|
Eye Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
EYE EVISCERATION/GLOBE EYE, RUPTURE REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
EYE EVISCERATION/GLOBE EYE, RUPTURE REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Eye Exam & Treatment 92014DSC
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 92014
|
| Hospital Charge Code |
5551272
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$275.53 |
| Rate for Payer: Aetna Commercial |
$186.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$63.07
|
| Rate for Payer: Anthem Medicare Advantage |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.07
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$186.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.07
|
| Rate for Payer: Health EOS Commercial |
$178.87
|
| Rate for Payer: HFN Commercial |
$186.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$275.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.07
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$94.60
|
| Rate for Payer: Preferred Network Access Commercial |
$186.73
|
| Rate for Payer: Quartz Beloit One Network |
$86.49
|
| Rate for Payer: Quartz Commercial |
$112.04
|
| Rate for Payer: Quartz Medicare Advantage |
$63.07
|
| Rate for Payer: The Alliance Commercial |
$157.66
|
| Rate for Payer: United Healthcare Medicaid |
$46.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.07
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$252.26
|
|
|
Eye Exam with Photos 9223526
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
CPT 92235 26
|
| Hospital Charge Code |
3190204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$532.53 |
| Rate for Payer: Aetna Commercial |
$532.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.08
|
| Rate for Payer: Aetna Managed Medicare |
$42.43
|
| Rate for Payer: Anthem Medicare Advantage |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.43
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$532.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.43
|
| Rate for Payer: Health EOS Commercial |
$510.11
|
| Rate for Payer: HFN Commercial |
$532.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.43
|
| Rate for Payer: Multiplan Commercial |
$448.45
|
| Rate for Payer: NAPHCARE Commercial |
$63.65
|
| Rate for Payer: Preferred Network Access Commercial |
$532.53
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$319.52
|
| Rate for Payer: Quartz Medicare Advantage |
$42.43
|
| Rate for Payer: The Alliance Commercial |
$106.08
|
| Rate for Payer: United Healthcare Medicaid |
$42.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.43
|
| Rate for Payer: WEA Trust Commercial |
$308.31
|
| Rate for Payer: WPS Commercial |
$169.73
|
|
|
Eye Exam with Photos 9225026
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 92250 26
|
| Hospital Charge Code |
3165648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$20.64
|
| Rate for Payer: Anthem Medicare Advantage |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.64
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.64
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.64
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$30.97
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$20.64
|
| Rate for Payer: The Alliance Commercial |
$51.61
|
| Rate for Payer: United Healthcare Medicaid |
$19.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.64
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$82.58
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$5,524.04
|
|
|
Service Code
|
APR-DRG 0821
|
| Min. Negotiated Rate |
$4,906.79 |
| Max. Negotiated Rate |
$5,524.04 |
| Rate for Payer: Anthem Medicaid |
$5,289.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,289.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,289.57
|
| Rate for Payer: Dean Health Medicaid |
$5,289.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,906.79
|
| Rate for Payer: Managed Health Services Medicaid |
$5,524.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,289.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,289.57
|
| Rate for Payer: United Healthcare Medicaid |
$5,289.57
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 0822
|
| Min. Negotiated Rate |
$6,308.73 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Anthem Medicaid |
$6,800.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,800.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,800.87
|
| Rate for Payer: Dean Health Medicaid |
$6,800.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,308.73
|
| Rate for Payer: Managed Health Services Medicaid |
$7,102.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,800.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,800.87
|
| Rate for Payer: United Healthcare Medicaid |
$6,800.87
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$17,975.04
|
|
|
Service Code
|
APR-DRG 0824
|
| Min. Negotiated Rate |
$15,966.55 |
| Max. Negotiated Rate |
$17,975.04 |
| Rate for Payer: Anthem Medicaid |
$17,212.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,212.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,212.09
|
| Rate for Payer: Dean Health Medicaid |
$17,212.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,966.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17,975.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,212.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,212.09
|
| Rate for Payer: United Healthcare Medicaid |
$17,212.09
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 0823
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
EYELID REPAIR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
EYELID REPAIR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Eyelids: Correction of trichiasis; epilation, by forceps only
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
1188898
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$280.59 |
| Rate for Payer: Aetna Commercial |
$280.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.01
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$280.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$280.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$236.29
|
| Rate for Payer: NAPHCARE Commercial |
$28.45
|
| Rate for Payer: Preferred Network Access Commercial |
$280.59
|
| Rate for Payer: Quartz Beloit One Network |
$129.96
|
| Rate for Payer: Quartz Commercial |
$168.36
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicaid |
$25.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$162.45
|
| Rate for Payer: WPS Commercial |
$85.36
|
|
|
Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
1188899
