ED Trabeculoplasty By Laser; 1 or more sessions BILAT
|
Facility
|
IP
|
$2,000.00
|
|
Service Code
|
CPT 65855 50
|
Hospital Charge Code |
6174416
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$980.00 |
Max. Negotiated Rate |
$1,840.00 |
Rate for Payer: Aetna Commercial |
$1,800.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cigna Commercial |
$1,840.00
|
Rate for Payer: Health EOS Commercial |
$1,780.00
|
Rate for Payer: HFN Commercial |
$1,840.00
|
Rate for Payer: Multiplan Commercial |
$1,600.00
|
Rate for Payer: NAPHCARE Commercial |
$1,200.00
|
Rate for Payer: Preferred Network Access Commercial |
$1,840.00
|
Rate for Payer: Quartz Beloit One Network |
$980.00
|
Rate for Payer: Quartz Commercial |
$1,200.00
|
Rate for Payer: WEA Trust Commercial |
$1,100.00
|
Rate for Payer: WPS Commercial |
$1,481.40
|
|
ED Trabeculoplasty By Laser; 1 or more sessions BILAT
|
Facility
|
OP
|
$2,000.00
|
|
Service Code
|
CPT 65855 50
|
Hospital Charge Code |
6174416
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$301.00 |
Max. Negotiated Rate |
$8,000.00 |
Rate for Payer: Aetna Commercial |
$1,800.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.00
|
Rate for Payer: Aetna Managed Medicare |
$560.00
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,300.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,000.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cash Price |
$600.00
|
Rate for Payer: Cigna Commercial |
$1,840.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$1,119.20
|
Rate for Payer: Health EOS Commercial |
$1,780.00
|
Rate for Payer: HFN Commercial |
$1,840.00
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,500.00
|
Rate for Payer: Multiplan Commercial |
$1,600.00
|
Rate for Payer: NAPHCARE Commercial |
$1,200.00
|
Rate for Payer: Preferred Network Access Commercial |
$1,840.00
|
Rate for Payer: Quartz Beloit One Network |
$980.00
|
Rate for Payer: Quartz Commercial |
$1,300.00
|
Rate for Payer: Quartz Medicare Advantage |
$1,200.00
|
Rate for Payer: The Alliance Commercial |
$8,000.00
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$1,100.00
|
Rate for Payer: WPS Commercial |
$1,481.40
|
|
ED Tracheotomy Tube Change prior to Establishment of Fistula Tract
|
Facility
|
OP
|
$110.00
|
|
Service Code
|
CPT 31502
|
Hospital Charge Code |
6173887
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$52.80 |
Max. Negotiated Rate |
$4,757.59 |
Rate for Payer: Aetna Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
Rate for Payer: Aetna Managed Medicare |
$241.43
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.80
|
Rate for Payer: Anthem Medicare Advantage |
$241.43
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$241.43
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$241.43
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cigna Commercial |
$101.20
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$241.43
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$241.43
|
Rate for Payer: Health EOS Commercial |
$97.90
|
Rate for Payer: HFN Commercial |
$101.20
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.12
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.43
|
Rate for Payer: Independent Care Health Plan Medicare |
$241.43
|
Rate for Payer: Managed Health Services Medicare Advantage |
$241.43
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$241.43
|
Rate for Payer: Multiplan Commercial |
$88.00
|
Rate for Payer: NAPHCARE Commercial |
$362.14
|
Rate for Payer: Preferred Network Access Commercial |
$101.20
|
Rate for Payer: Quartz Beloit One Network |
$53.90
|
Rate for Payer: Quartz Commercial |
$71.50
|
Rate for Payer: Quartz Medicare Advantage |
$241.43
|
Rate for Payer: The Alliance Commercial |
$965.72
|
Rate for Payer: United Healthcare Medicare Advantage |
$241.43
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$60.50
|
Rate for Payer: Wellcare Medicare |
$241.43
|
Rate for Payer: WPS Commercial |
$81.48
|
|
ED Tracheotomy Tube Change prior to Establishment of Fistula Tract
|
Facility
|
IP
|
$110.00
|
|
Service Code
|
CPT 31502
|
Hospital Charge Code |
6173887
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$53.90 |
