|
Eosinophil Smear Nasal
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
633721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Eosinophil Smear Nasal
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
633721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.02
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.02
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.02
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$9.03
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6.02
|
| Rate for Payer: The Alliance Commercial |
$24.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.02
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: Wellcare Medicare |
$6.02
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Eosinophil Urine
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
633722
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$3.17
|
| Rate for Payer: Anthem Medicare Advantage |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.17
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.17
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$4.76
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.17
|
| Rate for Payer: The Alliance Commercial |
$12.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$13.96
|
|
|
Eosinophil Urine
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
633722
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
Eosinophil Urine
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
633722
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$3.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.27
|
| Rate for Payer: Anthem Medicare Advantage |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.17
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.17
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$4.76
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$3.17
|
| Rate for Payer: The Alliance Commercial |
$12.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$3.17
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
EO with joint, Prefabricated L3760
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
3713509
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$2,326.94 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$73.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$367.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.78
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$156.62
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$156.62
|
| Rate for Payer: The Alliance Commercial |
$2,326.94
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
EO with joint, Prefabricated L3760
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
3713509
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
EO with joint, Prefabricated L3760
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
3713509
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$1,677.33 |
| Rate for Payer: Aetna Commercial |
$247.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$581.73
|
| Rate for Payer: Anthem Medicare Advantage |
$581.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.73
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$247.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.73
|
| Rate for Payer: Health EOS Commercial |
$237.55
|
| Rate for Payer: HFN Commercial |
$247.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,677.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.73
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$872.60
|
| Rate for Payer: Preferred Network Access Commercial |
$247.99
|
| Rate for Payer: Quartz Beloit One Network |
$114.86
|
| Rate for Payer: Quartz Commercial |
$148.79
|
| Rate for Payer: Quartz Medicare Advantage |
$581.73
|
| Rate for Payer: The Alliance Commercial |
$1,599.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.73
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$1,018.04
|
|
|
EO w/o joints CF L3702
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
3375561
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$1,343.56 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$1,343.56
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
EO w/o joints CF L3702
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
3375561
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
EO w/o joints CF L3702
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
3375561
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$968.50 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$335.89
|
| Rate for Payer: Anthem Medicare Advantage |
$335.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$335.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$335.89
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.89
|
| Rate for Payer: Health EOS Commercial |
$17.04
|
| Rate for Payer: HFN Commercial |
$17.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$968.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$335.89
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$503.83
|
| Rate for Payer: Preferred Network Access Commercial |
$17.78
|
| Rate for Payer: Quartz Beloit One Network |
$8.24
|
| Rate for Payer: Quartz Commercial |
$10.67
|
| Rate for Payer: Quartz Medicare Advantage |
$335.89
|
| Rate for Payer: The Alliance Commercial |
$923.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.89
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$587.81
|
|
|
EP 3-D Mapping +
|
Facility
|
IP
|
$3,021.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
4125525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,539.50 |
| Max. Negotiated Rate |
$2,890.49 |
| Rate for Payer: Aetna Commercial |
$2,827.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,701.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,665.18
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,890.49
|
| Rate for Payer: Health EOS Commercial |
$2,796.24
|
| Rate for Payer: HFN Commercial |
$2,890.49
|
| Rate for Payer: Multiplan Commercial |
$2,513.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,890.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,539.50
|
| Rate for Payer: Quartz Commercial |
$1,885.10
|
| Rate for Payer: WEA Trust Commercial |
$1,728.01
|
| Rate for Payer: WPS Commercial |
$2,327.08
|
|
|
EP 3-D Mapping +
|
Facility
|
OP
|
$3,021.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
4125525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$879.72 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$2,827.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,701.98
|
| Rate for Payer: Aetna Managed Medicare |
