|
Binocular Microscopy
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 92504
|
| Hospital Charge Code |
2566799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.00
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: HFN Commercial |
$161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.81
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: The Alliance Commercial |
$85.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
BIO A TISSUE REINFO 7cm X 10cm
|
Facility
|
IP
|
$5,796.00
|
|
| Hospital Charge Code |
2967378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,840.04 |
| Max. Negotiated Rate |
$5,332.32 |
| Rate for Payer: Aetna Commercial |
$5,216.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,984.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.88
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,332.32
|
| Rate for Payer: Health EOS Commercial |
$5,158.44
|
| Rate for Payer: HFN Commercial |
$5,332.32
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,332.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,840.04
|
| Rate for Payer: Quartz Commercial |
$3,477.60
|
| Rate for Payer: WEA Trust Commercial |
$3,187.80
|
| Rate for Payer: WPS Commercial |
$4,293.10
|
|
|
BIO A TISSUE REINFO 7cm X 10cm
|
Facility
|
OP
|
$5,796.00
|
|
| Hospital Charge Code |
2967378
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.88 |
| Max. Negotiated Rate |
$23,184.00 |
| Rate for Payer: Aetna Commercial |
$5,216.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,984.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,622.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,767.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,898.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,782.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.88
|
| Rate for Payer: Cash Price |
$1,738.80
|
| Rate for Payer: Cigna Commercial |
$5,332.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,243.44
|
| Rate for Payer: Health EOS Commercial |
$5,158.44
|
| Rate for Payer: HFN Commercial |
$5,332.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,347.00
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,332.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,840.04
|
| Rate for Payer: Quartz Commercial |
$3,767.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,477.60
|
| Rate for Payer: The Alliance Commercial |
$23,184.00
|
| Rate for Payer: WEA Trust Commercial |
$3,187.80
|
| Rate for Payer: WPS Commercial |
$4,293.10
|
|
|
BIOFDBK TRNG PERI/URO/RECT w/EMG and/or MANOMTRY 15 MIN 90912
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
5561223
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.20
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: HFN Commercial |
$153.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.65
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: The Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Medicaid |
$62.36
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
BIOFDBK TRNG PERI/URO/RECT w/EMG and/or MANOMTY 15 MIN 90912
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
5561225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.36 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.20
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: HFN Commercial |
$153.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.65
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: The Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Medicaid |
$62.36
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Biofeedback Training: Perineal Muscles, Anorectal Or urethral Sphincter
|
Professional
|
Both
|
$311.00
|
|
| Hospital Charge Code |
1190815
|
| Min. Negotiated Rate |
$136.84 |
| Max. Negotiated Rate |
$295.45 |
| Rate for Payer: Aetna Commercial |
$295.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$267.46
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cigna Commercial |
$295.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$155.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.60
|
| Rate for Payer: Health EOS Commercial |
$283.01
|
| Rate for Payer: HFN Commercial |
$295.45
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Preferred Network Access Commercial |
$295.45
|
| Rate for Payer: Quartz Beloit One Network |
$136.84
|
| Rate for Payer: Quartz Commercial |
$177.27
|
| Rate for Payer: The Alliance Commercial |
$155.50
|
| Rate for Payer: WEA Trust Commercial |
$171.05
|
| Rate for Payer: WPS Commercial |
$230.36
|
|
|
BIOFREEZE 360 SPRAY 4oz 081697374
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
2969697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
BIOFREEZE 360 SPRAY 4oz 081697374
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
2969697
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
BIOFREEZE 4oz TUBE
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2969696
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
BIOFREEZE 4oz TUBE
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2969696
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
BIOGLUE SYRINGE 5ML BG3515-5-US
|
Facility
|
OP
|
$5,940.00
|
|
|
Service Code
|
HCPCS A4364
|
| Hospital Charge Code |
2965000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,663.20 |
| Max. Negotiated Rate |
$23,760.00 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,108.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,663.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,861.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,970.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,851.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,148.20
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna Commercial |
$5,464.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,324.02
|
| Rate for Payer: Health EOS Commercial |
$5,286.60
|
| Rate for Payer: HFN Commercial |
$5,464.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,455.00
|
| Rate for Payer: Multiplan Commercial |
$4,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,464.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,910.60
|
| Rate for Payer: Quartz Commercial |
$3,861.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,564.00
|
| Rate for Payer: The Alliance Commercial |
$23,760.00
|
| Rate for Payer: WEA Trust Commercial |
$3,267.00
|
| Rate for Payer: WPS Commercial |
$4,399.76
|
|
|
BIOGLUE SYRINGE 5ML BG3515-5-US
|
Facility
|
IP
|
$5,940.00
|
|
|
Service Code
|
HCPCS A4364
|
| Hospital Charge Code |
2965000
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,910.60 |
| Max. Negotiated Rate |
$5,464.80 |
| Rate for Payer: Aetna Commercial |
$5,346.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,108.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,148.20
|
| Rate for Payer: Cash Price |
$1,782.00
|
| Rate for Payer: Cigna Commercial |
$5,464.80
|
| Rate for Payer: Health EOS Commercial |
$5,286.60
|
| Rate for Payer: HFN Commercial |
$5,464.80
|
| Rate for Payer: Multiplan Commercial |
$4,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,464.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,910.60
|
| Rate for Payer: Quartz Commercial |
$3,564.00
|
| Rate for Payer: WEA Trust Commercial |
$3,267.00
|
| Rate for Payer: WPS Commercial |
$4,399.76
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$63,693.00
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$22,911.29 |
| Max. Negotiated Rate |
$63,693.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,911.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,932.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,272.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,361.64
|
| Rate for Payer: Anthem Medicare Advantage |
$22,911.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,911.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,911.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,911.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,364.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,911.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,482.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,911.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,911.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,911.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,911.29
