|
ED Simple repair of wounds (scalp, neck, axillae, external genitalia, trunk) 7.6-12.5cm
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
6172917
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.76 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.76
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| 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 |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| 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 |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| 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 |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$186.55
|
| 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 |
$157.85
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
ED Simple repair of wounds (scalp,neck,trunk) <=2.5 cm
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
6172839
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.80
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| 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 |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| 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 |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| 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 |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| 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 |
$129.25
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
ED Simple repair of wounds (scalp,neck,trunk) <=2.5 cm
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
6172839
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
ED Simple repair of wounds (scalp,neck,trunk) 2.6-7.5 cm
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
6172840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.08 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.08
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| 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 |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| 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 |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| 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 |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$159.90
|
| 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 |
$135.30
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
ED Simple repair of wounds (scalp,neck,trunk) 2.6-7.5 cm
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
6172840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$147.60
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
ED Simple repair scalp, neck, axillae, external genitalia, trunk and/or extremities over 30.0 cm
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
6173543
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$925.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.08
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$668.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$514.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.44
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.84
|
| 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 |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$945.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$914.92
|
| Rate for Payer: HFN Commercial |
$945.76
|
| 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 |
$822.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$945.76
|
| Rate for Payer: Quartz Beloit One Network |
$503.72
|
| Rate for Payer: Quartz Commercial |
$668.20
|
| 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 |
$565.40
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$761.44
|
|
|
ED Simple repair scalp, neck, axillae, external genitalia, trunk and/or extremities over 30.0 cm
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 12007
|
| Hospital Charge Code |
6173543
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$503.72 |
| Max. Negotiated Rate |
$945.76 |
| Rate for Payer: Aetna Commercial |
$925.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.84
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$945.76
|
| Rate for Payer: Health EOS Commercial |
$914.92
|
| Rate for Payer: HFN Commercial |
$945.76
|
| Rate for Payer: Multiplan Commercial |
$822.40
|
| Rate for Payer: NAPHCARE Commercial |
$616.80
|
| Rate for Payer: Preferred Network Access Commercial |
$945.76
|
| Rate for Payer: Quartz Beloit One Network |
$503.72
|
| Rate for Payer: Quartz Commercial |
$616.80
|
| Rate for Payer: WEA Trust Commercial |
$565.40
|
| Rate for Payer: WPS Commercial |
$761.44
|
|
|
ED Snip incision Of Lacrimal Punctum
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 68440
|
| Hospital Charge Code |
6174435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.64 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$533.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.98
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$385.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$296.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$284.64
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$545.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$287.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$527.77
|
| Rate for Payer: HFN Commercial |
$545.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$287.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: NAPHCARE Commercial |
$431.91
|
| Rate for Payer: Preferred Network Access Commercial |
$545.56
|
| Rate for Payer: Quartz Beloit One Network |
$290.57
|
| Rate for Payer: Quartz Commercial |
$385.45
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,151.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$326.15
|
| Rate for Payer: Wellcare Medicare |
$287.94
|
| Rate for Payer: WPS Commercial |
$439.24
|
|
|
ED Snip incision Of Lacrimal Punctum
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 68440
|
| Hospital Charge Code |
6174435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$545.56 |
| Rate for Payer: Aetna Commercial |
$533.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.29
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$545.56
|
| Rate for Payer: Health EOS Commercial |
$527.77
|
| Rate for Payer: HFN Commercial |
$545.56
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: NAPHCARE Commercial |
$355.80
|
| Rate for Payer: Preferred Network Access Commercial |
$545.56
|
| Rate for Payer: Quartz Beloit One Network |
$290.57
|
| Rate for Payer: Quartz Commercial |
$355.80
|
| Rate for Payer: WEA Trust Commercial |
$326.15
|
| Rate for Payer: WPS Commercial |
$439.24
|
|
|
ED Spinal Puncture, Lumbar, Diagnostic
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
6172946
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ED Spinal Puncture, Lumbar, Diagnostic
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
6172946
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$683.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| Rate for Payer: Anthem Medicare Advantage |
$683.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| 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 |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| 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 |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| 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 |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.30
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| 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 |
$128.15
|
| Rate for Payer: Wellcare Medicare |
$683.53
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ED Strapping of Toes
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
6173881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.84
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| 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 |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| 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 |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| 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 |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$37.70
|
| 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 |
$31.90
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
ED Strapping of Toes
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
6173881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$34.80
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
ED Subconjunctival Injection
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
6174434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
ED Subconjunctival Injection
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
6174434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$393.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.16
|
| Rate for Payer: Anthem Medicare Advantage |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| 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 |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| 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 |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| 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 |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$590.73
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| 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 |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$393.82
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
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 |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$9,238.84 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,309.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Anthem Medicare Advantage |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,309.71
|
| 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 |
$925.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,309.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,309.71
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,592.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,309.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,309.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,309.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,309.71
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,464.56
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,309.71
|
| Rate for Payer: The Alliance Commercial |
$9,238.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,309.71
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: Wellcare Medicare |
$2,309.71
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
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 |
$17.36 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| 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 |
$57.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.20
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
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 |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
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 |
$103.20 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.20
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| 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 |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| 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 |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| 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 |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$139.75
|
| 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 |
$118.25
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
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 |
$105.35 |
| Max. Negotiated Rate |
$197.80 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
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 |
$1,037.33 |
| Max. Negotiated Rate |
$1,947.64 |
| Rate for Payer: Aetna Commercial |
$1,905.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,820.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.01
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$1,947.64
|
| Rate for Payer: Health EOS Commercial |
$1,884.13
|
| Rate for Payer: HFN Commercial |
$1,947.64
|
| Rate for Payer: Multiplan Commercial |
$1,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,947.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.33
|
| Rate for Payer: Quartz Commercial |
$1,270.20
|
| Rate for Payer: WEA Trust Commercial |
$1,164.35
|
| Rate for Payer: WPS Commercial |
$1,568.06
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$1,905.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,820.62
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,376.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,058.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,016.16
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.01
|
| 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 |
$635.10
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cash Price |
$635.10
|
| Rate for Payer: Cigna Commercial |
$1,947.64
|
| 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 |
$1,884.13
|
| Rate for Payer: HFN Commercial |
$1,947.64
|
| 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 |
$1,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,947.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.33
|
| Rate for Payer: Quartz Commercial |
$1,376.05
|
| 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 |
$1,164.35
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$1,568.06
|
|
|
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 |
$490.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Managed Medicare |
$574.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.00
|
| Rate for Payer: Anthem Medicare Advantage |
$574.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$574.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$574.53
|
| 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 |
$920.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$574.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$574.53
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,137.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$574.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$574.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$574.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$574.53
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$861.80
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$650.00
|
| Rate for Payer: Quartz Medicare Advantage |
$574.53
|
| Rate for Payer: The Alliance Commercial |
$2,298.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$574.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: Wellcare Medicare |
$574.53
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
