|
BIOPSY, SENTINAL LYMPH NODE
|
Facility
|
OP
|
$1,429.00
|
|
| Hospital Charge Code |
2960368
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$400.12 |
| Max. Negotiated Rate |
$5,716.00 |
| Rate for Payer: Aetna Commercial |
$1,286.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.94
|
| Rate for Payer: Aetna Managed Medicare |
$400.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.37
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,314.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.81
|
| Rate for Payer: HFN Commercial |
$1,314.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.75
|
| Rate for Payer: Multiplan Commercial |
$1,143.20
|
| Rate for Payer: NAPHCARE Commercial |
$857.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.68
|
| Rate for Payer: Quartz Beloit One Network |
$700.21
|
| Rate for Payer: Quartz Commercial |
$928.85
|
| Rate for Payer: Quartz Medicare Advantage |
$857.40
|
| Rate for Payer: The Alliance Commercial |
$5,716.00
|
| Rate for Payer: WEA Trust Commercial |
$785.95
|
| Rate for Payer: WPS Commercial |
$1,058.46
|
|
|
BIOPSY, SFT TSSE, UPPER ARM OR ELBOW, 3CM &> -BILAT 2407150
|
Professional
|
Both
|
$5,445.00
|
|
|
Service Code
|
CPT 24071 50
|
| Hospital Charge Code |
6172239
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$326.42 |
| Max. Negotiated Rate |
$5,172.75 |
| Rate for Payer: Aetna Commercial |
$5,172.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,682.70
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cigna Commercial |
$5,172.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$326.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,267.00
|
| Rate for Payer: Health EOS Commercial |
$4,954.95
|
| Rate for Payer: HFN Commercial |
$5,172.75
|
| Rate for Payer: Multiplan Commercial |
$4,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,172.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,395.80
|
| Rate for Payer: Quartz Commercial |
$3,103.65
|
| Rate for Payer: The Alliance Commercial |
$2,722.50
|
| Rate for Payer: United Healthcare Medicaid |
$326.42
|
| Rate for Payer: WEA Trust Commercial |
$2,994.75
|
| Rate for Payer: WPS Commercial |
$4,033.11
|
|
|
BIOPSY SHOULDER TISSUES 23065
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
CPT 23065
|
| Hospital Charge Code |
3013760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$1,434.50 |
| Rate for Payer: Aetna Commercial |
$1,434.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,298.60
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$1,434.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$906.00
|
| Rate for Payer: Health EOS Commercial |
$1,374.10
|
| Rate for Payer: HFN Commercial |
$1,434.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$542.10
|
| Rate for Payer: Multiplan Commercial |
$1,208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.50
|
| Rate for Payer: Quartz Beloit One Network |
$664.40
|
| Rate for Payer: Quartz Commercial |
$860.70
|
| Rate for Payer: The Alliance Commercial |
$755.00
|
| Rate for Payer: United Healthcare Medicaid |
$49.81
|
| Rate for Payer: WEA Trust Commercial |
$830.50
|
| Rate for Payer: WPS Commercial |
$1,118.46
|
|
|
BIOPSY SHOULDER TISSUES 23066
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
CPT 23066
|
| Hospital Charge Code |
3013761
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$1,217.71 |
| Rate for Payer: Aetna Commercial |
$1,156.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.62
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,156.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.20
|
| Rate for Payer: Health EOS Commercial |
$1,107.47
|
| Rate for Payer: HFN Commercial |
$1,156.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,217.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,217.71
|
| Rate for Payer: Multiplan Commercial |
$973.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,156.15
|
| Rate for Payer: Quartz Beloit One Network |
$535.48
|
| Rate for Payer: Quartz Commercial |
$693.69
|
| Rate for Payer: The Alliance Commercial |
$608.50
|
| Rate for Payer: United Healthcare Medicaid |
$74.72
|
| Rate for Payer: WEA Trust Commercial |
$669.35
|
| Rate for Payer: WPS Commercial |
$901.43
|
|
|
BIOPSY SOFT TISSUE OF BACK 21920
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 21920
|
| Hospital Charge Code |
3013745
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.65 |
| Max. Negotiated Rate |
$521.88 |
| Rate for Payer: Aetna Commercial |
$483.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$483.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.40
|
| Rate for Payer: Health EOS Commercial |
$463.19
|
| Rate for Payer: HFN Commercial |
$483.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$521.88