Max. Negotiated Rate |
$101.20 |
Rate for Payer: Aetna Commercial |
$99.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
Rate for Payer: Cash Price |
$33.00
|
Rate for Payer: Cigna Commercial |
$101.20
|
Rate for Payer: Health EOS Commercial |
$97.90
|
Rate for Payer: HFN Commercial |
$101.20
|
Rate for Payer: Multiplan Commercial |
$88.00
|
Rate for Payer: NAPHCARE Commercial |
$66.00
|
Rate for Payer: Preferred Network Access Commercial |
$101.20
|
Rate for Payer: Quartz Beloit One Network |
$53.90
|
Rate for Payer: Quartz Commercial |
$66.00
|
Rate for Payer: WEA Trust Commercial |
$60.50
|
Rate for Payer: WPS Commercial |
$81.48
|
|
ED Transfusion, blood or blood components
|
Facility
|
OP
|
$266.00
|
|
Service Code
|
CPT 36430
|
Hospital Charge Code |
6172939
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$127.68 |
Max. Negotiated Rate |
$11,874.87 |
Rate for Payer: Aetna Commercial |
$239.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
Rate for Payer: Aetna Managed Medicare |
$429.07
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.68
|
Rate for Payer: Anthem Medicare Advantage |
$429.07
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$429.07
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$429.07
|
Rate for Payer: Cash Price |
$79.80
|
Rate for Payer: Cash Price |
$79.80
|
Rate for Payer: Cash Price |
$79.80
|
Rate for Payer: Cigna Commercial |
$244.72
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$429.07
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$429.07
|
Rate for Payer: Health EOS Commercial |
$236.74
|
Rate for Payer: HFN Commercial |
$244.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.14
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$429.07
|
Rate for Payer: Independent Care Health Plan Medicare |
$429.07
|
Rate for Payer: Managed Health Services Medicare Advantage |
$429.07
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$429.07
|
Rate for Payer: Multiplan Commercial |
$212.80
|
Rate for Payer: NAPHCARE Commercial |
$643.60
|
Rate for Payer: Preferred Network Access Commercial |
$244.72
|
Rate for Payer: Quartz Beloit One Network |
$130.34
|
Rate for Payer: Quartz Commercial |
$172.90
|
Rate for Payer: Quartz Medicare Advantage |
$429.07
|
Rate for Payer: The Alliance Commercial |
$1,716.28
|
Rate for Payer: United Healthcare Medicare Advantage |
$429.07
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$146.30
|
Rate for Payer: Wellcare Medicare |
$429.07
|
Rate for Payer: WPS Commercial |
$197.03
|
|
ED Transfusion, blood or blood components
|
Facility
|
IP
|
$266.00
|
|
Service Code
|
CPT 36430
|
Hospital Charge Code |
6172939
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$130.34 |
Max. Negotiated Rate |
$244.72 |
Rate for Payer: Aetna Commercial |
$239.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
Rate for Payer: Cash Price |
$79.80
|
Rate for Payer: Cigna Commercial |
$244.72
|
Rate for Payer: Health EOS Commercial |
$236.74
|
Rate for Payer: HFN Commercial |
$244.72
|
Rate for Payer: Multiplan Commercial |
$212.80
|
Rate for Payer: NAPHCARE Commercial |
$159.60
|
Rate for Payer: Preferred Network Access Commercial |
$244.72
|
Rate for Payer: Quartz Beloit One Network |
$130.34
|
Rate for Payer: Quartz Commercial |
$159.60
|
Rate for Payer: WEA Trust Commercial |
$146.30
|
Rate for Payer: WPS Commercial |
$197.03
|
|
ED Treat Finger Fracture, each
|
Facility
|
OP
|
$822.00
|
|
Service Code
|
CPT 26725
|
Hospital Charge Code |
6177766
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$233.09 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$739.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
Rate for Payer: Aetna Managed Medicare |
$233.09
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.30
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.56
|
Rate for Payer: Anthem Medicare Advantage |
$233.09
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.66
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
Rate for Payer: Cash Price |
$246.60
|
Rate for Payer: Cash Price |
$246.60
|
Rate for Payer: Cash Price |
$246.60
|
Rate for Payer: Cigna Commercial |
