|
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 |
$156.69 |
| Max. Negotiated Rate |
$1,349.15 |
| Rate for Payer: Aetna Commercial |
$1,043.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$944.49
|
| Rate for Payer: Aetna Managed Medicare |
$299.81
|
| Rate for Payer: Anthem Medicare Advantage |
$299.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$299.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$299.81
|
| 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 |
$1,043.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.81
|
| Rate for Payer: Health EOS Commercial |
$999.40
|
| Rate for Payer: HFN Commercial |
$1,043.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,066.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,066.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$299.81
|
| Rate for Payer: Multiplan Commercial |
$878.59
|
| Rate for Payer: NAPHCARE Commercial |
$449.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,043.33
|
| Rate for Payer: Quartz Beloit One Network |
$483.23
|
| Rate for Payer: Quartz Commercial |
$626.00
|
| Rate for Payer: Quartz Medicare Advantage |
$299.81
|
| Rate for Payer: The Alliance Commercial |
$1,274.20
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$299.81
|
| Rate for Payer: WEA Trust Commercial |
$604.03
|
| Rate for Payer: WPS Commercial |
$1,349.15
|
|
|
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 |
$77.71 |
| Max. Negotiated Rate |
$580.94 |
| Rate for Payer: Aetna Commercial |
$580.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.91
|
| Rate for Payer: Aetna Managed Medicare |
$94.49
|
| Rate for Payer: Anthem Medicare Advantage |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.49
|
| 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 |
$580.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.49
|
| Rate for Payer: Health EOS Commercial |
$556.48
|
| Rate for Payer: HFN Commercial |
$580.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$388.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.49
|
| Rate for Payer: Multiplan Commercial |
$489.22
|
| Rate for Payer: NAPHCARE Commercial |
$141.74
|
| Rate for Payer: Preferred Network Access Commercial |
$580.94
|
| Rate for Payer: Quartz Beloit One Network |
$269.07
|
| Rate for Payer: Quartz Commercial |
$348.57
|
| Rate for Payer: Quartz Medicare Advantage |
$94.49
|
| Rate for Payer: The Alliance Commercial |
$401.60
|
| Rate for Payer: United Healthcare Medicaid |
$77.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.49
|
| Rate for Payer: WEA Trust Commercial |
$336.34
|
| Rate for Payer: WPS Commercial |
$425.22
|
|
|
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 |
$168.45 |
| Max. Negotiated Rate |
$1,304.16 |
| Rate for Payer: Aetna Commercial |
$1,304.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| 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 |
$1,304.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$823.68
|
| Rate for Payer: Health EOS Commercial |
$1,249.25
|
| Rate for Payer: HFN Commercial |
$1,304.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$414.85
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,304.16
|
| Rate for Payer: Quartz Beloit One Network |
$604.03
|
| Rate for Payer: Quartz Commercial |
$782.50
|
| Rate for Payer: The Alliance Commercial |
$686.40
|
| Rate for Payer: United Healthcare Medicaid |
$168.45
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: WPS Commercial |
$1,016.80
|
|
|
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 |
$623.25 |
| Max. Negotiated Rate |
$1,345.66 |
| Rate for Payer: Aetna Commercial |
$1,345.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,218.17
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,345.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$708.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$849.89
|
| Rate for Payer: Health EOS Commercial |
$1,289.00
|
| Rate for Payer: HFN Commercial |
$1,345.66
|
| Rate for Payer: Multiplan Commercial |
$1,133.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.66
|
| Rate for Payer: Quartz Beloit One Network |
$623.25
|
| Rate for Payer: Quartz Commercial |
$807.39
|
| Rate for Payer: The Alliance Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$779.06
|
| Rate for Payer: WPS Commercial |
$1,049.15
|
|
|
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 |
$388.07 |
| Rate for Payer: Aetna Commercial |
$193.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$86.24
|
| Rate for Payer: Anthem Medicare Advantage |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.24
|
| 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 |
$193.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.24
|
| Rate for Payer: Health EOS Commercial |
$185.49
|
| Rate for Payer: HFN Commercial |
$193.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$342.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.24
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$129.36
|
| Rate for Payer: Preferred Network Access Commercial |
$193.65
|
| Rate for Payer: Quartz Beloit One Network |
$89.69
|
| Rate for Payer: Quartz Commercial |
$116.19
|
| Rate for Payer: Quartz Medicare Advantage |
