|
BIOPSY/REMOVAL, LYMPH NODES 38510
|
Professional
|
Both
|
$1,918.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
3014583
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$230.44 |
| Max. Negotiated Rate |
$1,894.98 |
| Rate for Payer: Aetna Commercial |
$1,894.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$357.61
|
| Rate for Payer: Anthem Medicare Advantage |
$357.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$357.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$357.61
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,894.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.61
|
| Rate for Payer: Health EOS Commercial |
$1,815.20
|
| Rate for Payer: HFN Commercial |
$1,894.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,427.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,427.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$357.61
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$536.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.98
|
| Rate for Payer: Quartz Beloit One Network |
$877.68
|
| Rate for Payer: Quartz Commercial |
$1,136.99
|
| Rate for Payer: Quartz Medicare Advantage |
$357.61
|
| Rate for Payer: The Alliance Commercial |
$1,519.86
|
| Rate for Payer: United Healthcare Medicaid |
$230.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$357.61
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,609.26
|
|
|
BIOPSY, RENAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959894
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BIOPSY, RENAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959894
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BIOPSY, SCALENE NODE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BIOPSY, SCALENE NODE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959895
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BIOPSY, SENTINAL LYMPH NODE
|
Facility
|
OP
|
$1,429.00
|
|
| Hospital Charge Code |
2960368
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.12 |
| Max. Negotiated Rate |
$1,367.27 |
| Rate for Payer: Aetna Commercial |
$1,337.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.10
|
| Rate for Payer: Aetna Managed Medicare |
$416.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$966.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$743.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$713.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.66
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,367.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$831.68
|
| Rate for Payer: Health EOS Commercial |
$1,322.68
|
| Rate for Payer: HFN Commercial |
$1,367.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,114.62
|
| Rate for Payer: Multiplan Commercial |
$1,188.93
|
| Rate for Payer: NAPHCARE Commercial |
$891.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.27
|
| Rate for Payer: Quartz Beloit One Network |
$728.22
|
| Rate for Payer: Quartz Commercial |
$966.00
|
| Rate for Payer: Quartz Medicare Advantage |
$891.70
|
| Rate for Payer: The Alliance Commercial |
$743.08
|
| Rate for Payer: WEA Trust Commercial |
$817.39
|
| Rate for Payer: WPS Commercial |
$1,100.76
|
|
|
BIOPSY, SENTINAL LYMPH NODE
|
Facility
|
IP
|
$1,429.00
|
|
| Hospital Charge Code |
2960368
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$728.22 |
| Max. Negotiated Rate |
$1,367.27 |
| Rate for Payer: Aetna Commercial |
$1,337.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.66
|
| Rate for Payer: Cash Price |
$428.70
|
| Rate for Payer: Cigna Commercial |
$1,367.27
|
| Rate for Payer: Health EOS Commercial |
$1,322.68
|
| Rate for Payer: HFN Commercial |
$1,367.27
|
| Rate for Payer: Multiplan Commercial |
$1,188.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.27
|
| Rate for Payer: Quartz Beloit One Network |
$728.22
|
| Rate for Payer: Quartz Commercial |
$891.70
|
| Rate for Payer: WEA Trust Commercial |
$817.39
|
| Rate for Payer: WPS Commercial |
$1,100.76
|
|
|
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 |
$339.48 |
| Max. Negotiated Rate |
$5,379.66 |
| Rate for Payer: Aetna Commercial |
$5,379.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,870.01
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cigna Commercial |
$5,379.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$339.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,397.68
|
| Rate for Payer: Health EOS Commercial |
$5,153.15
|
| Rate for Payer: HFN Commercial |
$5,379.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,385.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,385.73
|
| Rate for Payer: Multiplan Commercial |
$4,530.24
|
| Rate for Payer: Preferred Network Access Commercial |
$5,379.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.63
|
| Rate for Payer: Quartz Commercial |
$3,227.80
|
| Rate for Payer: The Alliance Commercial |
$2,831.40
|
| Rate for Payer: United Healthcare Medicaid |
$339.48
|
| Rate for Payer: WEA Trust Commercial |
$3,114.54
|
| Rate for Payer: WPS Commercial |
$4,194.28
|
|
|
BIOPSY SHOULDER TISSUES 23065
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
CPT 23065
|
| Hospital Charge Code |
3013760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$1,491.88 |
| Rate for Payer: Aetna Commercial |
$1,491.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,350.54
|
| Rate for Payer: Aetna Managed Medicare |
$141.46
|
| Rate for Payer: Anthem Medicare Advantage |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.46
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cash Price |
$453.00
|
| Rate for Payer: Cigna Commercial |
$1,491.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.46
|
| Rate for Payer: Health EOS Commercial |
$1,429.06
|
| Rate for Payer: HFN Commercial |
$1,491.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$563.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.46
|
| Rate for Payer: Multiplan Commercial |
$1,256.32
|
| Rate for Payer: NAPHCARE Commercial |
$212.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.88
|
| Rate for Payer: Quartz Beloit One Network |
$690.98
|
| Rate for Payer: Quartz Commercial |
$895.13
|
