Code |
6173149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Aetna Managed Medicare |
$393.82
|
| 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 |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.82
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$393.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$393.82
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$393.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$393.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$393.82
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$590.73
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$113.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.82
|
| Rate for Payer: The Alliance Commercial |
$1,575.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.82
|
| Rate for Payer: United Healthcare PPO |
$131.25
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: Wellcare Medicare |
$393.82
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
ED Removal Of Skin Tags 15 Or Less
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
6174957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
ED Removal Of Skin Tags 15 Or Less
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
6174957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
ED Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peri
|
Facility
|
OP
|
$582.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
6173891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$279.36 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.36
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$378.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
ED Removal of Tunneled Central Venous Access Device, with Subcutaneous Port or Pump, Central or Peri
|
Facility
|
IP
|
$582.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
6173891
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.18 |
| Max. Negotiated Rate |
$535.44 |
| Rate for Payer: Aetna Commercial |
$523.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.46
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$535.44
|
| Rate for Payer: Health EOS Commercial |
$517.98
|
| Rate for Payer: HFN Commercial |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: NAPHCARE Commercial |
$349.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.44
|
| Rate for Payer: Quartz Beloit One Network |
$285.18
|
| Rate for Payer: Quartz Commercial |
$349.20
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
ED Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
6173890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.24
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
ED Removal of Tunneled Central Venous Catheter without Subcutaneous Port or Pump
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
6173890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
ED Removal Subcutaneous Cardiac Monitor
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
6195196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$671.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$641.56
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$484.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.08
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.38
|
| 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 |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$686.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$663.94
|
| Rate for Payer: HFN Commercial |
$686.32
|
| 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 |
$596.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$686.32
|
| Rate for Payer: Quartz Beloit One Network |
$365.54
|
| Rate for Payer: Quartz Commercial |
$484.90
|
| 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 |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$410.30
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$552.56
|
|
|
ED Removal Subcutaneous Cardiac Monitor
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
6195196
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.54 |
| Max. Negotiated Rate |
$686.32 |
| Rate for Payer: Aetna Commercial |
$671.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$641.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.38
|
| Rate for Payer: Cash Price |
$223.80
|
| Rate for Payer: Cigna Commercial |
$686.32
|
| Rate for Payer: Health EOS Commercial |
$663.94
|
| Rate for Payer: HFN Commercial |
$686.32
|
| Rate for Payer: Multiplan Commercial |
$596.80
|
| Rate for Payer: NAPHCARE Commercial |
$447.60
|
| Rate for Payer: Preferred Network Access Commercial |
$686.32
|
| Rate for Payer: Quartz Beloit One Network |
$365.54
|
| Rate for Payer: Quartz Commercial |
$447.60
|
| Rate for Payer: WEA Trust Commercial |
$410.30
|
| Rate for Payer: WPS Commercial |
$552.56
|
|
|
ED Remove Impacted Cerumen using Irrigation/lavage
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
6172916
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
ED Remove Impacted Cerumen using Irrigation/lavage
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
6172916
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
ED Remove Impacted Cerumen w/instrumentation, unilateral
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
6173865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
ED Remove Impacted Cerumen w/instrumentation, unilateral
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
6173865
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
ED Repair (Cheiloplasty) over One-Half Vertical Height or Complex
|
Facility
|
IP
|
$1,835.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
6173898
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$899.15 |
| Max. Negotiated Rate |
$1,688.20 |
| Rate for Payer: Aetna Commercial |
$1,651.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,578.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$972.55
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$1,688.20
|
| Rate for Payer: Health EOS Commercial |
$1,633.15
|
| Rate for Payer: HFN Commercial |
$1,688.20
|
| Rate for Payer: Multiplan Commercial |
$1,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,101.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,688.20
|
| Rate for Payer: Quartz Beloit One Network |
$899.15
|
| Rate for Payer: Quartz Commercial |
$1,101.00
|
| Rate for Payer: WEA Trust Commercial |
$1,009.25
|
| Rate for Payer: WPS Commercial |
$1,359.18
|
|
|
ED Repair (Cheiloplasty) over One-Half Vertical Height or Complex
|
Facility
|
OP
|
$1,835.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
6173898
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$1,651.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,578.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,192.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$917.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$880.80
|
| Rate for Payer: Anthem Medicare Advantage |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$972.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cash Price |
$550.50
|
| Rate for Payer: Cigna Commercial |
$1,688.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Health EOS Commercial |
$1,633.15
|
| Rate for Payer: HFN Commercial |
$1,688.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: Multiplan Commercial |
$1,468.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,688.20
|
| Rate for Payer: Quartz Beloit One Network |
$899.15
|
| Rate for Payer: Quartz Commercial |
$1,192.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$6,029.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,009.25
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
| Rate for Payer: WPS Commercial |
$1,359.18
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 1.1-2.5cm
|
Facility
|
IP
|
$801.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
6173176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.49 |
| Max. Negotiated Rate |
$736.92 |
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.53
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$736.92
|
| Rate for Payer: Health EOS Commercial |
$712.89
|
| Rate for Payer: HFN Commercial |
$736.92
|
| Rate for Payer: Multiplan Commercial |
$640.80
|
| Rate for Payer: NAPHCARE Commercial |
$480.60
|
| Rate for Payer: Preferred Network Access Commercial |
$736.92
|
| Rate for Payer: Quartz Beloit One Network |
$392.49
|
| Rate for Payer: Quartz Commercial |
$480.60
|
| Rate for Payer: WEA Trust Commercial |
$440.55
|
| Rate for Payer: WPS Commercial |
$593.30
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 1.1-2.5cm
|
Facility
|
OP
|
$801.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
6173176
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$720.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.86
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.48
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.77
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna Commercial |
$736.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$712.89
|
| Rate for Payer: HFN Commercial |
$736.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$640.80
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$736.92
|
| Rate for Payer: Quartz Beloit One Network |
$392.49
|
| Rate for Payer: Quartz Commercial |
$520.65
|
| Rate for Payer: Quartz Medicare Advantage |
$620.77
|
| Rate for Payer: The Alliance Commercial |
$2,483.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$440.55
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$593.30
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 2.6-7.5cm
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
6173177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$731.57 |
| Max. Negotiated Rate |
$1,373.56 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$895.80
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) 2.6-7.5cm
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
6173177
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.64
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.77
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$970.45
|
| Rate for Payer: Quartz Medicare Advantage |
$620.77
|
| Rate for Payer: The Alliance Commercial |
$2,483.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) each additional <= 5cm
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
6173178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Aetna Managed Medicare |
$144.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Health EOS Commercial |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.25
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$309.00
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$334.75
|
| Rate for Payer: Quartz Medicare Advantage |
$309.00
|
| Rate for Payer: The Alliance Commercial |
$2,060.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
ED Repair, complex (eyelids, nose, ears, lips) each additional <= 5cm
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
6173178
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.35 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| Rate for Payer: Health EOS Commercial |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$309.00
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$309.00
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
ED Repair, complex (forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet)†1.1-2.5cm
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
6173173
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$541.88 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