$86.24
|
| Rate for Payer: The Alliance Commercial |
$366.51
|
| Rate for Payer: United Healthcare Medicaid |
$154.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.24
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$388.07
|
|
|
Incision of Eyelid Fold 67715
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 67715
|
| Hospital Charge Code |
3190227
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.58 |
| Max. Negotiated Rate |
$448.11 |
| Rate for Payer: Aetna Commercial |
$322.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$99.58
|
| Rate for Payer: Anthem Medicare Advantage |
$99.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.58
|
| 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 |
$322.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.58
|
| Rate for Payer: Health EOS Commercial |
$308.53
|
| Rate for Payer: HFN Commercial |
$322.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$373.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.58
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$149.37
|
| Rate for Payer: Preferred Network Access Commercial |
$322.09
|
| Rate for Payer: Quartz Beloit One Network |
$149.18
|
| Rate for Payer: Quartz Commercial |
$193.25
|
| Rate for Payer: Quartz Medicare Advantage |
$99.58
|
| Rate for Payer: The Alliance Commercial |
$423.21
|
| Rate for Payer: United Healthcare Medicaid |
$154.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.58
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$448.11
|
|
|
INCISION OF FOOT FASCIA 28008
|
Professional
|
Both
|
$2,074.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
3014178
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$2,049.11 |
| Rate for Payer: Aetna Commercial |
$2,049.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,854.99
|
| Rate for Payer: Aetna Managed Medicare |
$272.03
|
| Rate for Payer: Anthem Medicare Advantage |
$272.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.03
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$2,049.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.03
|
| Rate for Payer: Health EOS Commercial |
$1,962.83
|
| Rate for Payer: HFN Commercial |
$2,049.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,039.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,039.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.03
|
| Rate for Payer: Multiplan Commercial |
$1,725.57
|
| Rate for Payer: NAPHCARE Commercial |
$408.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,049.11
|
| Rate for Payer: Quartz Beloit One Network |
$949.06
|
| Rate for Payer: Quartz Commercial |
$1,229.47
|
| Rate for Payer: Quartz Medicare Advantage |
$272.03
|
| Rate for Payer: The Alliance Commercial |
$1,156.14
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.03
|
| Rate for Payer: WEA Trust Commercial |
$1,186.33
|
| Rate for Payer: WPS Commercial |
$1,224.15
|
|
|
INCISION OF FOOT TENDON 28234
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 28234
|
| Hospital Charge Code |
3014222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$612.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$256.58
|
| Rate for Payer: Anthem Medicare Advantage |
$256.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.58
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$612.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.58
|
| Rate for Payer: Health EOS Commercial |
$586.77
|
| Rate for Payer: HFN Commercial |
$612.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$935.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.58
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$384.87
|
| Rate for Payer: Preferred Network Access Commercial |
$612.56
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: Quartz Medicare Advantage |
$256.58
|
| Rate for Payer: The Alliance Commercial |
$1,090.46
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.58
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$1,154.60
|
|
|
INCISION OF FOOT TENDON(S) 28230
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
CPT 28230
|
| Hospital Charge Code |
3014220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.03 |
| Max. Negotiated Rate |
$1,194.20 |
| Rate for Payer: Aetna Commercial |
$905.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.27
|
| Rate for Payer: Aetna Managed Medicare |
$265.38
|
| Rate for Payer: Anthem Medicare Advantage |
$265.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$265.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$265.38
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$905.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.38
|
| Rate for Payer: Health EOS Commercial |
$866.90
|
| Rate for Payer: HFN Commercial |
$905.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$997.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$997.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$265.38
|
| Rate for Payer: Multiplan Commercial |
$762.11
|
| Rate for Payer: NAPHCARE Commercial |
$398.07
|
| Rate for Payer: Preferred Network Access Commercial |
$905.01
|
| Rate for Payer: Quartz Beloit One Network |
$419.16
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: Quartz Medicare Advantage |
