|
Echo Acquisition
|
Facility
|
IP
|
$3,539.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375715
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,803.47 |
| Max. Negotiated Rate |
$3,386.12 |
| Rate for Payer: Aetna Commercial |
$3,312.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.70
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,386.12
|
| Rate for Payer: Health EOS Commercial |
$3,275.70
|
| Rate for Payer: HFN Commercial |
$3,386.12
|
| Rate for Payer: Multiplan Commercial |
$2,944.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.47
|
| Rate for Payer: Quartz Commercial |
$2,208.34
|
| Rate for Payer: WEA Trust Commercial |
$2,024.31
|
| Rate for Payer: WPS Commercial |
$2,726.09
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
5375700
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$4,464.43 |
| Rate for Payer: Aetna Commercial |
$4,367.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,173.27
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,154.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,426.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,329.27
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,571.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,464.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,715.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$4,318.85
|
| Rate for Payer: HFN Commercial |
$4,464.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$3,882.11
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,464.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,377.79
|
| Rate for Payer: Quartz Commercial |
$3,154.22
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$3,639.48
|
| Rate for Payer: WEA Trust Commercial |
$2,668.95
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$3,594.22
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
5375659
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$893.33 |
| Max. Negotiated Rate |
$1,677.27 |
| Rate for Payer: Aetna Commercial |
$1,640.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.25
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,677.27
|
| Rate for Payer: Health EOS Commercial |
$1,622.58
|
| Rate for Payer: HFN Commercial |
$1,677.27
|
| Rate for Payer: Multiplan Commercial |
$1,458.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.27
|
| Rate for Payer: Quartz Beloit One Network |
$893.33
|
| Rate for Payer: Quartz Commercial |
$1,093.87
|
| Rate for Payer: WEA Trust Commercial |
$1,002.72
|
| Rate for Payer: WPS Commercial |
$1,350.34
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
5375653
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,252.60 |
| Max. Negotiated Rate |
$2,351.81 |
| Rate for Payer: Aetna Commercial |
$2,300.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,198.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,354.85
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cigna Commercial |
$2,351.81
|
| Rate for Payer: Health EOS Commercial |
$2,275.12
|
| Rate for Payer: HFN Commercial |
$2,351.81
|
| Rate for Payer: Multiplan Commercial |
$2,045.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,351.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.60
|
| Rate for Payer: Quartz Commercial |
$1,533.79
|
| Rate for Payer: WEA Trust Commercial |
$1,405.98
|
| Rate for Payer: WPS Commercial |
$1,893.40
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5375712
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$772.55 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$945.98
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
5375653
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$2,351.81 |
| Rate for Payer: Aetna Commercial |
$2,300.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,198.44
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,661.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,278.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,227.03
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,354.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cigna Commercial |
$2,351.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,430.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$2,275.12
|
| Rate for Payer: HFN Commercial |
$2,351.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,045.06
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,351.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,252.60
|
| Rate for Payer: Quartz Commercial |
$1,661.61
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$1,917.24
|
| Rate for Payer: WEA Trust Commercial |
$1,405.98
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$1,893.40
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375694
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,249.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,730.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,660.84
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,936.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,249.05
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,595.06
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375650
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$3,541.12 |
| Rate for Payer: Aetna Commercial |
$3,464.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,310.17
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,501.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,924.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,847.54
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,039.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,541.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,153.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$3,425.65
|
| Rate for Payer: HFN Commercial |
$3,541.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$3,079.23
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,541.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,886.03
|
| Rate for Payer: Quartz Commercial |
$2,501.88
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,886.78
|
| Rate for Payer: WEA Trust Commercial |
$2,116.97
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$2,850.88
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$2,579.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
5375709
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$2,467.59 |
| Rate for Payer: Aetna Commercial |
$2,413.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,306.66
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,743.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,341.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,287.44
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,421.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cigna Commercial |
