|
EXERCISE STRESS TEST #91929
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
2971363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$879.30 |
| Rate for Payer: Aetna Commercial |
$860.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.55
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$879.30
|
| Rate for Payer: Health EOS Commercial |
$850.63
|
| Rate for Payer: HFN Commercial |
$879.30
|
| Rate for Payer: Multiplan Commercial |
$764.61
|
| Rate for Payer: Preferred Network Access Commercial |
$879.30
|
| Rate for Payer: Quartz Beloit One Network |
$468.32
|
| Rate for Payer: Quartz Commercial |
$573.46
|
| Rate for Payer: WEA Trust Commercial |
$525.67
|
| Rate for Payer: WPS Commercial |
$707.91
|
|
|
EXERCISE STRESS TEST #91929
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
2971363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.61 |
| Max. Negotiated Rate |
$879.30 |
| Rate for Payer: Aetna Commercial |
$860.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.95
|
| Rate for Payer: Aetna Managed Medicare |
$267.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$621.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.55
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$879.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.86
|
| Rate for Payer: Health EOS Commercial |
$850.63
|
| Rate for Payer: HFN Commercial |
$879.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.82
|
| Rate for Payer: Multiplan Commercial |
$764.61
|
| Rate for Payer: NAPHCARE Commercial |
$573.46
|
| Rate for Payer: Preferred Network Access Commercial |
$879.30
|
| Rate for Payer: Quartz Beloit One Network |
$468.32
|
| Rate for Payer: Quartz Commercial |
$621.24
|
| Rate for Payer: Quartz Medicare Advantage |
$573.46
|
| Rate for Payer: The Alliance Commercial |
$477.88
|
| Rate for Payer: WEA Trust Commercial |
$525.67
|
| Rate for Payer: WPS Commercial |
$707.91
|
|
|
Exercise Test for Bronchospasm - Pulmonary Function Test Charge
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
5381708
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$567.09
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$767.94
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$886.08
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
|
Exercise Test for Bronchospasm - Pulmonary Function Test Charge
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 94617
|
| Hospital Charge Code |
5381708
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$578.91 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$708.86
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
|
Exercise Tolerance Test; Physician Supervise W/o Interpretation & Report
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 93016
|
| Hospital Charge Code |
1188829
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$203.53 |
| Rate for Payer: Aetna Commercial |
$203.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.25
|
| Rate for Payer: Aetna Managed Medicare |
$21.05
|
| Rate for Payer: Anthem Medicare Advantage |
$21.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.05
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$203.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$194.96
|
| Rate for Payer: HFN Commercial |
$203.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$171.39
|
| Rate for Payer: NAPHCARE Commercial |
$31.57
|
| Rate for Payer: Preferred Network Access Commercial |
$203.53
|
| Rate for Payer: Quartz Beloit One Network |
$94.27
|
| Rate for Payer: Quartz Commercial |
$122.12
|
| Rate for Payer: Quartz Medicare Advantage |
$21.05
|
| Rate for Payer: The Alliance Commercial |
$79.99
|
| Rate for Payer: United Healthcare Medicaid |
$24.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.05
|
| Rate for Payer: WEA Trust Commercial |
$117.83
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
EXERCISE TOLERANCE TESTS
|
Facility
|
OP
|
$119.24
|
|
|
Service Code
|
EAPG 00080
|
| Min. Negotiated Rate |
$114.65 |
| Max. Negotiated Rate |
$119.24 |
| Rate for Payer: Anthem Medicaid |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$114.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.65
|
| Rate for Payer: Dean Health Medicaid |
$114.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$114.65
|
| Rate for Payer: Managed Health Services Medicaid |
$119.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$114.65
|
| Rate for Payer: United Healthcare Medicaid |
$114.65
|
|
|
EXOSTECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
EXOSTECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
EXPANDED HOURS ACCESS
|
Facility
|
OP
|
$10.48
|
|
|
Service Code
|
EAPG 00448
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Anthem Medicaid |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.08
|
| Rate for Payer: Dean Health Medicaid |
$10.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.08