$265.38
|
| Rate for Payer: The Alliance Commercial |
$1,127.85
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.38
|
| Rate for Payer: WEA Trust Commercial |
$523.95
|
| Rate for Payer: WPS Commercial |
$1,194.20
|
|
|
INCISION OF LIP FOLD 40806
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
3014606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.71 |
| Max. Negotiated Rate |
$478.19 |
| Rate for Payer: Aetna Commercial |
$478.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$27.71
|
| Rate for Payer: Anthem Medicare Advantage |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.71
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$478.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.71
|
| Rate for Payer: Health EOS Commercial |
$458.06
|
| Rate for Payer: HFN Commercial |
$478.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.71
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$41.56
|
| Rate for Payer: Preferred Network Access Commercial |
$478.19
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$286.92
|
| Rate for Payer: Quartz Medicare Advantage |
$27.71
|
| Rate for Payer: The Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.71
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$124.68
|
|
|
INCISION OF METATARSAL 28306
|
Professional
|
Both
|
$2,592.00
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
3014240
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$364.68 |
| Max. Negotiated Rate |
$2,560.90 |
| Rate for Payer: Aetna Commercial |
$2,560.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.28
|
| Rate for Payer: Aetna Managed Medicare |
$374.38
|
| Rate for Payer: Anthem Medicare Advantage |
$374.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$374.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$374.38
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,560.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.38
|
| Rate for Payer: Health EOS Commercial |
$2,453.07
|
| Rate for Payer: HFN Commercial |
$2,560.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,393.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,393.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$374.38
|
| Rate for Payer: Multiplan Commercial |
$2,156.54
|
| Rate for Payer: NAPHCARE Commercial |
$561.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,186.10
|
| Rate for Payer: Quartz Commercial |
$1,536.54
|
| Rate for Payer: Quartz Medicare Advantage |
$374.38
|
| Rate for Payer: The Alliance Commercial |
$1,591.11
|
| Rate for Payer: United Healthcare Medicaid |
$364.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$374.38
|
| Rate for Payer: WEA Trust Commercial |
$1,482.62
|
| Rate for Payer: WPS Commercial |
$1,684.71
|
|
|
INCISION OF METATARSAL 28308
|
Professional
|
Both
|
$2,922.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
3014241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$2,886.94 |
| Rate for Payer: Aetna Commercial |
$2,886.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,613.44
|
| Rate for Payer: Aetna Managed Medicare |
$362.82
|
| Rate for Payer: Anthem Medicare Advantage |
$362.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$362.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$362.82
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cigna Commercial |
$2,886.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$362.82
|
| Rate for Payer: Health EOS Commercial |
$2,765.38
|
| Rate for Payer: HFN Commercial |
$2,886.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,341.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,341.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$362.82
|
| Rate for Payer: Multiplan Commercial |
$2,431.10
|
| Rate for Payer: NAPHCARE Commercial |
$544.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,337.11
|
| Rate for Payer: Quartz Commercial |
$1,732.16
|
| Rate for Payer: Quartz Medicare Advantage |
$362.82
|
| Rate for Payer: The Alliance Commercial |
$1,542.01
|
| Rate for Payer: United Healthcare Medicaid |
$289.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.82
|
| Rate for Payer: WEA Trust Commercial |
$1,671.38
|
| Rate for Payer: WPS Commercial |
$1,632.71
|
|
|
INCISION OF RECTAL ABSCESS 46040
|
Professional
|
Both
|
$1,603.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
3014820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.21 |
| Max. Negotiated Rate |
$1,862.22 |
| Rate for Payer: Aetna Commercial |
$1,583.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,433.72
|
| Rate for Payer: Aetna Managed Medicare |
$413.83
|
| Rate for Payer: Anthem Medicare Advantage |
$413.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$413.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$413.83
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cigna Commercial |
$1,583.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.83
|
| Rate for Payer: Health EOS Commercial |
$1,517.08
|
| Rate for Payer: HFN Commercial |
$1,583.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,461.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,461.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$413.83
|
| Rate for Payer: Multiplan Commercial |