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Preferred Network Access Commercial |
$483.55
|
| Rate for Payer: Quartz Beloit One Network |
$223.96
|
| Rate for Payer: Quartz Commercial |
$290.13
|
| Rate for Payer: The Alliance Commercial |
$254.50
|
| Rate for Payer: United Healthcare Medicaid |
$72.65
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 21925
|
|
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, TEMPORAL ARTERY
|
Facility
|
OP
|
$1,129.00
|
|
| Hospital Charge Code |
2960403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$316.12 |
| Max. Negotiated Rate |
$4,516.00 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.94
|
| Rate for Payer: Aetna Managed Medicare |
$316.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$733.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$564.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.37
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,038.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$631.79
|
| Rate for Payer: Health EOS Commercial |
$1,004.81
|
| Rate for Payer: HFN Commercial |
$1,038.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$846.75
|
| Rate for Payer: Multiplan Commercial |
$903.20
|
| Rate for Payer: NAPHCARE Commercial |
$677.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,038.68
|
| Rate for Payer: Quartz Beloit One Network |
$553.21
|
| Rate for Payer: Quartz Commercial |
$733.85
|
| Rate for Payer: Quartz Medicare Advantage |
$677.40
|
| Rate for Payer: The Alliance Commercial |
$4,516.00
|
| Rate for Payer: WEA Trust Commercial |
$620.95
|
| Rate for Payer: WPS Commercial |
$836.25
|
|
|
BIOPSY, TEMPORAL ARTERY
|
Facility
|
IP
|
$1,129.00
|
|
| Hospital Charge Code |
2960403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$553.21 |
| Max. Negotiated Rate |
$1,038.68 |
| Rate for Payer: Aetna Commercial |
$1,016.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.37
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,038.68
|
| Rate for Payer: Health EOS Commercial |
$1,004.81
|
| Rate for Payer: HFN Commercial |
$1,038.68
|
| Rate for Payer: Multiplan Commercial |
$903.20
|
| Rate for Payer: NAPHCARE Commercial |
$677.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,038.68
|
| Rate for Payer: Quartz Beloit One Network |
$553.21
|
| Rate for Payer: Quartz Commercial |
$677.40
|
| Rate for Payer: WEA Trust Commercial |
$620.95
|
| Rate for Payer: WPS Commercial |
$836.25
|
|
|
BIOPSY, THIGH SOFT TISSUES 27323
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 27323
|
| Hospital Charge Code |
3014046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$342.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$342.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.60
|
| Rate for Payer: Health EOS Commercial |
$328.51
|
| Rate for Payer: HFN Commercial |
$342.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: Preferred Network Access Commercial |
$342.95
|
| Rate for Payer: Quartz Beloit One Network |
$158.84
|
| Rate for Payer: Quartz Commercial |
$205.77
|
| Rate for Payer: The Alliance Commercial |
$180.50
|
| Rate for Payer: United Healthcare Medicaid |
$39.10
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
BIOPSY TONGUE POSTERIOR ONE-THIRD 41105
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
CPT 41105
|
| Hospital Charge Code |
5581933
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,088.70 |
| Rate for Payer: Aetna Commercial |
$1,088.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$985.56
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,088.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$687.60
|
| Rate for Payer: Health EOS Commercial |
$1,042.86
|
| Rate for Payer: HFN Commercial |
$1,088.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$369.41
|
| Rate for Payer: Multiplan Commercial |
$916.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.70
|
| Rate for Payer: Quartz Beloit One Network |
$504.24
|
| Rate for Payer: Quartz Commercial |
$653.22
|
| Rate for Payer: The Alliance Commercial |
$573.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$630.30
|
| Rate for Payer: WPS Commercial |
$848.84
|
|
|
BIOPSY, TRANSANAL EXCISIONAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959897
|
|
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, TRANSANAL EXCISIONAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959897
|
|
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, URETHRA
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2959898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$407.40 |
| Max. Negotiated Rate |
$5,820.00 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Aetna Managed Medicare |
$407.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.22
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.25
