|
INCISION AND DRAINAGE, SCROTAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
INCISION AND DRAINAGE, SCROTAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Incision and Drainage Set Up
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
1498832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Incision and Drainage Set Up
|
Facility
|
IP
|
$213.00
|
|
| Hospital Charge Code |
1498832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
INCISION AND DRAINAGE, SHOULDER
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2950495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
INCISION AND DRAINAGE, SHOULDER
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2950495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
INCISION AND DRAINAGE, UPPER EXTREMITY/ELBOW/FOREARM
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960523
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
INCISION AND DRAINAGE, UPPER EXTREMITY/ELBOW/FOREARM
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960523
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
INCISION AND DRAINAGE, VULVAR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2962732
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| 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: 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: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| 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 |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
INCISION AND DRAINAGE, VULVAR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2962732
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
INCISION AND DRAINAGE, WRIST/HAND/FINGER
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
INCISION AND DRAINAGE, WRIST/HAND/FINGER
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960135
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Incision and removal of foreign body, subcutaneous tissues; complicated 10121
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
3013506
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.22 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Aetna Commercial |
$926.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna Commercial |
$926.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.00
|
| Rate for Payer: Health EOS Commercial |
$887.25
|
| Rate for Payer: HFN Commercial |
$926.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$615.10
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$926.25
|
| Rate for Payer: Quartz Beloit One Network |
$429.00
|
| Rate for Payer: Quartz Commercial |
$555.75
|
| Rate for Payer: The Alliance Commercial |
$487.50
|
| Rate for Payer: United Healthcare Medicaid |
$76.22
|
| Rate for Payer: WEA Trust Commercial |
$536.25
|
| Rate for Payer: WPS Commercial |
$722.18
|
|
|
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 10120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$394.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| 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: 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: 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: NAPHCARE Commercial |
$591.18
|
| 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 |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
|
|
Incision and removal of foreign body, subcutaneous tissues; simple 10120
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
3013505
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.63 |
| Max. Negotiated Rate |
$431.30 |
| Rate for Payer: Aetna Commercial |
$431.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.44
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$431.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.40
|
| Rate for Payer: Health EOS Commercial |
$413.14
|
| Rate for Payer: HFN Commercial |
$431.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$350.32
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: Preferred Network Access Commercial |
$431.30
|
| Rate for Payer: Quartz Beloit One Network |
$199.76
|
| Rate for Payer: Quartz Commercial |
$258.78
|
| Rate for Payer: The Alliance Commercial |
$227.00
|
| Rate for Payer: United Healthcare Medicaid |
$41.63
|
| Rate for Payer: WEA Trust Commercial |
$249.70
|
| Rate for Payer: WPS Commercial |
$336.28
|
|
|
Incision Drainage Lacrimal Sac 68420
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
CPT 68420
|
| Hospital Charge Code |
5454714
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.98 |
| Max. Negotiated Rate |
$1,618.80 |
| Rate for Payer: Aetna Commercial |
$1,618.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,465.44
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cash Price |
$511.20
|
| Rate for Payer: Cigna Commercial |
$1,618.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.40
|
| Rate for Payer: Health EOS Commercial |
$1,550.64
|
| Rate for Payer: HFN Commercial |
$1,618.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$558.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$558.62
|
| Rate for Payer: Multiplan Commercial |
$1,363.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.80
|
| Rate for Payer: Quartz Beloit One Network |
$749.76
|
| Rate for Payer: Quartz Commercial |
$971.28
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: United Healthcare Medicaid |
$112.98
|
| Rate for Payer: WEA Trust Commercial |
$937.20
|
| Rate for Payer: WPS Commercial |
$1,262.15
|
|
|
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DE QUERVAINS DISEASE)
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 25000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| 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: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| 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: NAPHCARE Commercial |
$2,382.86
|
| 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 |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
INCISION OF ANAL ABSCESS 46050
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
3014822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$465.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$465.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.00
|
| Rate for Payer: Health EOS Commercial |
$445.90
|
| Rate for Payer: HFN Commercial |