$2,467.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,500.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$2,387.12
|
| Rate for Payer: HFN Commercial |
$2,467.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,145.73
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,467.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,314.26
|
| Rate for Payer: Quartz Commercial |
$1,743.40
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,011.62
|
| Rate for Payer: WEA Trust Commercial |
$1,475.19
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$1,986.60
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375691
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,695.44 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,076.05
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$4,474.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375668
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,279.95 |
| Max. Negotiated Rate |
$4,280.72 |
| Rate for Payer: Aetna Commercial |
$4,187.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,001.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,466.07
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: Health EOS Commercial |
$4,141.13
|
| Rate for Payer: HFN Commercial |
$4,280.72
|
| Rate for Payer: Multiplan Commercial |
$3,722.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.95
|
| Rate for Payer: Quartz Commercial |
$2,791.78
|
| Rate for Payer: WEA Trust Commercial |
$2,559.13
|
| Rate for Payer: WPS Commercial |
$3,446.32
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375694
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,695.44 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,076.05
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$3,539.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375715
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$3,386.12 |
| Rate for Payer: Aetna Commercial |
$3,312.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,165.28
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,392.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,840.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,766.67
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,950.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,386.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,059.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$3,275.70
|
| Rate for Payer: HFN Commercial |
$3,386.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,944.45
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,386.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,803.47
|
| Rate for Payer: Quartz Commercial |
$2,392.36
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,760.42
|
| Rate for Payer: WEA Trust Commercial |
$2,024.31
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$2,726.09
|
|
|
ECHO ACQUISITION - 93308
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
6033628
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,095.74
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
ECHO ACQUISITION - 93308
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
6033628
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$876.60
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,187.06
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$1,369.68
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
Echocardiograph Complete 93306
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
4568799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.27 |
| Max. Negotiated Rate |
$1,408.89 |
| Rate for Payer: Aetna Commercial |
$1,408.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.41
|
| Rate for Payer: Aetna Managed Medicare |
$196.27
|
| Rate for Payer: Anthem Medicare Advantage |
$196.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$196.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$196.27
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,408.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.27
|
| Rate for Payer: Health EOS Commercial |
$1,349.57
|
| Rate for Payer: HFN Commercial |
$1,408.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$724.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$724.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$196.27
|
| Rate for Payer: Multiplan Commercial |
$1,186.43
|
| Rate for Payer: NAPHCARE Commercial |
$294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.89
|
| Rate for Payer: Quartz Beloit One Network |
$652.54
|
| Rate for Payer: Quartz Commercial |
$845.33
|
| Rate for Payer: Quartz Medicare Advantage |
$196.27
|
| Rate for Payer: The Alliance Commercial |
$745.82
|
| Rate for Payer: United Healthcare Medicaid |
$227.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$196.27
|
| Rate for Payer: WEA Trust Commercial |
$815.67
|
| Rate for Payer: WPS Commercial |
$785.08
|
|
|
ECHOCARDIOGRAPH COMPLETE 9330626
|
Professional
|
Both
|
$1,531.00
|
|
|
Service Code
|
CPT 93306 26
|
| Hospital Charge Code |
3015369
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$1,512.63 |
| Rate for Payer: Aetna Commercial |
$1,512.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$68.16
|
| Rate for Payer: Anthem Medicare Advantage |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.16
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,512.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.16
|
| Rate for Payer: Health EOS Commercial |
$1,448.94
|
| Rate for Payer: HFN Commercial |
$1,512.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$102.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.63
|
| Rate for Payer: Quartz Beloit One Network |
$700.59
|
| Rate for Payer: Quartz Commercial |
$907.58
|
| Rate for Payer: Quartz Medicare Advantage |
$68.16
|
| Rate for Payer: The Alliance Commercial |
$259.01
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.16
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$272.65
|
|
|
ECHOCARDIOGRAPHIC AGENT DURING STRESS ECHO 93352
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
CPT 93352
|
| Hospital Charge Code |
3015382
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.09 |
| Max. Negotiated Rate |
$141.73 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$35.43
|
| Rate for Payer: Anthem Medicare Advantage |
$35.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.43
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$106.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.43
|
| Rate for Payer: Health EOS Commercial |
$102.21
|
| Rate for Payer: HFN Commercial |
$106.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.43
