|
Echo Acquisition
|
Facility
|
IP
|
$3,701.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5375650
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,813.49 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,961.53
|
| Rate for Payer: Cash Price |
$1,110.30
|
| Rate for Payer: Cigna Commercial |
$3,404.92
|
| Rate for Payer: Health EOS Commercial |
$3,293.89
|
| Rate for Payer: HFN Commercial |
$3,404.92
|
| Rate for Payer: Multiplan Commercial |
$2,960.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,220.60
|
| 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 |
$2,220.60
|
| Rate for Payer: WEA Trust Commercial |
$2,035.55
|
| Rate for Payer: WPS Commercial |
$2,741.33
|
|
|
Echo Acquisition
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
5375653
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,204.42 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,302.74
|
| Rate for Payer: Cash Price |
$737.40
|
| Rate for Payer: Cigna Commercial |
$2,261.36
|
| Rate for Payer: Health EOS Commercial |
$2,187.62
|
| Rate for Payer: HFN Commercial |
$2,261.36
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,474.80
|
| 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 |
$1,474.80
|
| Rate for Payer: WEA Trust Commercial |
$1,351.90
|
| Rate for Payer: WPS Commercial |
$1,820.64
|
|
|
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
|
$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
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 93314
|
| Hospital Charge Code |
5375685
|
|
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
|
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
|
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
|
$2,579.00
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
5375706
|
|
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 - 93308
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
6033628
|
|
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 - 93308
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
6033628
|
|
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
|
|
|
Echocardiograph Complete 93306
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
4568799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.01 |
| Max. Negotiated Rate |
$1,354.70 |
| Rate for Payer: Aetna Commercial |
$1,354.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.36
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,354.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$855.60
|
| Rate for Payer: Health EOS Commercial |
$1,297.66
|
| Rate for Payer: HFN Commercial |
$1,354.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$696.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$696.40
|
| Rate for Payer: Multiplan Commercial |
$1,140.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.70
|
| Rate for Payer: Quartz Beloit One Network |
$627.44
|
| Rate for Payer: Quartz Commercial |
$812.82
|
| Rate for Payer: The Alliance Commercial |
$713.00
|
| Rate for Payer: United Healthcare Medicaid |
$219.01
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: WPS Commercial |
$1,056.24
|
|
|
ECHOCARDIOGRAPH COMPLETE 9330626
|
Professional
|
Both
|
$1,531.00
|
|
|
Service Code
|
CPT 93306 26
|
| Hospital Charge Code |
3015369
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.98 |
| Max. Negotiated Rate |
$1,454.45 |
| Rate for Payer: Aetna Commercial |
$1,454.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.66
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,454.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$765.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.60
|
| Rate for Payer: Health EOS Commercial |
$1,393.21
|
| Rate for Payer: HFN Commercial |
$1,454.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.98
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.45
|
| Rate for Payer: Quartz Beloit One Network |
$673.64
|
| Rate for Payer: Quartz Commercial |
$872.67
|
| Rate for Payer: The Alliance Commercial |
$765.50
|
| Rate for Payer: WEA Trust Commercial |
$842.05
|
| Rate for Payer: WPS Commercial |
$1,134.01
|
|
|
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 |
$31.82 |
| Max. Negotiated Rate |
$113.49 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$102.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.80
|
| Rate for Payer: Health EOS Commercial |
$98.28
|
| Rate for Payer: HFN Commercial |
$102.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.49
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$102.60
|
| Rate for Payer: Quartz Beloit One Network |
$47.52
|
| Rate for Payer: Quartz Commercial |
$61.56
|
| Rate for Payer: The Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$80.00
|
|
|
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 |
$211.29 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$973.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$973.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.00
|
| Rate for Payer: Health EOS Commercial |
$932.75
|
| Rate for Payer: HFN Commercial |
$973.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$814.05
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: Preferred Network Access Commercial |
$973.75
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$584.25
|
| Rate for Payer: The Alliance Commercial |
$512.50
|
| Rate for Payer: United Healthcare Medicaid |
$211.29
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
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 |
$289.32 |
| Max. Negotiated Rate |
$973.75 |
| Rate for Payer: Aetna Commercial |
$973.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$973.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$615.00
|
| Rate for Payer: Health EOS Commercial |
$932.75
|
| Rate for Payer: HFN Commercial |
$973.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.32
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: Preferred Network Access Commercial |
$973.75
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$584.25
|
| Rate for Payer: The Alliance Commercial |
$512.50
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
ECHO EXAM OF EYE 76519
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 76519
|
| Hospital Charge Code |
3015308
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$229.70 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.00
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.70
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$70.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
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 |
$61.60 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.00
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.16
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: The Alliance Commercial |
$70.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
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 |
$26.90 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: HFN Commercial |
$92.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.90
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: The Alliance Commercial |
$48.50
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
ECHO EXAM OF HEART 93307
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
3015371
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.92 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.00
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: HFN Commercial |
$498.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$490.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$490.28
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: The Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Medicaid |
$160.92
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$388.87
|
|
|
ECHO EXAM OF HEART 9330726
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 93307 26
|
| Hospital Charge Code |
3015370
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$262.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.00
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: HFN Commercial |
$498.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.23
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: The Alliance Commercial |
$262.50
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$388.87
|
|
|
ECHO EXAM OF HEART 93308
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
CPT 93308
|
| Hospital Charge Code |
3015372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.56 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Aetna Commercial |
$362.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$362.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.20
|
| Rate for Payer: Health EOS Commercial |
$347.62
|
| Rate for Payer: HFN Commercial |
$362.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.68
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.90
|
| Rate for Payer: Quartz Beloit One Network |
$168.08
|
| Rate for Payer: Quartz Commercial |
$217.74
|
| Rate for Payer: The Alliance Commercial |
$191.00
|
| Rate for Payer: United Healthcare Medicaid |
$100.56
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
Echo Guide for Biopsy 76942PP50
|
Professional
|
Both
|
$3,744.00
|
|
|
Service Code
|
CPT 76942 50
|
| Hospital Charge Code |
3856733
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,647.36 |
| Max. Negotiated Rate |
$3,556.80 |
| Rate for Payer: Aetna Commercial |
$3,556.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,219.84
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cigna Commercial |
$3,556.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,872.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,246.40
|
| Rate for Payer: Health EOS Commercial |
$3,407.04
|
| Rate for Payer: HFN Commercial |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,556.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,647.36
|
| Rate for Payer: Quartz Commercial |
$2,134.08
|
| Rate for Payer: The Alliance Commercial |
$1,872.00
|
| Rate for Payer: WEA Trust Commercial |
$2,059.20
|
| Rate for Payer: WPS Commercial |
$2,773.18
|
|
|
Echo Guide for Heart Biopsy 7693226
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 76932 26
|
| Hospital Charge Code |
4125286
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.84 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.00
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: HFN Commercial |
$456.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.84
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
Echo Interpretation
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 93350 26
|
| Hospital Charge Code |
5375675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Echo Interpretation
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375693
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.52 |
| Max. Negotiated Rate |
$1,240.16 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$808.80
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