$465.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$331.26
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$465.50
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$279.30
|
| Rate for Payer: The Alliance Commercial |
$245.00
|
| Rate for Payer: United Healthcare Medicaid |
$67.27
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
INCISION OF ANAL SPHINCTER 46080
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
CPT 46080
|
| Hospital Charge Code |
3014824
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$611.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.84
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cash Price |
$193.20
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.40
|
| Rate for Payer: Health EOS Commercial |
$586.04
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$519.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$519.33
|
| Rate for Payer: Multiplan Commercial |
$515.20
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$283.36
|
| Rate for Payer: Quartz Commercial |
$367.08
|
| Rate for Payer: The Alliance Commercial |
$322.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$354.20
|
| Rate for Payer: WPS Commercial |
$477.01
|
|
|
INCISION OF BREAST LESION 19020
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
3013674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,025.22 |
| Rate for Payer: Aetna Commercial |
$1,003.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.16
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$1,003.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$633.60
|
| Rate for Payer: Health EOS Commercial |
$960.96
|
| Rate for Payer: HFN Commercial |
$1,003.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,025.22
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,003.20
|
| Rate for Payer: Quartz Beloit One Network |
$464.64
|
| Rate for Payer: Quartz Commercial |
$601.92
|
| Rate for Payer: The Alliance Commercial |
$528.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$580.80
|
| Rate for Payer: WPS Commercial |
$782.18
|
|
|
Incision Of Conjunctiva, Drainage Of Cyst
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
1190827
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$558.60 |
| Rate for Payer: Aetna Commercial |
$558.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$558.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.80
|
| Rate for Payer: Health EOS Commercial |
$535.08
|
| Rate for Payer: HFN Commercial |
$558.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$373.47
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$558.60
|
| Rate for Payer: Quartz Beloit One Network |
$258.72
|
| Rate for Payer: Quartz Commercial |
$335.16
|
| Rate for Payer: The Alliance Commercial |
$294.00
|
| Rate for Payer: United Healthcare Medicaid |
$74.72
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
Incision of Eardrum 6942050
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
CPT 69420 50
|
| Hospital Charge Code |
3697560
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.97 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Aetna Commercial |
$1,254.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.20
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,254.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.00
|
| Rate for Payer: Health EOS Commercial |
$1,201.20
|
| Rate for Payer: HFN Commercial |
$1,254.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$398.89
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,254.00
|
| Rate for Payer: Quartz Beloit One Network |
$580.80
|
| Rate for Payer: Quartz Commercial |
$752.40
|
| Rate for Payer: The Alliance Commercial |
$660.00
|
| Rate for Payer: United Healthcare Medicaid |
$161.97
|
| Rate for Payer: WEA Trust Commercial |
$726.00
|
| Rate for Payer: WPS Commercial |
$977.72
|
|
|
Incision of Eardrum 69799-69420
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
CPT 69799 50
|
| Hospital Charge Code |
5322683
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$599.28 |
| Max. Negotiated Rate |
$1,293.90 |
| Rate for Payer: Aetna Commercial |
$1,293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,171.32
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,293.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$681.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$817.20
|
| Rate for Payer: Health EOS Commercial |
$1,239.42
|
| Rate for Payer: HFN Commercial |
$1,293.90
|
| Rate for Payer: Multiplan Commercial |
$1,089.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,293.90
|
| Rate for Payer: Quartz Beloit One Network |
$599.28
|
| Rate for Payer: Quartz Commercial |
$776.34
|
| Rate for Payer: The Alliance Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$749.10
|
| Rate for Payer: WPS Commercial |
$1,008.83
|
|
|
Incision of Eyelid 67710
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 67710
|
| Hospital Charge Code |
3850059
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$328.85 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$186.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.60
|
| Rate for Payer: Health EOS Commercial |
$178.36
|
| Rate for Payer: HFN Commercial |
$186.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$328.85
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$186.20
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$111.72
|
| Rate for Payer: The Alliance Commercial |
$98.00
|
| Rate for Payer: United Healthcare Medicaid |
$148.24
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
Incision of Eyelid Fold 67715
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
3190227
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$359.14 |
| Rate for Payer: Aetna Commercial |
$309.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$309.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.60
|
| Rate for Payer: Health EOS Commercial |
$296.66
|
| Rate for Payer: HFN Commercial |
$309.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$359.14
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$309.70
|
| Rate for Payer: Quartz Beloit One Network |
$143.44
|
| Rate for Payer: Quartz Commercial |
$185.82
|
| Rate for Payer: The Alliance Commercial |
$163.00
|
| Rate for Payer: United Healthcare Medicaid |
$148.24
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