|
| Rate for Payer: Managed Health Services Medicaid |
$10.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$10.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.08
|
| Rate for Payer: United Healthcare Medicaid |
$10.08
|
|
|
EXPANDER 450CC CONTOUR PROFILE
|
Facility
|
IP
|
$8,694.00
|
|
| Hospital Charge Code |
2965393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,430.46 |
| Max. Negotiated Rate |
$8,318.42 |
| Rate for Payer: Aetna Commercial |
$8,137.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,775.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.13
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: Cigna Commercial |
$8,318.42
|
| Rate for Payer: Health EOS Commercial |
$8,047.17
|
| Rate for Payer: HFN Commercial |
$8,318.42
|
| Rate for Payer: Multiplan Commercial |
$7,233.41
|
| Rate for Payer: Preferred Network Access Commercial |
$8,318.42
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.46
|
| Rate for Payer: Quartz Commercial |
$5,425.06
|
| Rate for Payer: WEA Trust Commercial |
$4,972.97
|
| Rate for Payer: WPS Commercial |
$6,696.99
|
|
|
EXPANDER 450CC CONTOUR PROFILE
|
Facility
|
OP
|
$8,694.00
|
|
| Hospital Charge Code |
2965393
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,531.69 |
| Max. Negotiated Rate |
$8,318.42 |
| Rate for Payer: Aetna Commercial |
$8,137.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,775.91
|
| Rate for Payer: Aetna Managed Medicare |
$2,531.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,877.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,520.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,340.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,792.13
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: Cigna Commercial |
$8,318.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,059.91
|
| Rate for Payer: Health EOS Commercial |
$8,047.17
|
| Rate for Payer: HFN Commercial |
$8,318.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,781.32
|
| Rate for Payer: Multiplan Commercial |
$7,233.41
|
| Rate for Payer: NAPHCARE Commercial |
$5,425.06
|
| Rate for Payer: Preferred Network Access Commercial |
$8,318.42
|
| Rate for Payer: Quartz Beloit One Network |
$4,430.46
|
| Rate for Payer: Quartz Commercial |
$5,877.14
|
| Rate for Payer: Quartz Medicare Advantage |
$5,425.06
|
| Rate for Payer: The Alliance Commercial |
$4,520.88
|
| Rate for Payer: WEA Trust Commercial |
$4,972.97
|
| Rate for Payer: WPS Commercial |
$6,696.99
|
|
|
EXPANULA WITH NO-SQUIRT CAP AR-6569
|
Facility
|
OP
|
$860.00
|
|
| Hospital Charge Code |
5767653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.43 |
| Max. Negotiated Rate |
$822.85 |
| Rate for Payer: Aetna Commercial |
$804.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$769.18
|
| Rate for Payer: Aetna Managed Medicare |
$250.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$581.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.03
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$822.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$500.52
|
| Rate for Payer: Health EOS Commercial |
$796.02
|
| Rate for Payer: HFN Commercial |
$822.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$670.80
|
| Rate for Payer: Multiplan Commercial |
$715.52
|
| Rate for Payer: NAPHCARE Commercial |
$536.64
|
| Rate for Payer: Preferred Network Access Commercial |
$822.85
|
| Rate for Payer: Quartz Beloit One Network |
$438.26
|
| Rate for Payer: Quartz Commercial |
$581.36
|
| Rate for Payer: Quartz Medicare Advantage |
$536.64
|
| Rate for Payer: The Alliance Commercial |
$447.20
|
| Rate for Payer: WEA Trust Commercial |
$491.92
|
| Rate for Payer: WPS Commercial |
$662.46
|
|
|
EXPANULA WITH NO-SQUIRT CAP AR-6569
|
Facility
|
IP
|
$860.00
|
|
| Hospital Charge Code |
5767653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.26 |
| Max. Negotiated Rate |
$822.85 |
| Rate for Payer: Aetna Commercial |
$804.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$769.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.03
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$822.85
|
| Rate for Payer: Health EOS Commercial |
$796.02
|
| Rate for Payer: HFN Commercial |
$822.85
|
| Rate for Payer: Multiplan Commercial |
$715.52
|
| Rate for Payer: Preferred Network Access Commercial |
$822.85
|
| Rate for Payer: Quartz Beloit One Network |
$438.26
|
| Rate for Payer: Quartz Commercial |
$536.64
|
| Rate for Payer: WEA Trust Commercial |
$491.92
|
| Rate for Payer: WPS Commercial |
$662.46
|
|
|
Exparel (Bupivacaine Liposome) 20 ml (MED)
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4594739
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$260.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$447.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.47
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.88
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$605.70
