|
ECHOCARDIOGRAPHIC AGENT DURING STRESS ECHO 93352
|
Professional
|
$108.00
|
|
|
Service Code
|
CPT 93352
|
| Hospital Charge Code |
3015382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.82 |
| Max. Negotiated Rate |
$129.64 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$32.41
|
| Rate for Payer: Anthem Medicare Advantage |
$32.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.41
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$102.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.41
|
| Rate for Payer: Health EOS Commercial |
$98.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.41
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$102.60
|
| Rate for Payer: Quartz Beloit One Network |
$47.52
|
| Rate for Payer: Quartz Commercial |
$61.56
|
| Rate for Payer: Quartz Medicare Advantage |
$32.41
|
| Rate for Payer: The Alliance Commercial |
$123.16
|
| Rate for Payer: United Healthcare Medicaid |
$31.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.41
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$129.64
|
|
|
ECHOCARDIOGRAPHY INC CONT MONITOR & MD SUPT 93351
|
Professional
|
$1,025.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
3015381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$211.29 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$973.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$223.91
|
| Rate for Payer: Anthem Medicare Advantage |
$223.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.91
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$973.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.91
|
| Rate for Payer: Health EOS Commercial |
$932.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$814.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.91
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: Preferred Network Access Commercial |
$973.75
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$584.25
|
| Rate for Payer: Quartz Medicare Advantage |
$223.91
|
| Rate for Payer: The Alliance Commercial |
$850.86
|
| Rate for Payer: United Healthcare Medicaid |
$211.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.91
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$895.64
|
|
|
Echocardiography Inc Cont Monitor & MD Supt 9335126
|
Professional
|
$1,025.00
|
|
|
Service Code
|
CPT 93351 26
|
| Hospital Charge Code |
5252613
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$973.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$79.58
|
| Rate for Payer: Anthem Medicare Advantage |
$79.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.58
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$973.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.58
|
| Rate for Payer: Health EOS Commercial |
$932.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.58
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: Preferred Network Access Commercial |
$973.75
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$584.25
|
| Rate for Payer: Quartz Medicare Advantage |
$79.58
|
| Rate for Payer: The Alliance Commercial |
$302.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.58
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$318.32
|
|
|
ECHO EXAM OF EYE 76519
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 76519
|
| Hospital Charge Code |
3015308
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$325.95 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$65.19
|
| Rate for Payer: Anthem Medicare Advantage |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.19
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.19
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.19
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$65.19
|
| Rate for Payer: The Alliance Commercial |
$247.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.19
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$325.95
|
|
|
ECHO EXAM OF EYE 7651926
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 76519 26
|
| Hospital Charge Code |
3015309
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$146.75 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$29.35
|
| Rate for Payer: Anthem Medicare Advantage |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.35
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.35
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.35
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$29.35
|
| Rate for Payer: The Alliance Commercial |
$111.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$146.75
|
|
|
Echo Exam of Eye, Thickness 7651426
|
Professional
|
$97.00
|
|
|
Service Code
|
CPT 76514 26
|
| Hospital Charge Code |
3219495
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$7.43
|
| Rate for Payer: Anthem Medicare Advantage |
$7.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.43
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.43
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.43
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: Quartz Medicare Advantage |
$7.43
|
| Rate for Payer: The Alliance Commercial |
$28.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.43
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$37.15
|
|
|
ECHO EXAM OF HEART 93307
|
Professional
|
$525.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
3015371
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.93 |
| Max. Negotiated Rate |
$527.72 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Aetna Managed Medicare |
$131.93
|
| Rate for Payer: Anthem Medicare Advantage |
$131.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.93