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$945.75
|
| Rate for Payer: Quartz Medicare Advantage |
$873.00
|
| Rate for Payer: The Alliance Commercial |
$5,820.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
BIOPSY, URETHRA
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2959898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$712.95 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$873.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
BIOPSY VALVE DISP W/IRRIGATION
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
2973332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$86.40
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
BIOPSY VALVE DISP W/IRRIGATION
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
2973332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Aetna Managed Medicare |
$40.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.58
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: Quartz Medicare Advantage |
$86.40
|
| Rate for Payer: The Alliance Commercial |
$576.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL 20251
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
CPT 20251
|
| Hospital Charge Code |
6170068
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$278.68 |
| Max. Negotiated Rate |
$2,671.40 |
| Rate for Payer: Aetna Commercial |
$2,671.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,418.32
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,671.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,687.20
|
| Rate for Payer: Health EOS Commercial |
$2,558.92
|
| Rate for Payer: HFN Commercial |
$2,671.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,381.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,381.89
|
| Rate for Payer: Multiplan Commercial |
$2,249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.28
|
| Rate for Payer: Quartz Commercial |
$1,602.84
|
| Rate for Payer: The Alliance Commercial |
$1,406.00
|
| Rate for Payer: United Healthcare Medicaid |
$278.68
|
| Rate for Payer: WEA Trust Commercial |
$1,546.60
|
| Rate for Payer: WPS Commercial |
$2,082.85
|
|
|
BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL - UNL PROC 2099920251
|
Professional
|
Both
|
$3,383.00
|
|
|
Service Code
|
CPT 20999
|
| Hospital Charge Code |
6170069
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,488.52 |
| Max. Negotiated Rate |
$3,213.85 |
| Rate for Payer: Aetna Commercial |
$3,213.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,909.38
|
| Rate for Payer: Cash Price |
$1,014.90
|
| Rate for Payer: Cash Price |
$1,014.90
|
| Rate for Payer: Cigna Commercial |
$3,213.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,691.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,029.80
|
| Rate for Payer: Health EOS Commercial |
$3,078.53
|
| Rate for Payer: HFN Commercial |
$3,213.85
|
| Rate for Payer: Multiplan Commercial |
$2,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,488.52
|
| Rate for Payer: Quartz Commercial |
$1,928.31
|
| Rate for Payer: The Alliance Commercial |
$1,691.50
|
| Rate for Payer: WEA Trust Commercial |
$1,860.65
|
| Rate for Payer: WPS Commercial |
$2,505.79
|
|
|
Biopsy, Vestibule of Mouth
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
1190861
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$311.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.80
|
| Rate for Payer: Health EOS Commercial |
$298.48
|
| Rate for Payer: HFN Commercial |
$311.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$291.86
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.60
|
| Rate for Payer: Quartz Beloit One Network |
$144.32
|
| Rate for Payer: Quartz Commercial |
$186.96
|
| Rate for Payer: The Alliance Commercial |
$164.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
BIOPSY, VULVAR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959899
|
|
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, VULVAR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959899
|
|
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
|
|
|
BIO SCREW 9X28
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2964675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
BIO SCREW 9X28
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2964675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
Biotinidase
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
4524639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$112.80
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
Biotinidase
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 82261
|
| Hospital Charge Code |
4524639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.20
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$67.48
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