$1,333.70
|
| Rate for Payer: NAPHCARE Commercial |
$620.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.76
|
| Rate for Payer: Quartz Beloit One Network |
$733.53
|
| Rate for Payer: Quartz Commercial |
$950.26
|
| Rate for Payer: Quartz Medicare Advantage |
$413.83
|
| Rate for Payer: The Alliance Commercial |
$1,758.76
|
| Rate for Payer: United Healthcare Medicaid |
$196.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$413.83
|
| Rate for Payer: WEA Trust Commercial |
$916.92
|
| Rate for Payer: WPS Commercial |
$1,862.22
|
|
|
INCISION OF TOE TENDON 28010
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
3014179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$1,045.30 |
| Rate for Payer: Aetna Commercial |
$1,045.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$946.28
|
| Rate for Payer: Aetna Managed Medicare |
$195.70
|
| Rate for Payer: Anthem Medicare Advantage |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.70
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$1,045.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.70
|
| Rate for Payer: Health EOS Commercial |
$1,001.29
|
| Rate for Payer: HFN Commercial |
$1,045.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$729.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.70
|
| Rate for Payer: Multiplan Commercial |
$880.26
|
| Rate for Payer: NAPHCARE Commercial |
$293.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.30
|
| Rate for Payer: Quartz Beloit One Network |
$484.14
|
| Rate for Payer: Quartz Commercial |
$627.18
|
| Rate for Payer: Quartz Medicare Advantage |
$195.70
|
| Rate for Payer: The Alliance Commercial |
$831.71
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.70
|
| Rate for Payer: WEA Trust Commercial |
$605.18
|
| Rate for Payer: WPS Commercial |
$880.64
|
|
|
INCISION OF TOE TENDON 28232
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
3014221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$1,024.17 |
| Rate for Payer: Aetna Commercial |
$578.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Aetna Managed Medicare |
$227.59
|
| Rate for Payer: Anthem Medicare Advantage |
$227.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.59
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$578.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.59
|
| Rate for Payer: Health EOS Commercial |
$554.59
|
| Rate for Payer: HFN Commercial |
$578.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$847.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$847.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.59
|
| Rate for Payer: Multiplan Commercial |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$341.39
|
| Rate for Payer: Preferred Network Access Commercial |
$578.97
|
| Rate for Payer: Quartz Beloit One Network |
$268.15
|
| Rate for Payer: Quartz Commercial |
$347.38
|
| Rate for Payer: Quartz Medicare Advantage |
$227.59
|
| Rate for Payer: The Alliance Commercial |
$967.27
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.59
|
| Rate for Payer: WEA Trust Commercial |
$335.19
|
| Rate for Payer: WPS Commercial |
$1,024.17
|
|
|
INCISION OF TOE TENDONS 28011
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
3014180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.50 |
| Max. Negotiated Rate |
$1,171.73 |
| Rate for Payer: Aetna Commercial |
$784.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.15
|
| Rate for Payer: Aetna Managed Medicare |
$260.38
|
| Rate for Payer: Anthem Medicare Advantage |
$260.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.38
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$784.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.38
|
| Rate for Payer: Health EOS Commercial |
$751.44
|
| Rate for Payer: HFN Commercial |
$784.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$983.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$983.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.38
|
| Rate for Payer: Multiplan Commercial |
$660.61
|
| Rate for Payer: NAPHCARE Commercial |
$390.58
|
| Rate for Payer: Preferred Network Access Commercial |
$784.47
|
| Rate for Payer: Quartz Beloit One Network |
$363.33
|
| Rate for Payer: Quartz Commercial |
$470.68
|
| Rate for Payer: Quartz Medicare Advantage |
$260.38
|
| Rate for Payer: The Alliance Commercial |
$1,106.64
|
| Rate for Payer: United Healthcare Medicaid |
$117.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.38
|
| Rate for Payer: WEA Trust Commercial |
$454.17
|
| Rate for Payer: WPS Commercial |
$1,171.73
|
|
|
INCISOR DEVICE PLUS TRUCLEAR 7209509
|
Facility
|
OP
|
$4,932.00
|
|
| Hospital Charge Code |
5106992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,436.20 |
| Max. Negotiated Rate |
$4,718.94 |
| Rate for Payer: Aetna Commercial |
$4,616.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,411.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,436.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,334.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,564.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,462.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,718.52
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna Commercial |