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$519.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$106.70
|
| Rate for Payer: Anthem Medicare Advantage |
$106.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.70
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$519.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.70
|
| Rate for Payer: Health EOS Commercial |
$497.81
|
| Rate for Payer: HFN Commercial |
$519.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$425.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.70
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$160.06
|
| Rate for Payer: Preferred Network Access Commercial |
$519.69
|
| Rate for Payer: Quartz Beloit One Network |
$240.70
|
| Rate for Payer: Quartz Commercial |
$311.81
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$453.49
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$480.17
|
|
|
Eyelids: Corrections of trichiasis; epilation, by forceps only 6782050
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
5673626
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna Commercial |
$560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$560.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$536.61
|
| Rate for Payer: HFN Commercial |
$560.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$28.45
|
| Rate for Payer: Preferred Network Access Commercial |
$560.20
|
| Rate for Payer: Quartz Beloit One Network |
$259.46
|
| Rate for Payer: Quartz Commercial |
$336.12
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicaid |
$25.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$85.36
|
|
|
Eyelids; Excision of Chalazion, Multiple Different Lids
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
1188897
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$778.54 |
| Rate for Payer: Aetna Commercial |
$778.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$704.79
|
| Rate for Payer: Aetna Managed Medicare |
$137.26
|
| Rate for Payer: Anthem Medicare Advantage |
$137.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.26
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$778.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.26
|
| Rate for Payer: Health EOS Commercial |
$745.76
|
| Rate for Payer: HFN Commercial |
$778.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.26
|
| Rate for Payer: Multiplan Commercial |
$655.62
|
| Rate for Payer: NAPHCARE Commercial |
$205.89
|
| Rate for Payer: Preferred Network Access Commercial |
$778.54
|
| Rate for Payer: Quartz Beloit One Network |
$360.59
|
| Rate for Payer: Quartz Commercial |
$467.13
|
| Rate for Payer: Quartz Medicare Advantage |
$137.26
|
| Rate for Payer: The Alliance Commercial |
$583.35
|
| Rate for Payer: United Healthcare Medicaid |
$93.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.26
|
| Rate for Payer: WEA Trust Commercial |
$450.74
|
| Rate for Payer: WPS Commercial |
$617.67
|
|
|
Eyelids; Excision of Chalazion, Multiple Same Lid
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
1188896
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.54 |
| Max. Negotiated Rate |
$864.50 |
| Rate for Payer: Aetna Commercial |
$864.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Aetna Managed Medicare |
$109.15
|
| Rate for Payer: Anthem Medicare Advantage |
$109.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$109.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$109.15
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$864.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.15
|
| Rate for Payer: Health EOS Commercial |
$828.10
|
| Rate for Payer: HFN Commercial |
$864.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$461.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$461.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$109.15
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.72
|
| Rate for Payer: Preferred Network Access Commercial |
$864.50
|
| Rate for Payer: Quartz Beloit One Network |
$400.40
|
| Rate for Payer: Quartz Commercial |
$518.70
|
| Rate for Payer: Quartz Medicare Advantage |
$109.15
|
| Rate for Payer: The Alliance Commercial |
$463.88
|
| Rate for Payer: United Healthcare Medicaid |
$85.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.15
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$491.17
|
|
|
Eyelids; Excision of Chalazion, Single
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
CPT 67800
|
| Hospital Charge Code |
1188895
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$446.58 |
| Rate for Payer: Aetna Commercial |
$446.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Aetna Managed Medicare |
$86.04
|
| Rate for Payer: Anthem Medicare Advantage |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.04
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$446.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.04
|
| Rate for Payer: Health EOS Commercial |
$427.77
|
| Rate for Payer: HFN Commercial |
$446.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$359.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.04
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: NAPHCARE Commercial |
$129.06
|
| Rate for Payer: Preferred Network Access Commercial |
$446.58
|
| Rate for Payer: Quartz Beloit One Network |
$206.84
|
| Rate for Payer: Quartz Commercial |
$267.95
|
| Rate for Payer: Quartz Medicare Advantage |
$86.04
|
| Rate for Payer: The Alliance Commercial |
$365.67
|
| Rate for Payer: United Healthcare Medicaid |
$68.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.04
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$387.18
|
|
|
EYE TRAUMA, INTRAOCULAR REPAIR PROCEDURE
|
Facility
|
OP
|
$5,256.00
|
|
| Hospital Charge Code |
2960043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,530.55 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,530.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,553.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,733.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,623.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,058.99
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,099.68
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: NAPHCARE Commercial |
$3,279.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,553.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,279.74
|
| Rate for Payer: The Alliance Commercial |
$2,733.12
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
EYE TRAUMA, INTRAOCULAR REPAIR PROCEDURE
|
Facility
|
IP
|
$5,256.00
|
|
| Hospital Charge Code |
2960043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,678.46 |
| Max. Negotiated Rate |
$5,028.94 |