$756.24
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
Rate for Payer: Health EOS Commercial |
$731.58
|
Rate for Payer: HFN Commercial |
$756.24
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
Rate for Payer: Multiplan Commercial |
$657.60
|
Rate for Payer: NAPHCARE Commercial |
$349.64
|
Rate for Payer: Preferred Network Access Commercial |
$756.24
|
Rate for Payer: Quartz Beloit One Network |
$402.78
|
Rate for Payer: Quartz Commercial |
$534.30
|
Rate for Payer: Quartz Medicare Advantage |
$233.09
|
Rate for Payer: The Alliance Commercial |
$932.36
|
Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$452.10
|
Rate for Payer: Wellcare Medicare |
$233.09
|
Rate for Payer: WPS Commercial |
$608.86
|
|
ED Treat Finger Fracture, each
|
Facility
|
IP
|
$822.00
|
|
Service Code
|
CPT 26725
|
Hospital Charge Code |
6177766
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$402.78 |
Max. Negotiated Rate |
$756.24 |
Rate for Payer: Aetna Commercial |
$739.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.66
|
Rate for Payer: Cash Price |
$246.60
|
Rate for Payer: Cigna Commercial |
$756.24
|
Rate for Payer: Health EOS Commercial |
$731.58
|
Rate for Payer: HFN Commercial |
$756.24
|
Rate for Payer: Multiplan Commercial |
$657.60
|
Rate for Payer: NAPHCARE Commercial |
$493.20
|
Rate for Payer: Preferred Network Access Commercial |
$756.24
|
Rate for Payer: Quartz Beloit One Network |
$402.78
|
Rate for Payer: Quartz Commercial |
$493.20
|
Rate for Payer: WEA Trust Commercial |
$452.10
|
Rate for Payer: WPS Commercial |
$608.86
|
|
ED Treat Hip Dislocation
|
Facility
|
IP
|
$941.00
|
|
Service Code
|
CPT 27265
|
Hospital Charge Code |
6175422
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$461.09 |
Max. Negotiated Rate |
$865.72 |
Rate for Payer: Aetna Commercial |
$846.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.26
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.73
|
Rate for Payer: Cash Price |
$282.30
|
Rate for Payer: Cigna Commercial |
$865.72
|
Rate for Payer: Health EOS Commercial |
$837.49
|
Rate for Payer: HFN Commercial |
$865.72
|
Rate for Payer: Multiplan Commercial |
$752.80
|
Rate for Payer: NAPHCARE Commercial |
$564.60
|
Rate for Payer: Preferred Network Access Commercial |
$865.72
|
Rate for Payer: Quartz Beloit One Network |
$461.09
|
Rate for Payer: Quartz Commercial |
$564.60
|
Rate for Payer: WEA Trust Commercial |
$517.55
|
Rate for Payer: WPS Commercial |
$697.00
|
|
ED Treat Hip Dislocation
|
Facility
|
OP
|
$941.00
|
|
Service Code
|
CPT 27265
|
Hospital Charge Code |
6175422
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$233.09 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$846.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.26
|
Rate for Payer: Aetna Managed Medicare |
$233.09
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.65
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.68
|
Rate for Payer: Anthem Medicare Advantage |
$233.09
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.73
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
Rate for Payer: Cash Price |
$282.30
|
Rate for Payer: Cash Price |
$282.30
|
Rate for Payer: Cash Price |
$282.30
|
Rate for Payer: Cigna Commercial |
$865.72
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
Rate for Payer: Health EOS Commercial |
$837.49
|
Rate for Payer: HFN Commercial |
$865.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
Rate for Payer: Multiplan Commercial |
$752.80
|
Rate for Payer: NAPHCARE Commercial |
$349.64
|
Rate for Payer: Preferred Network Access Commercial |
$865.72
|
Rate for Payer: Quartz Beloit One Network |
$461.09
|
Rate for Payer: Quartz Commercial |
$611.65
|
Rate for Payer: Quartz Medicare Advantage |
$233.09
|
Rate for Payer: The Alliance Commercial |
$932.36
|
Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$517.55
|
Rate for Payer: Wellcare Medicare |
$233.09
|
Rate for Payer: WPS Commercial |
$697.00
|
|
ED Treatment Closed Elbow DIslocation Req Anes
|
Facility
|
OP
|
$770.00
|
|
Service Code
|
CPT 24605
|
Hospital Charge Code |
6209410
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$301.00 |
