|
Echo Acquisition
|
Facility
|
IP
|
$6,243.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
5375703
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$3,059.07 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,308.79
|
| Rate for Payer: Cash Price |
$1,872.90
|
| Rate for Payer: Cigna Commercial |
$5,743.56
|
| Rate for Payer: Health EOS Commercial |
$5,556.27
|
| Rate for Payer: HFN Commercial |
$5,743.56
|
| Rate for Payer: Multiplan Commercial |
$4,994.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,745.80
|
| 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 |
$3,745.80
|
| Rate for Payer: WEA Trust Commercial |
$3,433.65
|
| Rate for Payer: WPS Commercial |
$4,624.19
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5375712
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,394.72 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$985.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.68
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$985.40
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$1,137.00
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375691
|
|
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
|
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
|
|
|
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
|
$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
|
$3,539.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375715
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,255.88 |
| Rate for Payer: Aetna Commercial |
$3,185.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,043.54
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,300.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,698.72
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.67
|
| 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 |
$1,061.70
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,255.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,980.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,149.71
|
| Rate for Payer: HFN Commercial |
$3,255.88
|
| 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 |
$2,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,255.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.11
|
| Rate for Payer: Quartz Commercial |
$2,300.35
|
| 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 |
$2,654.25
|
| Rate for Payer: WEA Trust Commercial |
$1,946.45
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,621.34
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$4,474.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375668
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$4,116.08 |
| Rate for Payer: Aetna Commercial |
$4,026.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,847.64
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,908.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,147.52
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,371.22
|
| 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 |
$1,342.20
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,116.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,503.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,981.86
|
| Rate for Payer: HFN Commercial |
$4,116.08
|
| 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 |
$3,579.20
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,116.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,192.26
|
| Rate for Payer: Quartz Commercial |
$2,908.10
|
| 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 |
$3,355.50
|
| Rate for Payer: WEA Trust Commercial |
$2,460.70
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$3,313.89
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375691
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| 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: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,162.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.96
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.31
|
| 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 |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,060.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,861.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$2,961.03
|
| Rate for Payer: HFN Commercial |
$3,060.84
|
| 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 |
$2,661.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| 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 |
$2,162.55
|
| 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 |
$2,495.25
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$3,539.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375715
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,734.11 |
| Max. Negotiated Rate |
$3,255.88 |
| Rate for Payer: Aetna Commercial |
$3,185.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,043.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,875.67
|
| Rate for Payer: Cash Price |
$1,061.70
|
| Rate for Payer: Cigna Commercial |
$3,255.88
|
| Rate for Payer: Health EOS Commercial |
$3,149.71
|
| Rate for Payer: HFN Commercial |
$3,255.88
|
| Rate for Payer: Multiplan Commercial |
$2,831.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,123.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,255.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,734.11
|
| Rate for Payer: Quartz Commercial |
$2,123.40
|
| Rate for Payer: WEA Trust Commercial |
$1,946.45
|
| Rate for Payer: WPS Commercial |
$2,621.34
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
5375656
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$925.61 |
| Max. Negotiated Rate |
$1,737.88 |
| Rate for Payer: Aetna Commercial |
$1,700.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,001.17
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,737.88
|
| Rate for Payer: Health EOS Commercial |
$1,681.21
|
| Rate for Payer: HFN Commercial |
$1,737.88
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,133.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,737.88
|
| Rate for Payer: Quartz Beloit One Network |
$925.61
|
| Rate for Payer: Quartz Commercial |
$1,133.40
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$4,474.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375677
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$4,116.08 |
| Rate for Payer: Aetna Commercial |
$4,026.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,847.64
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,908.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,237.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,147.52
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,371.22
|
| 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 |
$1,342.20
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,116.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,503.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,981.86
|
| Rate for Payer: HFN Commercial |
$4,116.08
|
| 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 |
$3,579.20
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,116.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,192.26
|
| Rate for Payer: Quartz Commercial |
$2,908.10
|
| 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 |
$3,355.50
|
| Rate for Payer: WEA Trust Commercial |
$2,460.70
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$3,313.89
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$4,666.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
5375700
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,286.34 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,472.98
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,292.72
|
| Rate for Payer: Health EOS Commercial |
$4,152.74
|
| Rate for Payer: HFN Commercial |
$4,292.72
|
| Rate for Payer: Multiplan Commercial |
$3,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,799.60
|
| 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 |
$2,799.60
|
| Rate for Payer: WEA Trust Commercial |
$2,566.30
|
| Rate for Payer: WPS Commercial |
$3,456.11
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$2,579.00
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
5375706
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,263.71 |
| Max. Negotiated Rate |
$2,372.68 |
| Rate for Payer: Aetna Commercial |
$2,321.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.87