|
| Rate for Payer: Quartz Medicare Advantage |
$559.10
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
Exparel (Bupivacaine Liposome) 20 ml (MED)
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
4594739
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$456.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$559.10
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
EXPLORATION, MAXILLARY SINUS 31020
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
CPT 31020
|
| Hospital Charge Code |
3014368
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,448.09 |
| Rate for Payer: Aetna Commercial |
$658.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.67
|
| Rate for Payer: Aetna Managed Medicare |
$321.80
|
| Rate for Payer: Anthem Medicare Advantage |
$321.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$321.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$321.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cash Price |
$199.80
|
| Rate for Payer: Cigna Commercial |
$658.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.80
|
| Rate for Payer: Health EOS Commercial |
$630.30
|
| Rate for Payer: HFN Commercial |
$658.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,373.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,373.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$321.80
|
| Rate for Payer: Multiplan Commercial |
$554.11
|
| Rate for Payer: NAPHCARE Commercial |
$482.70
|
| Rate for Payer: Preferred Network Access Commercial |
$658.01
|
| Rate for Payer: Quartz Beloit One Network |
$304.76
|
| Rate for Payer: Quartz Commercial |
$394.80
|
| Rate for Payer: Quartz Medicare Advantage |
$321.80
|
| Rate for Payer: The Alliance Commercial |
$1,367.64
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.80
|
| Rate for Payer: WEA Trust Commercial |
$380.95
|
| Rate for Payer: WPS Commercial |
$1,448.09
|
|
|
EXPLORATION, MAXILLARY SINUS 31030
|
Professional
|
Both
|
$2,810.00
|
|
|
Service Code
|
CPT 31030
|
| Hospital Charge Code |
3014369
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$463.49 |
| Max. Negotiated Rate |
$2,776.28 |
| Rate for Payer: Aetna Commercial |
$2,776.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,513.26
|
| Rate for Payer: Aetna Managed Medicare |
$463.49
|
| Rate for Payer: Anthem Medicare Advantage |
$463.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$463.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$463.49
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cash Price |
$843.00
|
| Rate for Payer: Cigna Commercial |
$2,776.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$783.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.49
|
| Rate for Payer: Health EOS Commercial |
$2,659.38
|
| Rate for Payer: HFN Commercial |
$2,776.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,818.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,818.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$463.49
|
| Rate for Payer: Multiplan Commercial |
$2,337.92
|
| Rate for Payer: NAPHCARE Commercial |
$695.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,776.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.86
|
| Rate for Payer: Quartz Commercial |
$1,665.77
|
| Rate for Payer: Quartz Medicare Advantage |
$463.49
|
| Rate for Payer: The Alliance Commercial |
$1,969.82
|
| Rate for Payer: United Healthcare Medicaid |
$783.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$463.49
|
| Rate for Payer: WEA Trust Commercial |
$1,607.32
|
| Rate for Payer: WPS Commercial |
$2,085.69
|
|
|
EXPLORATION OF FOOT JOINT 28020
|
Professional
|
Both
|
$2,274.00
|
|
|
Service Code
|
CPT 28020
|
| Hospital Charge Code |
3014181
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$341.27 |
| Max. Negotiated Rate |
$2,246.71 |
| Rate for Payer: Aetna Commercial |
$2,246.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,033.87
|
| Rate for Payer: Aetna Managed Medicare |
$341.27
|
| Rate for Payer: Anthem Medicare Advantage |
$341.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$341.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$341.27
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cigna Commercial |
$2,246.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.27
|
| Rate for Payer: Health EOS Commercial |
$2,152.11
|
| Rate for Payer: HFN Commercial |
$2,246.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,277.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,277.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$341.27
|
| Rate for Payer: Multiplan Commercial |
$1,891.97
|
| Rate for Payer: NAPHCARE Commercial |
$511.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,040.58
|
| Rate for Payer: Quartz Commercial |
$1,348.03
|
| Rate for Payer: Quartz Medicare Advantage |
$341.27
|
| Rate for Payer: The Alliance Commercial |
$1,450.38
|
| Rate for Payer: United Healthcare Medicaid |