Max. Negotiated Rate |
$6,354.28 |
Rate for Payer: Aetna Commercial |
$693.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$662.20
|
Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$500.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$385.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$369.60
|
Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$408.10
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Cigna Commercial |
$708.40
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
Rate for Payer: Health EOS Commercial |
$685.30
|
Rate for Payer: HFN Commercial |
$708.40
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
Rate for Payer: Multiplan Commercial |
$616.00
|
Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
Rate for Payer: Preferred Network Access Commercial |
$708.40
|
Rate for Payer: Quartz Beloit One Network |
$377.30
|
Rate for Payer: Quartz Commercial |
$500.50
|
Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
Rate for Payer: The Alliance Commercial |
$6,354.28
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$423.50
|
Rate for Payer: Wellcare Medicare |
$1,588.57
|
Rate for Payer: WPS Commercial |
$570.34
|
|
ED Treatment Closed Elbow DIslocation Req Anes
|
Facility
|
IP
|
$770.00
|
|
Service Code
|
CPT 24605
|
Hospital Charge Code |
6209410
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$377.30 |
Max. Negotiated Rate |
$708.40 |
Rate for Payer: Aetna Commercial |
$693.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$662.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$408.10
|
Rate for Payer: Cash Price |
$231.00
|
Rate for Payer: Cigna Commercial |
$708.40
|
Rate for Payer: Health EOS Commercial |
$685.30
|
Rate for Payer: HFN Commercial |
$708.40
|
Rate for Payer: Multiplan Commercial |
$616.00
|
Rate for Payer: NAPHCARE Commercial |
$462.00
|
Rate for Payer: Preferred Network Access Commercial |
$708.40
|
Rate for Payer: Quartz Beloit One Network |
$377.30
|
Rate for Payer: Quartz Commercial |
$462.00
|
Rate for Payer: WEA Trust Commercial |
$423.50
|
Rate for Payer: WPS Commercial |
$570.34
|
|
ED Treatment of superficial wound dehiscence; simple closure with packing
|
Facility
|
IP
|
$420.00
|
|
Service Code
|
CPT 12021
|
Hospital Charge Code |
6173544
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$205.80 |
Max. Negotiated Rate |
$386.40 |
Rate for Payer: Aetna Commercial |
$378.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
Rate for Payer: Cash Price |
$126.00
|
Rate for Payer: Cigna Commercial |
$386.40
|
Rate for Payer: Health EOS Commercial |
$373.80
|
Rate for Payer: HFN Commercial |
$386.40
|
Rate for Payer: Multiplan Commercial |
$336.00
|
Rate for Payer: NAPHCARE Commercial |
$252.00
|
Rate for Payer: Preferred Network Access Commercial |
$386.40
|
Rate for Payer: Quartz Beloit One Network |
$205.80
|
Rate for Payer: Quartz Commercial |
$252.00
|
Rate for Payer: WEA Trust Commercial |
$231.00
|
Rate for Payer: WPS Commercial |
$311.09
|
|
ED Treatment of superficial wound dehiscence; simple closure with packing
|
Facility
|
OP
|
$420.00
|
|
Service Code
|
CPT 12021
|
Hospital Charge Code |
6173544
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$201.60 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$378.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
Rate for Payer: Aetna Managed Medicare |
$394.12
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.60
|
Rate for Payer: Anthem Medicare Advantage |
$394.12
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
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 |
$126.00
|
Rate for Payer: Cash Price |
$126.00
|
Rate for Payer: Cash Price |
$126.00
|
Rate for Payer: Cigna Commercial |
$386.40
|
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 |
$373.80
|
Rate for Payer: HFN Commercial |
$386.40
|
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 |
$336.00
|
Rate for Payer: NAPHCARE Commercial |
$591.18
|
Rate for Payer: Preferred Network Access Commercial |
$386.40
|
Rate for Payer: Quartz Beloit One Network |
$205.80
|
Rate for Payer: Quartz Commercial |
$273.00
|
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 |