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cigna Commercial |
$2,372.68
|
| Rate for Payer: Health EOS Commercial |
$2,295.31
|
| Rate for Payer: HFN Commercial |
$2,372.68
|
| Rate for Payer: Multiplan Commercial |
$2,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,547.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,372.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.71
|
| Rate for Payer: Quartz Commercial |
$1,547.40
|
| Rate for Payer: WEA Trust Commercial |
$1,418.45
|
| Rate for Payer: WPS Commercial |
$1,910.27
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
5375662
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$242.20 |
| 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: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,141.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$842.88
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,141.40
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$2,579.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
5375709
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,263.71 |
| Max. Negotiated Rate |
$2,372.68 |
| Rate for Payer: Aetna Commercial |
$2,321.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.87
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cigna Commercial |
$2,372.68
|
| Rate for Payer: Health EOS Commercial |
$2,295.31
|
| Rate for Payer: HFN Commercial |
$2,372.68
|
| Rate for Payer: Multiplan Commercial |
$2,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,547.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,372.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.71
|
| Rate for Payer: Quartz Commercial |
$1,547.40
|
| Rate for Payer: WEA Trust Commercial |
$1,418.45
|
| Rate for Payer: WPS Commercial |
$1,910.27
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375650
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,404.92 |
| Rate for Payer: Aetna Commercial |
$3,330.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,182.86
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,405.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,850.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,776.48
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| 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 |
$1,110.30
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,071.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| 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 |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,404.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,813.49
|
| Rate for Payer: Quartz Commercial |
$2,405.65
|
| 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 |
$2,775.75
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$4,474.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375677
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,192.26 |
| Max. Negotiated Rate |
$4,116.08 |
| Rate for Payer: Aetna Commercial |
$4,026.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,847.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,371.22
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,116.08
|
| Rate for Payer: Health EOS Commercial |
$3,981.86
|
| Rate for Payer: HFN Commercial |
$4,116.08
|
| Rate for Payer: Multiplan Commercial |
$3,579.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,684.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,116.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,192.26
|
| Rate for Payer: Quartz Commercial |
$2,684.40
|
| Rate for Payer: WEA Trust Commercial |
$2,460.70
|
| Rate for Payer: WPS Commercial |
$3,313.89
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662
|
| Hospital Charge Code |
5375659
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$7,012.00 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Aetna Managed Medicare |
$490.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.98
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.75
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,139.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.80
|
| Rate for Payer: The Alliance Commercial |
$7,012.00
|
| Rate for Payer: United Healthcare PPO |
$1,314.75
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5375694
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| 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: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,162.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.96
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.31
|
| 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 |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,060.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,861.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$2,961.03
|
| Rate for Payer: HFN Commercial |
$3,060.84
|
| 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 |
$2,661.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| 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 |
$2,162.55
|
| 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 |
$2,495.25
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$4,474.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375668
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,192.26 |
| Max. Negotiated Rate |
$4,116.08 |
| Rate for Payer: Aetna Commercial |
$4,026.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,847.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,371.22
|
| Rate for Payer: Cash Price |
$1,342.20
|
| Rate for Payer: Cigna Commercial |
$4,116.08
|
| Rate for Payer: Health EOS Commercial |
$3,981.86
|
| Rate for Payer: HFN Commercial |
$4,116.08
|
| Rate for Payer: Multiplan Commercial |
$3,579.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,684.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,116.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,192.26
|
| Rate for Payer: Quartz Commercial |
$2,684.40
|
| Rate for Payer: WEA Trust Commercial |
$2,460.70
|
| Rate for Payer: WPS Commercial |
$3,313.89
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5375688
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| 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: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| 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 |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: United Healthcare PPO |
$1,437.75
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
Echo Acquisition
|
Facility
|
OP
|
$2,579.00
|
|
|
Service Code
|
CPT 93316
|
| Hospital Charge Code |
5375709
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$2,372.68 |
| Rate for Payer: Aetna Commercial |
$2,321.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.94
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,676.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.92
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.87
|
| 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 |
$773.70
|
| Rate for Payer: Cash Price |
$773.70
|
| Rate for Payer: Cigna Commercial |
$2,372.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,443.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$2,295.31
|
| Rate for Payer: HFN Commercial |
$2,372.68
|
| 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 |
$2,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,372.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.71
|
| Rate for Payer: Quartz Commercial |
$1,676.35
|
| 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 |
$1,934.25
|
| Rate for Payer: WEA Trust Commercial |
$1,418.45
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$1,910.27
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$4,412.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5375673
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,161.88 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,338.36
|
| Rate for Payer: Cash Price |
$1,323.60
|
| Rate for Payer: Cigna Commercial |
$4,059.04
|
| Rate for Payer: Health EOS Commercial |
$3,926.68
|
| Rate for Payer: HFN Commercial |
$4,059.04
|
| Rate for Payer: Multiplan Commercial |
$3,529.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,647.20
|
| 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 |
$2,647.20
|
| Rate for Payer: WEA Trust Commercial |
$2,426.60
|
| Rate for Payer: WPS Commercial |
$3,267.97
|
|
|
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
|
|