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$53.15
|
| Rate for Payer: Preferred Network Access Commercial |
$106.70
|
| Rate for Payer: Quartz Beloit One Network |
$49.42
|
| Rate for Payer: Quartz Commercial |
$64.02
|
| Rate for Payer: Quartz Medicare Advantage |
$35.43
|
| Rate for Payer: The Alliance Commercial |
$134.64
|
| Rate for Payer: United Healthcare Medicaid |
$33.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.43
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$141.73
|
|
|
ECHOCARDIOGRAPHY
|
Facility
|
OP
|
$101.23
|
|
|
Service Code
|
EAPG 00081
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$101.23 |
| Rate for Payer: Anthem Medicaid |
$97.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.33
|
| Rate for Payer: Dean Health Medicaid |
$97.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.33
|
| Rate for Payer: Managed Health Services Medicaid |
$101.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.33
|
| Rate for Payer: United Healthcare Medicaid |
$97.33
|
|
|
ECHOCARDIOGRAPHY INC CONT MONITOR & MD SUPT 93351
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
3015381
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.74 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Aetna Commercial |
$1,012.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$232.85
|
| Rate for Payer: Anthem Medicare Advantage |
$232.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$232.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$232.85
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$1,012.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.85
|
| Rate for Payer: Health EOS Commercial |
$970.06
|
| Rate for Payer: HFN Commercial |
$1,012.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$846.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$846.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$232.85
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$349.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.70
|
| Rate for Payer: Quartz Beloit One Network |
$469.04
|
| Rate for Payer: Quartz Commercial |
$607.62
|
| Rate for Payer: Quartz Medicare Advantage |
$232.85
|
| Rate for Payer: The Alliance Commercial |
$884.81
|
| Rate for Payer: United Healthcare Medicaid |
$219.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.85
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$931.38
|
|
|
Echocardiography Inc Cont Monitor & MD Supt 9335126
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
CPT 93351 26
|
| Hospital Charge Code |
5252613
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$1,012.70 |
| Rate for Payer: Aetna Commercial |
$1,012.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$82.00
|
| Rate for Payer: Anthem Medicare Advantage |
$82.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.00
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$1,012.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.00
|
| Rate for Payer: Health EOS Commercial |
$970.06
|
| Rate for Payer: HFN Commercial |
$1,012.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$123.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.70
|
| Rate for Payer: Quartz Beloit One Network |
$469.04
|
| Rate for Payer: Quartz Commercial |
$607.62
|
| Rate for Payer: Quartz Medicare Advantage |
$82.00
|
| Rate for Payer: The Alliance Commercial |
$311.62
|
| Rate for Payer: United Healthcare Medicaid |
$131.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$328.02
|
|
|
ECHO EXAM OF EYE 76519
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 76519
|
| Hospital Charge Code |
3015308
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$347.72 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$69.54
|
| Rate for Payer: Anthem Medicare Advantage |
$69.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.54
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.54
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$238.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.54
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$104.32
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$69.54
|
| Rate for Payer: The Alliance Commercial |
$264.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.54
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$347.72
|
|
|
ECHO EXAM OF EYE 7651926
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 76519 26
|
| Hospital Charge Code |
3015309
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$152.46 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$30.49
|
| Rate for Payer: Anthem Medicare Advantage |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.49
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.49
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.49
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$45.74
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$30.49
|
| Rate for Payer: The Alliance Commercial |
$115.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.49
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$152.46
|
|
|
Echo Exam of Eye, Thickness 7651426
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 76514 26
|
| Hospital Charge Code |
3219495
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$7.63
|
| Rate for Payer: Anthem Medicare Advantage |
$7.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.63
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.63
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$11.45
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: Quartz Medicare Advantage |
$7.63
|
| Rate for Payer: The Alliance Commercial |
$29.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.63
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$38.17
|
|
|
ECHO EXAM OF HEART 93307
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
3015371
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$137.62 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$137.62
|
| Rate for Payer: Anthem Medicare Advantage |
$137.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.62
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.62
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: HFN Commercial |
$518.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$509.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$509.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.62
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$206.43
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: Quartz Medicare Advantage |
$137.62
|
| Rate for Payer: The Alliance Commercial |
$522.97
|
| Rate for Payer: United Healthcare Medicaid |
$167.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.62
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$550.49
|
|