$231.00
|
Rate for Payer: Wellcare Medicare |
$394.12
|
Rate for Payer: WPS Commercial |
$311.09
|
|
ED Trimming of Nondystrophic Nails
|
Facility
|
IP
|
$28.00
|
|
Service Code
|
CPT 11719
|
Hospital Charge Code |
6174786
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$13.72 |
Max. Negotiated Rate |
$25.76 |
Rate for Payer: Aetna Commercial |
$25.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cigna Commercial |
$25.76
|
Rate for Payer: Health EOS Commercial |
$24.92
|
Rate for Payer: HFN Commercial |
$25.76
|
Rate for Payer: Multiplan Commercial |
$22.40
|
Rate for Payer: NAPHCARE Commercial |
$16.80
|
Rate for Payer: Preferred Network Access Commercial |
$25.76
|
Rate for Payer: Quartz Beloit One Network |
$13.72
|
Rate for Payer: Quartz Commercial |
$16.80
|
Rate for Payer: WEA Trust Commercial |
$15.40
|
Rate for Payer: WPS Commercial |
$20.74
|
|
ED Trimming of Nondystrophic Nails
|
Facility
|
OP
|
$28.00
|
|
Service Code
|
CPT 11719
|
Hospital Charge Code |
6174786
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$13.44 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$25.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
Rate for Payer: Aetna Managed Medicare |
$60.46
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.20
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.44
|
Rate for Payer: Anthem Medicare Advantage |
$60.46
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
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 |
$8.40
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cash Price |
$8.40
|
Rate for Payer: Cigna Commercial |
$25.76
|
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 |
$24.92
|
Rate for Payer: HFN Commercial |
$25.76
|
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 |
$22.40
|
Rate for Payer: NAPHCARE Commercial |
$90.69
|
Rate for Payer: Preferred Network Access Commercial |
$25.76
|
Rate for Payer: Quartz Beloit One Network |
$13.72
|
Rate for Payer: Quartz Commercial |
$18.20
|
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 |
$15.40
|
Rate for Payer: Wellcare Medicare |
$60.46
|
Rate for Payer: WPS Commercial |
$20.74
|
|
ED Tube thoracostomy, w/connect to drainage system, if performed, open (sep proc)
|
Facility
|
OP
|
$630.00
|
|
Service Code
|
CPT 32551
|
Hospital Charge Code |
6177679
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$301.00 |
Max. Negotiated Rate |
$6,331.88 |
Rate for Payer: Aetna Commercial |
$567.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
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 |
$1,582.97
|
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 |
$1,582.97
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
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 |
$1,582.97
|
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 |
$560.70
|
Rate for Payer: HFN Commercial |
$579.60
|
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 |
$504.00
|
Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
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 |
$1,582.97
|
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 |
$346.50
|
Rate for Payer: Wellcare Medicare |
$1,582.97
|
Rate for Payer: WPS Commercial |
$466.64
|
|
ED Tube thoracostomy, w/connect to drainage system, if performed, open (sep proc)
|
Facility
|
IP
|
$630.00
|
|
Service Code
|
CPT 32551
|
Hospital Charge Code |
6177679
|
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 Tympanostomy With Tube
|
Facility
|
OP
|
$543.00
|
|
Service Code
|
CPT 69433
|
Hospital Charge Code |
6174446
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$260.64 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$488.70
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
Rate for Payer: Aetna Managed Medicare |
$543.83
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
Rate for Payer: Anthem Medicare Advantage |
$543.83
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.83
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.83
|
Rate for Payer: Cash Price |
$162.90
|
Rate for Payer: Cash Price |
$162.90
|
Rate for Payer: Cash Price |
$162.90
|
Rate for Payer: Cigna Commercial |
$499.56