| Rate for Payer: Quartz Medicare Advantage |
$141.46
|
| Rate for Payer: The Alliance Commercial |
$601.21
|
| Rate for Payer: United Healthcare Medicaid |
$51.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.46
|
| Rate for Payer: WEA Trust Commercial |
$863.72
|
| Rate for Payer: WPS Commercial |
$636.57
|
|
|
BIOPSY SHOULDER TISSUES 23066
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
CPT 23066
|
| Hospital Charge Code |
3013761
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.71 |
| Max. Negotiated Rate |
$1,576.79 |
| Rate for Payer: Aetna Commercial |
$1,202.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.48
|
| Rate for Payer: Aetna Managed Medicare |
$350.40
|
| Rate for Payer: Anthem Medicare Advantage |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$350.40
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cash Price |
$365.10
|
| Rate for Payer: Cigna Commercial |
$1,202.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.40
|
| Rate for Payer: Health EOS Commercial |
$1,151.77
|
| Rate for Payer: HFN Commercial |
$1,202.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,266.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,266.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$1,012.54
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,202.40
|
| Rate for Payer: Quartz Beloit One Network |
$556.90
|
| Rate for Payer: Quartz Commercial |
$721.44
|
| Rate for Payer: Quartz Medicare Advantage |
$350.40
|
| Rate for Payer: The Alliance Commercial |
$1,489.19
|
| Rate for Payer: United Healthcare Medicaid |
$77.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$350.40
|
| Rate for Payer: WEA Trust Commercial |
$696.12
|
| Rate for Payer: WPS Commercial |
$1,576.79
|
|
|
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 |
$75.56 |
| Max. Negotiated Rate |
$620.99 |
| Rate for Payer: Aetna Commercial |
$502.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$138.00
|
| Rate for Payer: Anthem Medicare Advantage |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.00
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$502.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.00
|
| Rate for Payer: Health EOS Commercial |
$481.72
|
| Rate for Payer: HFN Commercial |
$502.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$542.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$502.89
|
| Rate for Payer: Quartz Beloit One Network |
$232.92
|
| Rate for Payer: Quartz Commercial |
$301.74
|
| Rate for Payer: Quartz Medicare Advantage |
$138.00
|
| Rate for Payer: The Alliance Commercial |
$586.49
|
| Rate for Payer: United Healthcare Medicaid |
$75.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$620.99
|
|
|
BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 21925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
BIOPSY, TEMPORAL ARTERY
|
Facility
|
OP
|
$1,129.00
|
|
| Hospital Charge Code |
2960403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$328.76 |
| Max. Negotiated Rate |
$1,080.23 |
| Rate for Payer: Aetna Commercial |
$1,056.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Aetna Managed Medicare |
$328.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$763.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$587.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$563.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.30
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,080.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$657.08
|
| Rate for Payer: Health EOS Commercial |
$1,045.00
|
| Rate for Payer: HFN Commercial |
$1,080.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$880.62
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: NAPHCARE Commercial |
$704.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,080.23
|
| Rate for Payer: Quartz Beloit One Network |
$575.34
|
| Rate for Payer: Quartz Commercial |
$763.20
|
| Rate for Payer: Quartz Medicare Advantage |
$704.50
|
| Rate for Payer: The Alliance Commercial |
$587.08
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$869.67
|
|
|
BIOPSY, TEMPORAL ARTERY
|
Facility
|
IP
|
$1,129.00
|
|
| Hospital Charge Code |
2960403
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$575.34 |
| Max. Negotiated Rate |
$1,080.23 |
| Rate for Payer: Aetna Commercial |
$1,056.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.30
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,080.23
|
| Rate for Payer: Health EOS Commercial |
$1,045.00
|
| Rate for Payer: HFN Commercial |
$1,080.23
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,080.23
|
| Rate for Payer: Quartz Beloit One Network |
$575.34
|
| Rate for Payer: Quartz Commercial |
$704.50
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$869.67
|
|
|
BIOPSY, THIGH SOFT TISSUES 27323
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
CPT 27323
|
| Hospital Charge Code |
3014046
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$691.24 |
| Rate for Payer: Aetna Commercial |
$356.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Aetna Managed Medicare |
$153.61
|
| Rate for Payer: Anthem Medicare Advantage |
$153.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.61
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$356.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.61
|
| Rate for Payer: Health EOS Commercial |
$341.65
|
| Rate for Payer: HFN Commercial |
$356.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$607.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$607.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.61
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: NAPHCARE Commercial |
$230.41
|
| Rate for Payer: Preferred Network Access Commercial |
$356.67
|
| Rate for Payer: Quartz Beloit One Network |
$165.19
|
| Rate for Payer: Quartz Commercial |
$214.00
|
| Rate for Payer: Quartz Medicare Advantage |
$153.61
|
| Rate for Payer: The Alliance Commercial |
$652.83
|
| Rate for Payer: United Healthcare Medicaid |
$40.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.61
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$691.24
|
|
|
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 |
$78.34 |
| Max. Negotiated Rate |