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.93
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$490.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$490.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.93
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: Quartz Medicare Advantage |
$131.93
|
| Rate for Payer: The Alliance Commercial |
$501.33
|
| Rate for Payer: United Healthcare Medicaid |
$160.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.93
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$527.72
|
|
|
ECHO EXAM OF HEART 9330726
|
Professional
|
$525.00
|
|
|
Service Code
|
CPT 93307 26
|
| Hospital Charge Code |
3015370
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Aetna Managed Medicare |
$41.90
|
| Rate for Payer: Anthem Medicare Advantage |
$41.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.90
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: Quartz Medicare Advantage |
$41.90
|
| Rate for Payer: The Alliance Commercial |
$159.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.90
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$167.60
|
|
|
ECHO EXAM OF HEART 93308
|
Professional
|
$382.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
3015372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.68 |
| Max. Negotiated Rate |
$378.72 |
| Rate for Payer: Aetna Commercial |
$362.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Aetna Managed Medicare |
$94.68
|
| Rate for Payer: Anthem Medicare Advantage |
$94.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.68
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$362.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.68
|
| Rate for Payer: Health EOS Commercial |
$347.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.68
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.90
|
| Rate for Payer: Quartz Beloit One Network |
$168.08
|
| Rate for Payer: Quartz Commercial |
$217.74
|
| Rate for Payer: Quartz Medicare Advantage |
$94.68
|
| Rate for Payer: The Alliance Commercial |
$359.78
|
| Rate for Payer: United Healthcare Medicaid |
$100.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.68
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$378.72
|
|
|
Echo Guide for Biopsy 76942PP50
|
Professional
|
$3,744.00
|
|
|
Service Code
|
CPT 76942 50
|
| Hospital Charge Code |
3856733
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,647.36 |
| Max. Negotiated Rate |
$3,556.80 |
| Rate for Payer: Aetna Commercial |
$3,556.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,219.84
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cigna Commercial |
$3,556.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,872.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,246.40
|
| Rate for Payer: Health EOS Commercial |
$3,407.04
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,556.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,647.36
|
| Rate for Payer: Quartz Commercial |
$2,134.08
|
| Rate for Payer: The Alliance Commercial |
$1,872.00
|
| Rate for Payer: WEA Trust Commercial |
$2,059.20
|
| Rate for Payer: WPS Commercial |
$2,773.18
|
|
|
Echo Guide for Heart Biopsy 7693226
|
Professional
|
$480.00
|
|
|
Service Code
|
CPT 76932 26
|
| Hospital Charge Code |
4125286
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.10 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$33.10
|
| Rate for Payer: Anthem Medicare Advantage |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.10
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.10
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.10
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: Quartz Medicare Advantage |
$33.10
|
| Rate for Payer: The Alliance Commercial |
$125.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.10
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$165.50
|
|
|
Echo Interpretation
|
Facility
OP
|
$1,408.00
|
|
|
Service Code
|
CPT 93314 26
|
| Hospital Charge Code |
5375705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$5,632.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Aetna Managed Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$915.20
|
| Rate for Payer: Quartz Medicare Advantage |
$844.80
|
| Rate for Payer: The Alliance Commercial |
$5,632.00
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
Echo Interpretation
|
Facility
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375696
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$5,392.00 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Aetna Managed Medicare |
$377.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.00
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$876.20
|
| Rate for Payer: Quartz Medicare Advantage |
$808.80
|
| Rate for Payer: The Alliance Commercial |
$5,392.00
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
IP
|
$1,408.00
|
|
|
Service Code
|
CPT 93314 26
|
| Hospital Charge Code |
5375705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$1,295.36 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$844.80
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
Echo Interpretation
|
Facility
OP
|
$186.00
|
|
|
Service Code
|
CPT 93350 26
|
| Hospital Charge Code |
5375675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Echo Interpretation
|
Facility
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375693
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$5,392.00 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Aetna Managed Medicare |
$377.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.00
