|
Eastern Equine IgM
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.00
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: HFN Commercial |
$80.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: The Alliance Commercial |
$42.50
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Eastern Equine IgM
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
EASY CLIP 10x10x10 EZM10-10-10
|
Facility
|
OP
|
$6,178.00
|
|
| Hospital Charge Code |
2965383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.84 |
| Max. Negotiated Rate |
$24,712.00 |
| Rate for Payer: Aetna Commercial |
$5,560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,313.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,729.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,015.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,089.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,965.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,274.34
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$5,683.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,457.21
|
| Rate for Payer: Health EOS Commercial |
$5,498.42
|
| Rate for Payer: HFN Commercial |
$5,683.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,633.50
|
| Rate for Payer: Multiplan Commercial |
$4,942.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,706.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,683.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.22
|
| Rate for Payer: Quartz Commercial |
$4,015.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,706.80
|
| Rate for Payer: The Alliance Commercial |
$24,712.00
|
| Rate for Payer: WEA Trust Commercial |
$3,397.90
|
| Rate for Payer: WPS Commercial |
$4,576.04
|
|
|
EASY CLIP 10x10x10 EZM10-10-10
|
Facility
|
IP
|
$6,178.00
|
|
| Hospital Charge Code |
2965383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,027.22 |
| Max. Negotiated Rate |
$5,683.76 |
| Rate for Payer: Aetna Commercial |
$5,560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,313.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,274.34
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$5,683.76
|
| Rate for Payer: Health EOS Commercial |
$5,498.42
|
| Rate for Payer: HFN Commercial |
$5,683.76
|
| Rate for Payer: Multiplan Commercial |
$4,942.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,706.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,683.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.22
|
| Rate for Payer: Quartz Commercial |
$3,706.80
|
| Rate for Payer: WEA Trust Commercial |
$3,397.90
|
| Rate for Payer: WPS Commercial |
$4,576.04
|
|
|
ebus intervent periph lesion - Bronchoscopy Charge
|
Facility
|
OP
|
$4,900.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
5412630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,372.00 |
| Max. Negotiated Rate |
$19,600.00 |
| Rate for Payer: Aetna Commercial |
$4,410.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,214.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,372.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,185.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,450.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,352.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$4,508.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$4,361.00
|
| Rate for Payer: HFN Commercial |
$4,508.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,675.00
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,940.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,508.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.00
|
| Rate for Payer: Quartz Commercial |
$3,185.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,940.00
|
| Rate for Payer: The Alliance Commercial |
$19,600.00
|
| Rate for Payer: WEA Trust Commercial |
$2,695.00
|
| Rate for Payer: WPS Commercial |
$3,629.43
|
|
|
ebus intervent periph lesion - Bronchoscopy Charge
|
Facility
|
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
5412630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,401.00 |
| Max. Negotiated Rate |
$4,508.00 |
| Rate for Payer: Aetna Commercial |
$4,410.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,214.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$4,508.00
|
| Rate for Payer: Health EOS Commercial |
$4,361.00
|
| Rate for Payer: HFN Commercial |
$4,508.00
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,940.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,508.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.00
|
| Rate for Payer: Quartz Commercial |
$2,940.00
|
| Rate for Payer: WEA Trust Commercial |
$2,695.00
|
| Rate for Payer: WPS Commercial |
$3,629.43
|
|
|
ebus sampling 1-2 nodes - Bronchoscopy Charge
|
Facility
|
OP
|
$7,707.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
5412628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$13,769.28 |
| Rate for Payer: Aetna Commercial |
$6,936.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,628.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cigna Commercial |
$7,090.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$6,859.23
|
| Rate for Payer: HFN Commercial |
$7,090.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$6,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,090.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,776.43
|
| Rate for Payer: Quartz Commercial |
$5,009.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$6,292.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$4,238.85
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$5,708.57
|
|
|
ebus sampling 1-2 nodes - Bronchoscopy Charge
|
Facility
|
IP
|
$7,707.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
5412628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,776.43 |
| Max. Negotiated Rate |
$7,090.44 |
| Rate for Payer: Aetna Commercial |
$6,936.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,628.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.71
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cigna Commercial |
$7,090.44
|
| Rate for Payer: Health EOS Commercial |
$6,859.23
|
| Rate for Payer: HFN Commercial |
$7,090.44
|
| Rate for Payer: Multiplan Commercial |
$6,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,090.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,776.43
|
| Rate for Payer: Quartz Commercial |
$4,624.20
|
| Rate for Payer: WEA Trust Commercial |
$4,238.85
|
| Rate for Payer: WPS Commercial |
$5,708.57
|
|
|
ebus sampling 3 > nodes - Bronchoscopy Charge