$879.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,665.18
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,890.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,758.22
|
| Rate for Payer: Health EOS Commercial |
$2,796.24
|
| Rate for Payer: HFN Commercial |
$2,890.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,356.38
|
| Rate for Payer: Multiplan Commercial |
$2,513.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,885.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,890.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,539.50
|
| Rate for Payer: Quartz Commercial |
$2,042.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,885.10
|
| Rate for Payer: The Alliance Commercial |
$908.17
|
| Rate for Payer: WEA Trust Commercial |
$1,728.01
|
| Rate for Payer: WPS Commercial |
$2,327.08
|
|
|
EP Ablation Addl Site +
|
Facility
|
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
3052518
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$956.18 |
| Max. Negotiated Rate |
$30,304.56 |
| Rate for Payer: Aetna Commercial |
$3,727.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,561.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,159.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,194.88
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cigna Commercial |
$3,809.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,317.52
|
| Rate for Payer: Health EOS Commercial |
$3,685.74
|
| Rate for Payer: HFN Commercial |
$3,809.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,105.96
|
| Rate for Payer: Multiplan Commercial |
$3,313.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,809.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,029.23
|
| Rate for Payer: Quartz Commercial |
$2,691.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,484.77
|
| Rate for Payer: The Alliance Commercial |
$956.18
|
| Rate for Payer: WEA Trust Commercial |
$2,277.70
|
| Rate for Payer: WPS Commercial |
$3,067.33
|
|
|
EP Ablation Addl Site +
|
Facility
|
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
3052518
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,029.23 |
| Max. Negotiated Rate |
$3,809.98 |
| Rate for Payer: Aetna Commercial |
$3,727.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,561.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,194.88
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cigna Commercial |
$3,809.98
|
| Rate for Payer: Health EOS Commercial |
$3,685.74
|
| Rate for Payer: HFN Commercial |
$3,809.98
|
| Rate for Payer: Multiplan Commercial |
$3,313.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,809.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,029.23
|
| Rate for Payer: Quartz Commercial |
$2,484.77
|
| Rate for Payer: WEA Trust Commercial |
$2,277.70
|
| Rate for Payer: WPS Commercial |
$3,067.33
|
|
|
EP AV Node Ablation W/WO Pacing
|
Facility
|
OP
|
$12,080.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
3052515
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,155.97 |
| Max. Negotiated Rate |
$32,833.13 |
| Rate for Payer: Aetna Commercial |
$11,306.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,804.35
|
| Rate for Payer: Aetna Managed Medicare |
$8,208.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,658.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,208.28
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cigna Commercial |
$11,558.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,208.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,030.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,208.28
|
| Rate for Payer: Health EOS Commercial |
$11,181.25
|
| Rate for Payer: HFN Commercial |
$11,558.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,534.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,208.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,208.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,208.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,208.28
|
| Rate for Payer: Multiplan Commercial |
$10,050.56
|
| Rate for Payer: NAPHCARE Commercial |
$12,312.42
|
| Rate for Payer: Preferred Network Access Commercial |
$11,558.14
|
| Rate for Payer: Quartz Beloit One Network |
$6,155.97
|
| Rate for Payer: Quartz Commercial |
$8,166.08
|
| Rate for Payer: Quartz Medicare Advantage |
$8,208.28
|
| Rate for Payer: The Alliance Commercial |
$32,833.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,208.28
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$6,909.76
|
| Rate for Payer: Wellcare Medicare |
$8,208.28
|
| Rate for Payer: WPS Commercial |
$9,305.22
|
|
|
EP AV Node Ablation W/WO Pacing
|
Facility
|
IP
|
$12,080.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
3052515
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,155.97 |
| Max. Negotiated Rate |
$11,558.14 |
| Rate for Payer: Aetna Commercial |
$11,306.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,804.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,658.50
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cigna Commercial |
$11,558.14
|
| Rate for Payer: Health EOS Commercial |
$11,181.25
|
| Rate for Payer: HFN Commercial |
$11,558.14
|
| Rate for Payer: Multiplan Commercial |
$10,050.56
|
| Rate for Payer: Preferred Network Access Commercial |
$11,558.14
|
| Rate for Payer: Quartz Beloit One Network |
$6,155.97
|
| Rate for Payer: Quartz Commercial |
$7,537.92
|
| Rate for Payer: WEA Trust Commercial |
$6,909.76
|
| Rate for Payer: WPS Commercial |
$9,305.22
|
|
|
EP Blazer II Small Curve 4mm
|
Facility
|
OP
|
$6,303.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,835.43 |
| Max. Negotiated Rate |
$6,030.71 |
| Rate for Payer: Aetna Commercial |
$5,899.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,637.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,835.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,260.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,277.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,146.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,474.21
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cigna Commercial |
$6,030.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,668.35
|
| Rate for Payer: Health EOS Commercial |
$5,834.06
|
| Rate for Payer: HFN Commercial |
$6,030.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,916.34
|
| Rate for Payer: Multiplan Commercial |
$5,244.10
|
| Rate for Payer: NAPHCARE Commercial |
$3,933.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,030.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,212.01
|
| Rate for Payer: Quartz Commercial |
