|
BIOPSY, BREAST/TYLECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959875
|
|
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, BREAST, WITH PLACEMENT OF BREAST LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET), WHEN PERFORMED, AND IMAGING OF THE BIOPSY SPECIMEN, WHEN PERFORMED, PERCUTANEOUS; FIRST LESION, INCLUDING ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 19083
|
|
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 |
$4,757.59
|
| 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 W/ ULTRASOUND NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959877
|
|
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, BREAST W/ ULTRASOUND NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959877
|
|
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, BREAST W/ X-RAY NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959876
|
|
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, BREAST W/ X-RAY NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959876
|
|
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 CONJUNCTIVA 68100
|
Professional
|
Both
|
$715.00
|
|
|
Service Code
|
CPT 68100
|
| Hospital Charge Code |
6243512
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$679.25 |
| Rate for Payer: Aetna Commercial |
$679.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.90
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cash Price |
$214.50
|
| Rate for Payer: Cigna Commercial |
$679.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$429.00
|
| Rate for Payer: Health EOS Commercial |
$650.65
|
| Rate for Payer: HFN Commercial |
$679.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$319.96
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$679.25
|
| Rate for Payer: Quartz Beloit One Network |
$314.60
|
| Rate for Payer: Quartz Commercial |
$407.55
|
| Rate for Payer: The Alliance Commercial |
$357.50
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$393.25
|
| Rate for Payer: WPS Commercial |
$529.60
|
|
|
Biopsy Each Additional Lobe - Bronchoscopy Charge
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
5773675
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.03 |
| Max. Negotiated Rate |
$595.24 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$388.20
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
Biopsy Each Additional Lobe - Bronchoscopy Charge
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT 31632
|
| Hospital Charge Code |
5773675
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.16 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$582.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.42
|
| Rate for Payer: Aetna Managed Medicare |
$181.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.91
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cash Price |
$194.10
|
| Rate for Payer: Cigna Commercial |
$595.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$575.83
|
| Rate for Payer: HFN Commercial |
$595.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.25
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: NAPHCARE Commercial |
$388.20
|
| Rate for Payer: Preferred Network Access Commercial |
$595.24
|
| Rate for Payer: Quartz Beloit One Network |
$317.03
|
| Rate for Payer: Quartz Commercial |
$420.55
|
| Rate for Payer: Quartz Medicare Advantage |
$388.20
|
| Rate for Payer: The Alliance Commercial |
$2,588.00
|
| Rate for Payer: WEA Trust Commercial |
$355.85
|
| Rate for Payer: WPS Commercial |
$479.23
|
|
|
BIOPSY FOREARM SOFT TISSUES 25065
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
CPT 25065
|
| Hospital Charge Code |
3013859
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$532.25 |
| Rate for Payer: Aetna Commercial |
$488.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$488.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.40
|
| Rate for Payer: Health EOS Commercial |
$467.74
|
| Rate for Payer: HFN Commercial |
$488.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$532.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$532.25
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: Preferred Network Access Commercial |
$488.30
|
| Rate for Payer: Quartz Beloit One Network |
$226.16
|
| Rate for Payer: Quartz Commercial |
$292.98
|
| Rate for Payer: The Alliance Commercial |
$257.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.10
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
BIOPSY INSTRUMENT 14GA X 16M
|
Facility
|
OP
|
$875.00
|
|
| Hospital Charge Code |
2975019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.50
|
| Rate for Payer: Aetna Managed Medicare |
$245.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.75
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$805.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.65
|
| Rate for Payer: Health EOS Commercial |
$778.75
|
| Rate for Payer: HFN Commercial |
$805.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$656.25
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: NAPHCARE Commercial |
$525.00
|
| Rate for Payer: Preferred Network Access Commercial |
$805.00
|
| Rate for Payer: Quartz Beloit One Network |
$428.75
|
| Rate for Payer: Quartz Commercial |
$568.75
|
| Rate for Payer: Quartz Medicare Advantage |
$525.00
|
| Rate for Payer: The Alliance Commercial |
$3,500.00
|
| Rate for Payer: WEA Trust Commercial |
$481.25
|
| Rate for Payer: WPS Commercial |
$648.11
|
|
|
BIOPSY INSTRUMENT 14GA X 16M
|
Facility
|
IP
|
$875.00
|
|
| Hospital Charge Code |
2975019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.75 |
| Max. Negotiated Rate |
$805.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.75
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$805.00
|
| Rate for Payer: Health EOS Commercial |
$778.75
|
| Rate for Payer: HFN Commercial |
$805.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: NAPHCARE Commercial |
$525.00
|
| Rate for Payer: Preferred Network Access Commercial |
$805.00
|
| Rate for Payer: Quartz Beloit One Network |
$428.75
|
| Rate for Payer: Quartz Commercial |
$525.00
|
| Rate for Payer: WEA Trust Commercial |
$481.25
|
| Rate for Payer: WPS Commercial |
$648.11
|
|
|