$4,718.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,870.42
|
| Rate for Payer: Health EOS Commercial |
$4,565.06
|
| Rate for Payer: HFN Commercial |
$4,718.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,846.96
|
| Rate for Payer: Multiplan Commercial |
$4,103.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,077.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,718.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,513.35
|
| Rate for Payer: Quartz Commercial |
$3,334.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,077.57
|
| Rate for Payer: The Alliance Commercial |
$2,564.64
|
| Rate for Payer: WEA Trust Commercial |
$2,821.10
|
| Rate for Payer: WPS Commercial |
$3,799.12
|
|
|
INCISOR DEVICE PLUS TRUCLEAR 7209509
|
Facility
|
IP
|
$4,932.00
|
|
| Hospital Charge Code |
5106992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,513.35 |
| Max. Negotiated Rate |
$4,718.94 |
| Rate for Payer: Aetna Commercial |
$4,616.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,411.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,718.52
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna Commercial |
$4,718.94
|
| Rate for Payer: Health EOS Commercial |
$4,565.06
|
| Rate for Payer: HFN Commercial |
$4,718.94
|
| Rate for Payer: Multiplan Commercial |
$4,103.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,718.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,513.35
|
| Rate for Payer: Quartz Commercial |
$3,077.57
|
| Rate for Payer: WEA Trust Commercial |
$2,821.10
|
| Rate for Payer: WPS Commercial |
$3,799.12
|
|
|
INCISOR DEVICE TRUCLEAR 72202536
|
Facility
|
IP
|
$6,020.00
|
|
| Hospital Charge Code |
5074635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,067.79 |
| Max. Negotiated Rate |
$5,759.94 |
| Rate for Payer: Aetna Commercial |
$5,634.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,384.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,318.22
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cigna Commercial |
$5,759.94
|
| Rate for Payer: Health EOS Commercial |
$5,572.11
|
| Rate for Payer: HFN Commercial |
$5,759.94
|
| Rate for Payer: Multiplan Commercial |
$5,008.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,759.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,067.79
|
| Rate for Payer: Quartz Commercial |
$3,756.48
|
| Rate for Payer: WEA Trust Commercial |
$3,443.44
|
| Rate for Payer: WPS Commercial |
$4,637.21
|
|
|
INCISOR DEVICE TRUCLEAR 72202536
|
Facility
|
OP
|
$6,020.00
|
|
| Hospital Charge Code |
5074635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,753.02 |
| Max. Negotiated Rate |
$5,759.94 |
| Rate for Payer: Aetna Commercial |
$5,634.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,384.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,753.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,069.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,130.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,005.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,318.22
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cigna Commercial |
$5,759.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,503.64
|
| Rate for Payer: Health EOS Commercial |
$5,572.11
|
| Rate for Payer: HFN Commercial |
$5,759.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,695.60
|
| Rate for Payer: Multiplan Commercial |
$5,008.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,756.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,759.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,067.79
|
| Rate for Payer: Quartz Commercial |
$4,069.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,756.48
|
| Rate for Payer: The Alliance Commercial |
$3,130.40
|
| Rate for Payer: WEA Trust Commercial |
$3,443.44
|
| Rate for Payer: WPS Commercial |
$4,637.21
|
|
|
Inconclusive - Urine Pregnancy POC
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$8.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.86
|
| Rate for Payer: Anthem Medicare Advantage |
$8.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.95
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.95
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$13.43
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$112.22
|
| Rate for Payer: Quartz Medicare Advantage |
$8.95
|
| Rate for Payer: The Alliance Commercial |
$35.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.95
|
| Rate for Payer: United Healthcare PPO |
$129.48
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: Wellcare Medicare |
$8.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Inconclusive - Urine Pregnancy POC
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Incontinence Service
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$139.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.40
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$299.52
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
Incontinence Service
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
Indigo Carmine 5ml ampule [Med]
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
2974948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