$470.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.27
|
| Rate for Payer: WEA Trust Commercial |
$1,300.73
|
| Rate for Payer: WPS Commercial |
$1,535.70
|
|
|
EXPLORATION OF FOOT JOINT 28022
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
CPT 28022
|
| Hospital Charge Code |
3014182
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.02 |
| Max. Negotiated Rate |
$1,382.57 |
| Rate for Payer: Aetna Commercial |
$1,134.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,026.77
|
| Rate for Payer: Aetna Managed Medicare |
$307.24
|
| Rate for Payer: Anthem Medicare Advantage |
$307.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$307.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$307.24
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,134.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.24
|
| Rate for Payer: Health EOS Commercial |
$1,086.47
|
| Rate for Payer: HFN Commercial |
$1,134.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,141.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$307.24
|
| Rate for Payer: Multiplan Commercial |
$955.14
|
| Rate for Payer: NAPHCARE Commercial |
$460.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.22
|
| Rate for Payer: Quartz Beloit One Network |
$525.32
|
| Rate for Payer: Quartz Commercial |
$680.53
|
| Rate for Payer: Quartz Medicare Advantage |
$307.24
|
| Rate for Payer: The Alliance Commercial |
$1,305.76
|
| Rate for Payer: United Healthcare Medicaid |
$282.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.24
|
| Rate for Payer: WEA Trust Commercial |
$656.66
|
| Rate for Payer: WPS Commercial |
$1,382.57
|
|
|
EXPLORATION OF TOE JOINT 28024
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
CPT 28024
|
| Hospital Charge Code |
3014183
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.69 |
| Max. Negotiated Rate |
$1,314.94 |
| Rate for Payer: Aetna Commercial |
$1,103.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.04
|
| Rate for Payer: Aetna Managed Medicare |
$292.21
|
| Rate for Payer: Anthem Medicare Advantage |
$292.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.21
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cash Price |
$335.10
|
| Rate for Payer: Cigna Commercial |
$1,103.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.21
|
| Rate for Payer: Health EOS Commercial |
$1,057.13
|
| Rate for Payer: HFN Commercial |
$1,103.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,065.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,065.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.21
|
| Rate for Payer: Multiplan Commercial |
$929.34
|
| Rate for Payer: NAPHCARE Commercial |
$438.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.60
|
| Rate for Payer: Quartz Beloit One Network |
$511.14
|
| Rate for Payer: Quartz Commercial |
$662.16
|
| Rate for Payer: Quartz Medicare Advantage |
$292.21
|
| Rate for Payer: The Alliance Commercial |
$1,241.89
|
| Rate for Payer: United Healthcare Medicaid |
$203.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.21
|
| Rate for Payer: WEA Trust Commercial |
$638.92
|
| Rate for Payer: WPS Commercial |
$1,314.94
|
|
|
EXPLORE/IRRIGATE TEAR DUCTS 68840
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
CPT 68840
|
| Hospital Charge Code |
3015260
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.39 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| Rate for Payer: Aetna Managed Medicare |
$103.98
|
| Rate for Payer: Anthem Medicare Advantage |
$103.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.98
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$535.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.98
|
| Rate for Payer: Health EOS Commercial |
$512.95
|
| Rate for Payer: HFN Commercial |
$535.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$408.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.98
|
| Rate for Payer: Multiplan Commercial |
$450.94
|
| Rate for Payer: NAPHCARE Commercial |
$155.97
|
| Rate for Payer: Preferred Network Access Commercial |
$535.50
|
| Rate for Payer: Quartz Beloit One Network |
$248.02
|
| Rate for Payer: Quartz Commercial |
$321.30
|
| Rate for Payer: Quartz Medicare Advantage |
$103.98
|
| Rate for Payer: The Alliance Commercial |
$441.91
|
| Rate for Payer: United Healthcare Medicaid |
$66.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.98
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: WPS Commercial |
$467.91
|
|
|
EXPLORE WOUND, ABDOMEN 20102
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
CPT 20102
|
| Hospital Charge Code |
3013702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$227.57 |
| Max. Negotiated Rate |
$1,794.21 |
| Rate for Payer: Aetna Commercial |
$1,794.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.23
|
| Rate for Payer: Aetna Managed Medicare |
$227.57
|
| Rate for Payer: Anthem Medicare Advantage |