BIOPSY, LIVER
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959885
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
BIOPSY, LIVER
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959885
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
BIOPSY LOWER LEG SOFT TISSUE 27613
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
CPT 27613
|
| Hospital Charge Code |
3014112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Aetna Commercial |
$895.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$810.98
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cigna Commercial |
$895.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$858.13
|
| Rate for Payer: HFN Commercial |
$895.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$535.43
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Preferred Network Access Commercial |
$895.85
|
| Rate for Payer: Quartz Beloit One Network |
$414.92
|
| Rate for Payer: Quartz Commercial |
$537.51
|
| Rate for Payer: The Alliance Commercial |
$471.50
|
| Rate for Payer: United Healthcare Medicaid |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$518.65
|
| Rate for Payer: WPS Commercial |
$698.48
|
|
|
BIOPSY LOWER LEG SOFT TISSUE 27614
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
CPT 27614
|
| Hospital Charge Code |
3014113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.35 |
| Max. Negotiated Rate |
$1,583.65 |
| Rate for Payer: Aetna Commercial |
$1,583.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,433.62
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cash Price |
$500.10
|
| Rate for Payer: Cigna Commercial |
$1,583.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,000.20
|
| Rate for Payer: Health EOS Commercial |
$1,516.97
|
| Rate for Payer: HFN Commercial |
$1,583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,364.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,364.77
|
| Rate for Payer: Multiplan Commercial |
$1,333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.65
|
| Rate for Payer: Quartz Beloit One Network |
$733.48
|
| Rate for Payer: Quartz Commercial |
$950.19
|
| Rate for Payer: The Alliance Commercial |
$833.50
|
| Rate for Payer: United Healthcare Medicaid |
$209.35
|
| Rate for Payer: WEA Trust Commercial |
$916.85
|
| Rate for Payer: WPS Commercial |
$1,234.75
|
|
|
BIOPSY, LUNG
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
BIOPSY, LUNG
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
BIOPSY, LYMPH NODE, OPEN
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959889
|
|
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, LYMPH NODE, OPEN
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959889
|
|
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, MUSCLE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959888
|
|
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, MUSCLE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959888
|
|
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 MUSCLE PERCUTANEOUS NEEDLE 20206
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
CPT 20206
|
| Hospital Charge Code |
6181982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.43 |
| Max. Negotiated Rate |
$656.45 |
| Rate for Payer: Aetna Commercial |
$656.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.26
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$656.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$414.60
|
| Rate for Payer: Health EOS Commercial |
$628.81
|
| Rate for Payer: HFN Commercial |
$656.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.53
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Preferred Network Access Commercial |
$656.45
|
| Rate for Payer: Quartz Beloit One Network |
$304.04
|
| Rate for Payer: Quartz Commercial |
$393.87
|
| Rate for Payer: The Alliance Commercial |
$345.50
|
| Rate for Payer: United Healthcare Medicaid |
$131.43
|
| Rate for Payer: WEA Trust Commercial |
$380.05
|
| Rate for Payer: WPS Commercial |
$511.82
|
|
|
BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITAL MEGACOLON)
|
Facility
|
OP
|
$11,100.96
|
|
|
Service Code
|
CPT 45100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$11,100.96 |
| Rate for Payer: Aetna Managed Medicare |
$2,775.24
|
| 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 |
$2,775.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,775.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,775.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,775.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,775.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,323.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,775.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,775.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,775.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,775.24
|
| Rate for Payer: NAPHCARE Commercial |
$4,162.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.24
|
| Rate for Payer: The Alliance Commercial |
$11,100.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,775.24
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,775.24
|
|
|
BIOPSY OF BREAST, OPEN 19101
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
3013676
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$268.83 |
| Max. Negotiated Rate |
$1,586.50 |
| Rate for Payer: Aetna Commercial |
$1,586.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,436.20
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cash Price |
$501.00
|
| Rate for Payer: Cigna Commercial |
$1,586.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.00
|
| Rate for Payer: Health EOS Commercial |
$1,519.70
|
| Rate for Payer: HFN Commercial |
$1,586.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$729.97
|
| Rate for Payer: Multiplan Commercial |
$1,336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.50
|
| Rate for Payer: Quartz Beloit One Network |
$734.80
|
| Rate for Payer: Quartz Commercial |
$951.90
|
| Rate for Payer: The Alliance Commercial |
$835.00
|
| Rate for Payer: United Healthcare Medicaid |
$268.83
|
| Rate for Payer: WEA Trust Commercial |
$918.50
|
| Rate for Payer: WPS Commercial |
$1,236.97
|
|