| Rate for Payer: Aetna Commercial |
$4,919.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,700.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,897.11
|
| Rate for Payer: Cash Price |
$1,576.80
|
| Rate for Payer: Cigna Commercial |
$5,028.94
|
| Rate for Payer: Health EOS Commercial |
$4,864.95
|
| Rate for Payer: HFN Commercial |
$5,028.94
|
| Rate for Payer: Multiplan Commercial |
$4,372.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5,028.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,678.46
|
| Rate for Payer: Quartz Commercial |
$3,279.74
|
| Rate for Payer: WEA Trust Commercial |
$3,006.43
|
| Rate for Payer: WPS Commercial |
$4,048.70
|
|
|
Eylea 1 mg charge
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
3002805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$794.46 |
| Max. Negotiated Rate |
$2,635.98 |
| Rate for Payer: Aetna Commercial |
$2,635.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Aetna Managed Medicare |
$794.46
|
| Rate for Payer: Anthem Medicare Advantage |
$794.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.46
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,635.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$794.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$874.77
|
| Rate for Payer: Health EOS Commercial |
$2,525.00
|
| Rate for Payer: HFN Commercial |
$2,635.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,395.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,395.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.46
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,635.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,220.88
|
| Rate for Payer: Quartz Commercial |
$1,581.59
|
| Rate for Payer: Quartz Medicare Advantage |
$794.46
|
| Rate for Payer: The Alliance Commercial |
$2,184.75
|
| Rate for Payer: United Healthcare Medicaid |
$794.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.46
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: WPS Commercial |
$2,186.93
|
|
|
Eylea 1 mg charge
|
Facility
|
OP
|
$2,668.00
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
3002805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$794.46 |
| Max. Negotiated Rate |
$3,177.82 |
| Rate for Payer: Aetna Commercial |
$2,497.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Aetna Managed Medicare |
$794.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,331.87
|
| Rate for Payer: Anthem Medicare Advantage |
$794.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.46
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,552.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$794.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,157.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$794.46
|
| Rate for Payer: Health EOS Commercial |
$2,469.50
|
| Rate for Payer: HFN Commercial |
$2,552.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,955.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$794.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$794.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$794.46
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,552.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.61
|
| Rate for Payer: Quartz Commercial |
$1,803.57
|
| Rate for Payer: Quartz Medicare Advantage |
$794.46
|
| Rate for Payer: The Alliance Commercial |
$3,177.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.46
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: Wellcare Medicare |
$794.46
|
| Rate for Payer: WPS Commercial |
$2,186.93
|
|
|
Eylea 1 mg charge
|
Facility
|
IP
|
$2,668.00
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
3002805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,359.61 |
| Max. Negotiated Rate |
$2,552.74 |
| Rate for Payer: Aetna Commercial |
$2,497.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.60
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,552.74
|
| Rate for Payer: Health EOS Commercial |
$2,469.50
|
| Rate for Payer: HFN Commercial |
$2,552.74
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,552.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.61
|
| Rate for Payer: Quartz Commercial |
$1,664.83
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: WPS Commercial |
$2,055.16
|
|
|
Eylea 1 mg charge J0178 man
|
Facility
|
OP
|
$2,668.00
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
3373501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$794.46 |
| Max. Negotiated Rate |
$3,177.82 |
| Rate for Payer: Aetna Commercial |
$2,497.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Aetna Managed Medicare |
$794.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,331.87
|
| Rate for Payer: Anthem Medicare Advantage |
$794.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.46
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,552.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$794.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,157.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$794.46
|
| Rate for Payer: Health EOS Commercial |
$2,469.50
|
| Rate for Payer: HFN Commercial |
$2,552.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,955.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$794.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$794.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$794.46
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,552.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.61
|
| Rate for Payer: Quartz Commercial |
$1,803.57
|
| Rate for Payer: Quartz Medicare Advantage |
$794.46
|
| Rate for Payer: The Alliance Commercial |
$3,177.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.46
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: Wellcare Medicare |
$794.46
|
| Rate for Payer: WPS Commercial |
$2,186.93
|
|
|
Eylea 1 mg charge J0178 man
|
Facility
|
IP
|
$2,668.00
|
|
|
Service Code
|
HCPCS J0178
|
| Hospital Charge Code |
3373501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,359.61 |
| Max. Negotiated Rate |
$2,552.74 |
| Rate for Payer: Aetna Commercial |
$2,497.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.60
|
| Rate for Payer: Cash Price |
$800.40
|
| Rate for Payer: Cigna Commercial |
$2,552.74
|
| Rate for Payer: Health EOS Commercial |
$2,469.50
|
| Rate for Payer: HFN Commercial |
$2,552.74
|
| Rate for Payer: Multiplan Commercial |
$2,219.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,552.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.61
|
| Rate for Payer: Quartz Commercial |
$1,664.83
|
| Rate for Payer: WEA Trust Commercial |
$1,526.10
|
| Rate for Payer: WPS Commercial |
$2,055.16
|
|