|
| Rate for Payer: NAPHCARE Commercial |
$34,366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$22,911.29
|
| Rate for Payer: The Alliance Commercial |
$63,693.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,911.29
|
| Rate for Payer: United Healthcare PPO |
$36,186.95
|
| Rate for Payer: Wellcare Medicare |
$22,911.29
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$89,889.00
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$32,334.00 |
| Max. Negotiated Rate |
$89,889.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,334.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,702.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,192.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,486.86
|
| Rate for Payer: Anthem Medicare Advantage |
$32,334.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,334.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,334.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57,155.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,334.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,695.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,334.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,334.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,334.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,334.00
|
| Rate for Payer: NAPHCARE Commercial |
$48,501.00
|
| Rate for Payer: Quartz Medicare Advantage |
$32,334.00
|
| Rate for Payer: The Alliance Commercial |
$89,889.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,334.00
|
| Rate for Payer: United Healthcare PPO |
$51,144.79
|
| Rate for Payer: Wellcare Medicare |
$32,334.00
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$49,877.00
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$17,941.25 |
| Max. Negotiated Rate |
$49,877.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,941.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,022.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,910.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,417.08
|
| Rate for Payer: Anthem Medicare Advantage |
$17,941.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,941.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,941.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,941.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,545.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,941.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,348.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,941.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,941.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,941.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,941.25
|
| Rate for Payer: NAPHCARE Commercial |
$26,911.88
|
| Rate for Payer: Quartz Medicare Advantage |
$17,941.25
|
| Rate for Payer: The Alliance Commercial |
$49,877.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,941.25
|
| Rate for Payer: United Healthcare PPO |
$28,297.38
|
| Rate for Payer: Wellcare Medicare |
$17,941.25
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE 24065
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
CPT 24065
|
| Hospital Charge Code |
3013804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.52 |
| Max. Negotiated Rate |
$547.11 |
| Rate for Payer: Aetna Commercial |
$509.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.96
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$509.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.60
|
| Rate for Payer: Health EOS Commercial |
$487.76
|
| Rate for Payer: HFN Commercial |
$509.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.11
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$509.20
|
| Rate for Payer: Quartz Beloit One Network |
$235.84
|
| Rate for Payer: Quartz Commercial |
$305.52
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: United Healthcare Medicaid |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$294.80
|
| Rate for Payer: WPS Commercial |
$397.02
|
|
|
BIOPSY ARM/ELBOW SOFT TISSUE 24066
|
Professional
|
Both
|
$1,369.00
|
|
|
Service Code
|
CPT 24066
|
| Hospital Charge Code |
3013805
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.81 |
| Max. Negotiated Rate |
$1,385.91 |
| Rate for Payer: Aetna Commercial |
$1,300.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,177.34
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,300.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$821.40
|
| Rate for Payer: Health EOS Commercial |
$1,245.79
|
| Rate for Payer: HFN Commercial |
$1,300.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,385.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,385.91
|
| Rate for Payer: Multiplan Commercial |
$1,095.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,300.55
|
| Rate for Payer: Quartz Beloit One Network |
$602.36
|
| Rate for Payer: Quartz Commercial |
$780.33
|
| Rate for Payer: The Alliance Commercial |
$684.50
|
| Rate for Payer: United Healthcare Medicaid |
$186.81
|
| Rate for Payer: WEA Trust Commercial |
$752.95
|
| Rate for Payer: WPS Commercial |
$1,014.02
|
|
|
BIOPSY, BLADDER
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959845
|
|
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
|
|
|
BIOPSY, BLADDER
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959845
|
|
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
|
|
|
BIOPSY, BONE MARROW
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959869
|
|
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
|
|
|
BIOPSY, BONE MARROW
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959869
|
|
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
|
|
|
BIOPSY, BONE, OPEN; SUPERFICIAL (EG, STERNUM, SPINOUS PROCESS, RIB, PATELLA, OLECRANON PROCESS, CALCANEUS, TARSAL, METATARSAL, CARPAL, METACARPAL, PHALANX)
|
Facility
|
OP
|
$11,234.20
|
|
|
Service Code
|
CPT 20240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.55 |
| Max. Negotiated Rate |
$11,234.20 |
| Rate for Payer: Aetna Managed Medicare |
$2,808.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,808.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,808.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,808.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,447.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,808.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,808.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,808.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,808.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.55
|
| Rate for Payer: The Alliance Commercial |
$11,234.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,808.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$2,808.55
|
|
|
BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL 20220
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 20220
|
| Hospital Charge Code |
6210550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.43 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$918.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.20
|
| Rate for Payer: Health EOS Commercial |
$879.97
|
| Rate for Payer: HFN Commercial |
$918.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.71
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$918.65
|
| Rate for Payer: Quartz Beloit One Network |
$425.48
|
| Rate for Payer: Quartz Commercial |
$551.19
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$92.43
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
BIOPSY, BONE, TROCAR, OR NEEDLE; SUPERFICIAL (EG, ILIUM, STERNUM, SPINOUS PROCESS, RIBS)
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 20220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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 |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
BIOPSY, BREAST/TYLECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959875
|
|
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
|
|