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$876.20
|
| Rate for Payer: Quartz Medicare Advantage |
$808.80
|
| Rate for Payer: The Alliance Commercial |
$5,392.00
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375696
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.52 |
| Max. Negotiated Rate |
$1,240.16 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$808.80
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375693
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.52 |
| Max. Negotiated Rate |
$1,240.16 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$808.80
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 93350 26
|
| Hospital Charge Code |
5375675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Echo Stress Test 93350
|
Facility
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5381792
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
Echo Stress Test 93350
|
Facility
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5381792
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
Echo Transeophag Congen Probe Plcmt 9331526
|
Professional
|
$2,125.00
|
|
|
Service Code
|
CPT 93315 26
|
| Hospital Charge Code |
4834611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$2,018.75 |
| Rate for Payer: Aetna Commercial |
$2,018.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Aetna Managed Medicare |
$121.52
|
| Rate for Payer: Anthem Medicare Advantage |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.52
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,018.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,062.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.52
|
| Rate for Payer: Health EOS Commercial |
$1,933.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.52
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.75
|
| Rate for Payer: Quartz Beloit One Network |
$935.00
|
| Rate for Payer: Quartz Commercial |
$1,211.25
|
| Rate for Payer: Quartz Medicare Advantage |
$121.52
|
| Rate for Payer: The Alliance Commercial |
$461.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.52
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$486.08
|
|
|
ECHO TRANSESOPHAGEAL 9331226
|
Professional
|
$1,458.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
3015375
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.61 |
| Max. Negotiated Rate |
$1,385.10 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.88
|
| Rate for Payer: Aetna Managed Medicare |
$102.61
|
| Rate for Payer: Anthem Medicare Advantage |
$102.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.61
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$1,385.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$729.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.61
|
| Rate for Payer: Health EOS Commercial |
$1,326.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$372.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.61
|
| Rate for Payer: Multiplan Commercial |
$1,166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,385.10
|
| Rate for Payer: Quartz Beloit One Network |
$641.52
|
| Rate for Payer: Quartz Commercial |
$831.06
|
| Rate for Payer: Quartz Medicare Advantage |
$102.61
|
| Rate for Payer: The Alliance Commercial |
$389.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.61
|
| Rate for Payer: WEA Trust Commercial |
$801.90
|
| Rate for Payer: WPS Commercial |
$410.44
|
|
|
Echo Transthoracic 9330326
|
Professional
|
$815.00
|
|
|
Service Code
|
CPT 93303 26
|
| Hospital Charge Code |
4075841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Aetna Commercial |
$774.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.90
|
| Rate for Payer: Aetna Managed Medicare |
$59.29
|
| Rate for Payer: Anthem Medicare Advantage |
$59.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.29
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$774.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$407.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.29
|
| Rate for Payer: Health EOS Commercial |
$741.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$214.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.29
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: Preferred Network Access Commercial |
$774.25
|
| Rate for Payer: Quartz Beloit One Network |
$358.60
|
| Rate for Payer: Quartz Commercial |
$464.55
|
| Rate for Payer: Quartz Medicare Advantage |
$59.29
|
| Rate for Payer: The Alliance Commercial |
$225.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.29
|
| Rate for Payer: WEA Trust Commercial |
$448.25
|
| Rate for Payer: WPS Commercial |
$237.16
|
|
|
ECHO TRANSTHORACIC 9330826
|
Professional
|
$382.00
|
|
|
Service Code
|
CPT 93308 26
|
| Hospital Charge Code |
3015373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Aetna Commercial |
$362.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Aetna Managed Medicare |
$23.97
|
| Rate for Payer: Anthem Medicare Advantage |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.97
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$362.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.97
|
| Rate for Payer: Health EOS Commercial |
$347.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.97
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.90
|
| Rate for Payer: Quartz Beloit One Network |
$168.08
|
| Rate for Payer: Quartz Commercial |
$217.74
|
| Rate for Payer: Quartz Medicare Advantage |
$23.97
|
| Rate for Payer: The Alliance Commercial |
$91.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.97
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$95.88
|
|