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$543.83
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$543.83
|
Rate for Payer: Health EOS Commercial |
$483.27
|
Rate for Payer: HFN Commercial |
$499.56
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,023.05
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.83
|
Rate for Payer: Independent Care Health Plan Medicare |
$543.83
|
Rate for Payer: Managed Health Services Medicare Advantage |
$543.83
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$543.83
|
Rate for Payer: Multiplan Commercial |
$434.40
|
Rate for Payer: NAPHCARE Commercial |
$815.74
|
Rate for Payer: Preferred Network Access Commercial |
$499.56
|
Rate for Payer: Quartz Beloit One Network |
$266.07
|
Rate for Payer: Quartz Commercial |
$352.95
|
Rate for Payer: Quartz Medicare Advantage |
$543.83
|
Rate for Payer: The Alliance Commercial |
$2,175.32
|
Rate for Payer: United Healthcare Medicare Advantage |
$543.83
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$298.65
|
Rate for Payer: Wellcare Medicare |
$543.83
|
Rate for Payer: WPS Commercial |
$402.20
|
|
ED Tympanostomy With Tube
|
Facility
|
IP
|
$543.00
|
|
Service Code
|
CPT 69433
|
Hospital Charge Code |
6174446
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$266.07 |
Max. Negotiated Rate |
$499.56 |
Rate for Payer: Aetna Commercial |
$488.70
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
Rate for Payer: Cash Price |
$162.90
|
Rate for Payer: Cigna Commercial |
$499.56
|
Rate for Payer: Health EOS Commercial |
$483.27
|
Rate for Payer: HFN Commercial |
$499.56
|
Rate for Payer: Multiplan Commercial |
$434.40
|
Rate for Payer: NAPHCARE Commercial |
$325.80
|
Rate for Payer: Preferred Network Access Commercial |
$499.56
|
Rate for Payer: Quartz Beloit One Network |
$266.07
|
Rate for Payer: Quartz Commercial |
$325.80
|
Rate for Payer: WEA Trust Commercial |
$298.65
|
Rate for Payer: WPS Commercial |
$402.20
|
|
ED Unna Boot
|
Facility
|
OP
|
$118.00
|
|
Service Code
|
CPT 29580
|
Hospital Charge Code |
6173882
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$56.64 |
Max. Negotiated Rate |
$4,218.22 |
Rate for Payer: Aetna Commercial |
$106.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
Rate for Payer: Aetna Managed Medicare |
$155.74
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
Rate for Payer: Anthem Medicare Advantage |
$155.74
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.74
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.74
|
Rate for Payer: Cash Price |
$35.40
|
Rate for Payer: Cash Price |
$35.40
|
Rate for Payer: Cash Price |
$35.40
|
Rate for Payer: Cigna Commercial |
$108.56
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.74
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.74
|
Rate for Payer: Health EOS Commercial |
$105.02
|
Rate for Payer: HFN Commercial |
$108.56
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.35
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.74
|
Rate for Payer: Independent Care Health Plan Medicare |
$155.74
|
Rate for Payer: Managed Health Services Medicare Advantage |
$155.74
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.74
|
Rate for Payer: Multiplan Commercial |
$94.40
|
Rate for Payer: NAPHCARE Commercial |
$233.61
|
Rate for Payer: Preferred Network Access Commercial |
$108.56
|
Rate for Payer: Quartz Beloit One Network |
$57.82
|
Rate for Payer: Quartz Commercial |
$76.70
|
Rate for Payer: Quartz Medicare Advantage |
$155.74
|
Rate for Payer: The Alliance Commercial |
$622.96
|
Rate for Payer: United Healthcare Medicare Advantage |
$155.74
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$64.90
|
Rate for Payer: Wellcare Medicare |
$155.74
|
Rate for Payer: WPS Commercial |
$87.40
|
|
ED Unna Boot
|
Facility
|
IP
|
$118.00
|
|
Service Code
|
CPT 29580
|
Hospital Charge Code |
6173882
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$57.82 |
Max. Negotiated Rate |
$108.56 |
Rate for Payer: Aetna Commercial |
$106.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
Rate for Payer: Cash Price |
$35.40
|
Rate for Payer: Cigna Commercial |
$108.56
|
Rate for Payer: Health EOS Commercial |