|
Facility
|
IP
|
$10,386.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
5412629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,089.14 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$9,347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,931.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,504.58
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cigna Commercial |
$9,555.12
|
| Rate for Payer: Health EOS Commercial |
$9,243.54
|
| Rate for Payer: HFN Commercial |
$9,555.12
|
| Rate for Payer: Multiplan Commercial |
$8,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,555.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,089.14
|
| Rate for Payer: Quartz Commercial |
$6,231.60
|
| Rate for Payer: WEA Trust Commercial |
$5,712.30
|
| Rate for Payer: WPS Commercial |
$7,692.91
|
|
|
ebus sampling 3 > nodes - Bronchoscopy Charge
|
Facility
|
OP
|
$10,386.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
5412629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$13,769.28 |
| Rate for Payer: Aetna Commercial |
$9,347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,931.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,504.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cigna Commercial |
$9,555.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$9,243.54
|
| Rate for Payer: HFN Commercial |
$9,555.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$8,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$9,555.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,089.14
|
| Rate for Payer: Quartz Commercial |
$6,750.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$6,292.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$5,712.30
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$7,692.91
|
|
|
ECCENTER TI SYNTHES
|
Facility
|
IP
|
$4,889.00
|
|
| Hospital Charge Code |
2966227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,395.61 |
| Max. Negotiated Rate |
$4,497.88 |
| Rate for Payer: Aetna Commercial |
$4,400.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,204.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,591.17
|
| Rate for Payer: Cash Price |
$1,466.70
|
| Rate for Payer: Cigna Commercial |
$4,497.88
|
| Rate for Payer: Health EOS Commercial |
$4,351.21
|
| Rate for Payer: HFN Commercial |
$4,497.88
|
| Rate for Payer: Multiplan Commercial |
$3,911.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,933.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,497.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,395.61
|
| Rate for Payer: Quartz Commercial |
$2,933.40
|
| Rate for Payer: WEA Trust Commercial |
$2,688.95
|
| Rate for Payer: WPS Commercial |
$3,621.28
|
|
|
ECCENTER TI SYNTHES
|
Facility
|
OP
|
$4,889.00
|
|
| Hospital Charge Code |
2966227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,368.92 |
| Max. Negotiated Rate |
$19,556.00 |
| Rate for Payer: Aetna Commercial |
$4,400.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,204.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,368.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,177.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,444.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,346.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,591.17
|
| Rate for Payer: Cash Price |
$1,466.70
|
| Rate for Payer: Cigna Commercial |
$4,497.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,735.88
|
| Rate for Payer: Health EOS Commercial |
$4,351.21
|
| Rate for Payer: HFN Commercial |
$4,497.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,666.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,933.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,497.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,395.61
|
| Rate for Payer: Quartz Commercial |
$3,177.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,933.40
|
| Rate for Payer: The Alliance Commercial |
$19,556.00
|
| Rate for Payer: WEA Trust Commercial |
$2,688.95
|
| Rate for Payer: WPS Commercial |
$3,621.28
|
|
|
ECG Monitor/Report 93224
|
Professional
|
Both
|
$2,895.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
3147545
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$2,750.25 |
| Rate for Payer: Aetna Commercial |
$2,750.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,489.70
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$2,750.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,737.00
|
| Rate for Payer: Health EOS Commercial |
$2,634.45
|
| Rate for Payer: HFN Commercial |
$2,750.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$268.42
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,750.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.80
|
| Rate for Payer: Quartz Commercial |
$1,650.15
|
| Rate for Payer: The Alliance Commercial |
$1,447.50
|
| Rate for Payer: United Healthcare Medicaid |
$107.00
|
| Rate for Payer: WEA Trust Commercial |
$1,592.25
|
| Rate for Payer: WPS Commercial |
$2,144.33
|
|
|
ECG Record/Review 93268
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
3165512
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$671.19 |
| Rate for Payer: Aetna Commercial |
$570.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$570.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.60
|
| Rate for Payer: Health EOS Commercial |
$546.91
|
| Rate for Payer: HFN Commercial |
$570.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$671.19
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$570.95
|
| Rate for Payer: Quartz Beloit One Network |
$264.44
|
| Rate for Payer: Quartz Commercial |
$342.57
|
| Rate for Payer: The Alliance Commercial |
$300.50
|
| Rate for Payer: United Healthcare Medicaid |
$240.79
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
ECG/Review,Interpret Only 93272
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
3219490
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: HFN Commercial |
$637.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.67
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
Echinococcus Antibody
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
977931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna Commercial |
$164.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$164.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.80
|
| Rate for Payer: Health EOS Commercial |
$157.43
|
| Rate for Payer: HFN Commercial |
$164.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.35
|
| Rate for Payer: Quartz Beloit One Network |