$227.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.57
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cigna Commercial |
$1,794.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.57
|
| Rate for Payer: Health EOS Commercial |
$1,718.66
|
| Rate for Payer: HFN Commercial |
$1,794.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$862.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$862.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.57
|
| Rate for Payer: Multiplan Commercial |
$1,510.91
|
| Rate for Payer: NAPHCARE Commercial |
$341.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.21
|
| Rate for Payer: Quartz Beloit One Network |
$831.00
|
| Rate for Payer: Quartz Commercial |
$1,076.52
|
| Rate for Payer: Quartz Medicare Advantage |
$227.57
|
| Rate for Payer: The Alliance Commercial |
$967.18
|
| Rate for Payer: United Healthcare Medicaid |
$254.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.57
|
| Rate for Payer: WEA Trust Commercial |
$1,038.75
|
| Rate for Payer: WPS Commercial |
$1,024.08
|
|
|
EXPLORE WOUND, CHEST 20101
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 20101
|
| Hospital Charge Code |
3013701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.63 |
| Max. Negotiated Rate |
$2,553.98 |
| Rate for Payer: Aetna Commercial |
$2,553.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$186.63
|
| Rate for Payer: Anthem Medicare Advantage |
$186.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$186.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$186.63
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,553.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.63
|
| Rate for Payer: Health EOS Commercial |
$2,446.44
|
| Rate for Payer: HFN Commercial |
$2,553.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$708.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$708.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$186.63
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$279.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.90
|
| Rate for Payer: Quartz Commercial |
$1,532.39
|
| Rate for Payer: Quartz Medicare Advantage |
$186.63
|
| Rate for Payer: The Alliance Commercial |
$793.17
|
| Rate for Payer: United Healthcare Medicaid |
$207.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.63
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$839.83
|
|
|
EXPLORE WOUND, EXTREMITY 20103
|
Professional
|
Both
|
$2,392.00
|
|
|
Service Code
|
CPT 20103
|
| Hospital Charge Code |
3013703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$299.82 |
| Max. Negotiated Rate |
$2,363.30 |
| Rate for Payer: Aetna Commercial |
$2,363.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,139.40
|
| Rate for Payer: Aetna Managed Medicare |
$299.82
|
| Rate for Payer: Anthem Medicare Advantage |
$299.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$299.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$299.82
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cigna Commercial |
$2,363.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$342.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.82
|
| Rate for Payer: Health EOS Commercial |
$2,263.79
|
| Rate for Payer: HFN Commercial |
$2,363.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,185.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,185.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$299.82
|
| Rate for Payer: Multiplan Commercial |
$1,990.14
|
| Rate for Payer: NAPHCARE Commercial |
$449.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,363.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,094.58
|
| Rate for Payer: Quartz Commercial |
$1,417.98
|
| Rate for Payer: Quartz Medicare Advantage |
$299.82
|
| Rate for Payer: The Alliance Commercial |
$1,274.24
|
| Rate for Payer: United Healthcare Medicaid |
$342.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$299.82
|
| Rate for Payer: WEA Trust Commercial |
$1,368.22
|
| Rate for Payer: WPS Commercial |
$1,349.20
|
|
|
Export Aspiration 6Fr
|
Facility
|
IP
|
$5,768.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2549084
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,939.37 |
| Max. Negotiated Rate |
$5,518.82 |
| Rate for Payer: Aetna Commercial |
$5,398.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,158.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,179.32
|
| Rate for Payer: Cash Price |
$1,730.40
|
| Rate for Payer: Cigna Commercial |
$5,518.82
|
| Rate for Payer: Health EOS Commercial |
$5,338.86
|
| Rate for Payer: HFN Commercial |
$5,518.82
|
| Rate for Payer: Multiplan Commercial |
$4,798.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,518.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,939.37
|
| Rate for Payer: Quartz Commercial |
$3,599.23
|
| Rate for Payer: WEA Trust Commercial |
$3,299.30
|
| Rate for Payer: WPS Commercial |
$4,443.09
|
|