$105.02
|
Rate for Payer: HFN Commercial |
$108.56
|
Rate for Payer: Multiplan Commercial |
$94.40
|
Rate for Payer: NAPHCARE Commercial |
$70.80
|
Rate for Payer: Preferred Network Access Commercial |
$108.56
|
Rate for Payer: Quartz Beloit One Network |
$57.82
|
Rate for Payer: Quartz Commercial |
$70.80
|
Rate for Payer: WEA Trust Commercial |
$64.90
|
Rate for Payer: WPS Commercial |
$87.40
|
|
ED Ureteral endoscopy & treatment
|
Facility
|
OP
|
$649.00
|
|
Service Code
|
CPT 50961
|
Hospital Charge Code |
6177680
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$301.00 |
Max. Negotiated Rate |
$19,025.46 |
Rate for Payer: Aetna Commercial |
$584.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
Rate for Payer: Aetna Managed Medicare |
$5,114.37
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.85
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.52
|
Rate for Payer: Anthem Medicare Advantage |
$5,114.37
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.97
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,114.37
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,114.37
|
Rate for Payer: Cash Price |
$194.70
|
Rate for Payer: Cash Price |
$194.70
|
Rate for Payer: Cash Price |
$194.70
|
Rate for Payer: Cigna Commercial |
$597.08
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,114.37
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,114.37
|
Rate for Payer: Health EOS Commercial |
$577.61
|
Rate for Payer: HFN Commercial |
$597.08
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,025.46
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,114.37
|
Rate for Payer: Independent Care Health Plan Medicare |
$5,114.37
|
Rate for Payer: Managed Health Services Medicare Advantage |
$5,114.37
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,114.37
|
Rate for Payer: Multiplan Commercial |
$519.20
|
Rate for Payer: NAPHCARE Commercial |
$7,671.56
|
Rate for Payer: Preferred Network Access Commercial |
$597.08
|
Rate for Payer: Quartz Beloit One Network |
$318.01
|
Rate for Payer: Quartz Commercial |
$421.85
|
Rate for Payer: Quartz Medicare Advantage |
$5,114.37
|
Rate for Payer: The Alliance Commercial |
$8,694.43
|
Rate for Payer: United Healthcare Medicare Advantage |
$5,114.37
|
Rate for Payer: United Healthcare PPO |
$301.00
|
Rate for Payer: WEA Trust Commercial |
$356.95
|
Rate for Payer: Wellcare Medicare |
$5,114.37
|
Rate for Payer: WPS Commercial |
$480.71
|
|
ED Ureteral endoscopy & treatment
|
Facility
|
IP
|
$649.00
|
|
Service Code
|
CPT 50961
|
Hospital Charge Code |
6177680
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$318.01 |
Max. Negotiated Rate |
$597.08 |
Rate for Payer: Aetna Commercial |
$584.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.97
|
Rate for Payer: Cash Price |
$194.70
|
Rate for Payer: Cigna Commercial |
$597.08
|
Rate for Payer: Health EOS Commercial |
$577.61
|
Rate for Payer: HFN Commercial |
$597.08
|
Rate for Payer: Multiplan Commercial |
$519.20
|
Rate for Payer: NAPHCARE Commercial |
$389.40
|
Rate for Payer: Preferred Network Access Commercial |
$597.08
|
Rate for Payer: Quartz Beloit One Network |
$318.01
|
Rate for Payer: Quartz Commercial |
$389.40
|
Rate for Payer: WEA Trust Commercial |
$356.95
|
Rate for Payer: WPS Commercial |
$480.71
|
|
ED US Vasc Access Sits Vsl Patency NDL Entry
|
Facility
|
IP
|
$179.00
|
|
Service Code
|
CPT 76937
|
Hospital Charge Code |
6181795
|
Hospital Revenue Code
|
450
|
Min. Negotiated Rate |
$87.71 |
Max. Negotiated Rate |
$164.68 |
Rate for Payer: Aetna Commercial |
$161.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
Rate for Payer: Cash Price |
$53.70
|
Rate for Payer: Cigna Commercial |
$164.68
|
Rate for Payer: Health EOS Commercial |
$159.31
|
Rate for Payer: HFN Commercial |
$164.68
|
Rate for Payer: Multiplan Commercial |
$143.20
|
Rate for Payer: NAPHCARE Commercial |
$107.40
|
Rate for Payer: Preferred Network Access Commercial |
$164.68
|
Rate for Payer: Quartz Beloit One Network |
$87.71
|
Rate for Payer: Quartz Commercial |
$107.40
|
Rate for Payer: WEA Trust Commercial |
$98.45
|
Rate for Payer: WPS Commercial |
$132.59
|
|