$1,132.25 |
| Rate for Payer: Aetna Commercial |
$1,132.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.98
|
| Rate for Payer: Aetna Managed Medicare |
$97.74
|
| Rate for Payer: Anthem Medicare Advantage |
$97.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.74
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,132.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.74
|
| Rate for Payer: Health EOS Commercial |
$1,084.57
|
| Rate for Payer: HFN Commercial |
$1,132.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$384.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.74
|
| Rate for Payer: Multiplan Commercial |
$953.47
|
| Rate for Payer: NAPHCARE Commercial |
$146.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,132.25
|
| Rate for Payer: Quartz Beloit One Network |
$524.41
|
| Rate for Payer: Quartz Commercial |
$679.35
|
| Rate for Payer: Quartz Medicare Advantage |
$97.74
|
| Rate for Payer: The Alliance Commercial |
$415.39
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.74
|
| Rate for Payer: WEA Trust Commercial |
$655.51
|
| Rate for Payer: WPS Commercial |
$439.83
|
|
|
BIOPSY, TRANSANAL EXCISIONAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BIOPSY, TRANSANAL EXCISIONAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959897
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BIOPSY, URETHRA
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
2959898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$741.47 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
BIOPSY, URETHRA
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
2959898
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Aetna Managed Medicare |
$423.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$983.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.81
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: NAPHCARE Commercial |
$907.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$983.58
|
| Rate for Payer: Quartz Medicare Advantage |
$907.92
|
| Rate for Payer: The Alliance Commercial |
$756.60
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
BIOPSY VALVE DISP W/IRRIGATION
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
2973332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$89.86
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
BIOPSY VALVE DISP W/IRRIGATION
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
2973332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$41.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.81
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: Quartz Medicare Advantage |
$89.86
|
| Rate for Payer: The Alliance Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
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 |
$289.83 |
| Max. Negotiated Rate |
$2,778.26 |
| Rate for Payer: Aetna Commercial |
$2,778.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,515.05
|
| Rate for Payer: Aetna Managed Medicare |
$390.29
|
| Rate for Payer: Anthem Medicare Advantage |
$390.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$390.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$390.29
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,778.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.29
|
| Rate for Payer: Health EOS Commercial |
$2,661.28
|
| Rate for Payer: HFN Commercial |
$2,778.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,437.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$390.29
|
| Rate for Payer: Multiplan Commercial |
$2,339.58
|
| Rate for Payer: NAPHCARE Commercial |
$585.44
|
| Rate for Payer: Preferred Network Access Commercial |
$2,778.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.77
|
| Rate for Payer: Quartz Commercial |
$1,666.95
|
| Rate for Payer: Quartz Medicare Advantage |
$390.29
|
| Rate for Payer: The Alliance Commercial |
$1,658.74
|
| Rate for Payer: United Healthcare Medicaid |
$289.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$390.29
|
| Rate for Payer: WEA Trust Commercial |
$1,608.46
|
| Rate for Payer: WPS Commercial |
$1,756.31
|
|
|
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 |
$1,548.06 |
| Max. Negotiated Rate |
$3,342.40 |
| Rate for Payer: Aetna Commercial |
$3,342.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,025.76
|
| Rate for Payer: Cash Price |
$1,014.90
|
| Rate for Payer: Cash Price |
$1,014.90
|
| Rate for Payer: Cigna Commercial |
$3,342.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,759.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,110.99
|
| Rate for Payer: Health EOS Commercial |
$3,201.67
|
| Rate for Payer: HFN Commercial |
$3,342.40
|
| Rate for Payer: Multiplan Commercial |
$2,814.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,342.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,548.06
|
| Rate for Payer: Quartz Commercial |
$2,005.44
|
| Rate for Payer: The Alliance Commercial |
$1,759.16
|
| Rate for Payer: WEA Trust Commercial |
$1,935.08
|
| Rate for Payer: WPS Commercial |
$2,605.92
|
|
|
Biopsy, Vestibule of Mouth
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
1190861
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$362.37 |
| Rate for Payer: Aetna Commercial |
$324.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$80.53
|
| Rate for Payer: Anthem Medicare Advantage |
$80.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.53
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$324.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.53
|
| Rate for Payer: Health EOS Commercial |
$310.42
|
| Rate for Payer: HFN Commercial |
$324.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$303.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.53
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$120.79
|
| Rate for Payer: Preferred Network Access Commercial |
$324.06
|
| Rate for Payer: Quartz Beloit One Network |
$150.09
|
| Rate for Payer: Quartz Commercial |
$194.44
|
| Rate for Payer: Quartz Medicare Advantage |
$80.53
|
| Rate for Payer: The Alliance Commercial |
$342.24
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.53
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$362.37
|
|