$4,260.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3,933.07
|
| Rate for Payer: The Alliance Commercial |
$3,277.56
|
| Rate for Payer: WEA Trust Commercial |
$3,605.32
|
| Rate for Payer: WPS Commercial |
$4,855.20
|
|
|
EP Blazer II Small Curve 4mm
|
Facility
|
IP
|
$6,303.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,212.01 |
| Max. Negotiated Rate |
$6,030.71 |
| Rate for Payer: Aetna Commercial |
$5,899.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,637.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,474.21
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cigna Commercial |
$6,030.71
|
| Rate for Payer: Health EOS Commercial |
$5,834.06
|
| Rate for Payer: HFN Commercial |
$6,030.71
|
| Rate for Payer: Multiplan Commercial |
$5,244.10
|
| Rate for Payer: Preferred Network Access Commercial |
$6,030.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,212.01
|
| Rate for Payer: Quartz Commercial |
$3,933.07
|
| Rate for Payer: WEA Trust Commercial |
$3,605.32
|
| Rate for Payer: WPS Commercial |
$4,855.20
|
|
|
EP Blazer Prime STD Curve 4mm
|
Facility
|
OP
|
$6,598.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,921.34 |
| Max. Negotiated Rate |
$6,312.97 |
| Rate for Payer: Aetna Commercial |
$6,175.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,901.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,921.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,460.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,430.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,293.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,636.82
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$6,312.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,840.04
|
| Rate for Payer: Health EOS Commercial |
$6,107.11
|
| Rate for Payer: HFN Commercial |
$6,312.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,146.44
|
| Rate for Payer: Multiplan Commercial |
$5,489.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,117.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,312.97
|
| Rate for Payer: Quartz Beloit One Network |
$3,362.34
|
| Rate for Payer: Quartz Commercial |
$4,460.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,117.15
|
| Rate for Payer: The Alliance Commercial |
$3,430.96
|
| Rate for Payer: WEA Trust Commercial |
$3,774.06
|
| Rate for Payer: WPS Commercial |
$5,082.44
|
|
|
EP Blazer Prime STD Curve 4mm
|
Facility
|
IP
|
$6,598.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,362.34 |
| Max. Negotiated Rate |
$6,312.97 |
| Rate for Payer: Aetna Commercial |
$6,175.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,901.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,636.82
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$6,312.97
|
| Rate for Payer: Health EOS Commercial |
$6,107.11
|
| Rate for Payer: HFN Commercial |
$6,312.97
|
| Rate for Payer: Multiplan Commercial |
$5,489.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,312.97
|
| Rate for Payer: Quartz Beloit One Network |
$3,362.34
|
| Rate for Payer: Quartz Commercial |
$4,117.15
|
| Rate for Payer: WEA Trust Commercial |
$3,774.06
|
| Rate for Payer: WPS Commercial |
$5,082.44
|
|
|
EP Bundle of HIS Recording
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
4125702
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$964.16 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,180.61
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
EP Bundle of HIS Recording
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
4125702
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$964.16 |
| Max. Negotiated Rate |
$32,833.13 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Aetna Managed Medicare |
$8,208.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,304.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,476.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,104.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,208.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,208.28
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,208.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,208.28
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,534.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,208.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,208.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,208.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,208.28
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: NAPHCARE Commercial |
$12,312.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,278.99
|
| Rate for Payer: Quartz Medicare Advantage |
$8,208.28
|
| Rate for Payer: The Alliance Commercial |
$32,833.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,208.28
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: Wellcare Medicare |
$8,208.28
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
EPC
|
Facility
|
OP
|
$2,034.00
|
|
| Hospital Charge Code |
3075871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$592.30 |
| Max. Negotiated Rate |
$1,946.13 |
| Rate for Payer: Aetna Commercial |
$1,903.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.21
|
| Rate for Payer: Aetna Managed Medicare |
$592.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.14
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,946.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.79
|
| Rate for Payer: Health EOS Commercial |
$1,882.67
|
| Rate for Payer: HFN Commercial |
$1,946.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.52
|
| Rate for Payer: Multiplan Commercial |
$1,692.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.53
|
| Rate for Payer: Quartz Commercial |
$1,374.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.22
|
| Rate for Payer: The Alliance Commercial |
$1,057.68
|
| Rate for Payer: WEA Trust Commercial |
$1,163.45
|
| Rate for Payer: WPS Commercial |
$1,566.79
|
|
|
EPC
|
Facility
|
IP
|
$2,034.00
|
|
| Hospital Charge Code |
3075871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,036.53 |
| Max. Negotiated Rate |
$1,946.13 |
| Rate for Payer: Aetna Commercial |
$1,903.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.14
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,946.13
|
| Rate for Payer: Health EOS Commercial |
$1,882.67
|
| Rate for Payer: HFN Commercial |
$1,946.13
|
| Rate for Payer: Multiplan Commercial |
$1,692.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.53
|
| Rate for Payer: Quartz Commercial |
$1,269.22
|
| Rate for Payer: WEA Trust Commercial |
$1,163.45
|
| Rate for Payer: WPS Commercial |
$1,566.79
|
|