$76.12
|
| Rate for Payer: Quartz Commercial |
$98.61
|
| Rate for Payer: The Alliance Commercial |
$86.50
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Echinococcus Antibody
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
977931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$103.80
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Echinococcus Antibody
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
977931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.81
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$112.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$129.75
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5375662
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$860.44 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,053.60
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$4,412.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375681
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$4,059.04 |
| Rate for Payer: Aetna Commercial |
$3,970.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,794.32
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,867.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,117.76
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,338.36
|
| 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 |
$1,323.60
|
| Rate for Payer: Cash Price |
$1,323.60
|
| Rate for Payer: Cigna Commercial |
$4,059.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,468.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,926.68
|
| Rate for Payer: HFN Commercial |
$4,059.04
|
| 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 |
$3,529.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,059.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,161.88
|
| Rate for Payer: Quartz Commercial |
$2,867.80
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$3,309.00
|
| Rate for Payer: WEA Trust Commercial |
$2,426.60
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$3,267.97
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$6,243.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
5375703
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$5,743.56 |
| Rate for Payer: Aetna Commercial |
$5,618.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,368.98
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,057.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,121.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,996.64
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,308.79
|
| 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 |
$1,872.90
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,743.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,493.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$5,556.27
|
| Rate for Payer: HFN Commercial |
$5,743.56
|
| 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 |
$4,994.40
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$5,743.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,059.07
|
| Rate for Payer: Quartz Commercial |
$4,057.95
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$4,682.25
|
| Rate for Payer: WEA Trust Commercial |
$3,433.65
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$4,624.19
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
5375653
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$2,261.36 |
| Rate for Payer: Aetna Commercial |
$2,212.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,113.88
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,597.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,229.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,179.84
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,302.74
|
| 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 |
$737.40
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cigna Commercial |
$2,261.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,375.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$2,187.62
|
| Rate for Payer: HFN Commercial |
$2,261.36
|
| 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 |
$1,966.40
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,261.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.42
|
| Rate for Payer: Quartz Commercial |
$1,597.70
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$1,843.50
|
| Rate for Payer: WEA Trust Commercial |
$1,351.90
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$1,820.64
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375694
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,630.23 |
| Max. Negotiated Rate |
$3,060.84 |
| Rate for Payer: Aetna Commercial |
$2,994.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,861.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.31
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,060.84
|
| Rate for Payer: Health EOS Commercial |
$2,961.03
|
| Rate for Payer: HFN Commercial |
$3,060.84
|
| Rate for Payer: Multiplan Commercial |
$2,661.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,996.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,060.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.23
|
| Rate for Payer: Quartz Commercial |
$1,996.20
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5375688
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$4,666.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
5375700
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$4,292.72 |
| Rate for Payer: Aetna Commercial |
$4,199.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,012.76
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,032.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,333.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,239.68
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,472.98
|
| 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 |
$1,399.80
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,292.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,611.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$4,152.74
|
| Rate for Payer: HFN Commercial |
$4,292.72
|
| 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 |
$3,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,292.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,286.34
|
| Rate for Payer: Quartz Commercial |
$3,032.90
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$3,499.50
|
| Rate for Payer: WEA Trust Commercial |
$2,566.30
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$3,456.11
|
|
