|
EXCISOR FISCHER CONE BIOPSY MEDIUM 900-151
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
5591349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$127.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.86
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$272.69
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| Rate for Payer: Quartz Medicare Advantage |
$272.69
|
| Rate for Payer: The Alliance Commercial |
$227.24
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
EXCISOR FISCHER CONE BIOPSY MEDIUM 900-151
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
5591349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
EXCISOR FISCHER CONE BIOPSY SMALL 900-150
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
5591348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
EXCISOR FISCHER CONE BIOPSY SMALL 900-150
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
5591348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$127.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.86
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$272.69
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| Rate for Payer: Quartz Medicare Advantage |
$272.69
|
| Rate for Payer: The Alliance Commercial |
$227.24
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
EXC, TUMOR, SOFT TIS, NECK OR AN THOR 3cm OR GREAT 21552
|
Professional
|
Both
|
$2,516.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
3013737
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$2,485.81 |
| Rate for Payer: Aetna Commercial |
$2,485.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,250.31
|
| Rate for Payer: Aetna Managed Medicare |
$402.99
|
| Rate for Payer: Anthem Medicare Advantage |
$402.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$402.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$402.99
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,485.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.99
|
| Rate for Payer: Health EOS Commercial |
$2,381.14
|
| Rate for Payer: HFN Commercial |
$2,485.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,518.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$402.99
|
| Rate for Payer: Multiplan Commercial |
$2,093.31
|
| Rate for Payer: NAPHCARE Commercial |
$604.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,151.32
|
| Rate for Payer: Quartz Commercial |
$1,491.48
|
| Rate for Payer: Quartz Medicare Advantage |
$402.99
|
| Rate for Payer: The Alliance Commercial |
$1,712.71
|
| Rate for Payer: United Healthcare Medicaid |
$376.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$402.99
|
| Rate for Payer: WEA Trust Commercial |
$1,439.15
|
| Rate for Payer: WPS Commercial |
$1,813.45
|
|
|
EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM 21013
|
Professional
|
Both
|
$1,778.00
|
|
|
Service Code
|
CPT 21013
|
| Hospital Charge Code |
6178395
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$355.96 |
| Max. Negotiated Rate |
$1,756.66 |
| Rate for Payer: Aetna Commercial |
$1,756.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,590.24
|
| Rate for Payer: Aetna Managed Medicare |
$355.96
|
| Rate for Payer: Anthem Medicare Advantage |
$355.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.96
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,756.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$412.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.96
|
| Rate for Payer: Health EOS Commercial |
$1,682.70
|
| Rate for Payer: HFN Commercial |
$1,756.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,382.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,382.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.96
|
| Rate for Payer: Multiplan Commercial |
$1,479.30
|
| Rate for Payer: NAPHCARE Commercial |
$533.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,756.66
|
| Rate for Payer: Quartz Beloit One Network |
$813.61
|
| Rate for Payer: Quartz Commercial |
$1,054.00
|
| Rate for Payer: Quartz Medicare Advantage |
$355.96
|
| Rate for Payer: The Alliance Commercial |
$1,512.83
|
| Rate for Payer: United Healthcare Medicaid |
$412.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.96
|
| Rate for Payer: WEA Trust Commercial |
$1,017.02
|
| Rate for Payer: WPS Commercial |
$1,601.82
|
|
|
EXERCISE BAND LF 4INX50 BLUE #5613-18
|
Facility
|
OP
|
$1,282.00
|
|
| Hospital Charge Code |
2974095
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$373.32 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$373.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$866.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.96
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$799.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$866.63
|
| Rate for Payer: Quartz Medicare Advantage |
$799.97
|
| Rate for Payer: The Alliance Commercial |
$666.64
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
EXERCISE BAND LF 4INX50 BLUE #5613-18
|
Facility
|
IP
|
$1,282.00
|
|
| Hospital Charge Code |
2974095
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$653.31 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$799.97
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
EXERCISE BAND LF 4INX50 GREEN #5613-17
|
Facility
|
IP
|
$1,051.00
|
|
| Hospital Charge Code |
2971970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$535.59 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$655.82
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
EXERCISE BAND LF 4INX50 GREEN #5613-17
|
Facility
|
OP
|
$1,051.00
|
|
| Hospital Charge Code |
2971970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$306.05 |
| Max. Negotiated Rate |
$1,005.60 |
| Rate for Payer: Aetna Commercial |
$983.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.01
|
| Rate for Payer: Aetna Managed Medicare |
$306.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$710.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$524.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.31
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$1,005.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$611.68
|
| Rate for Payer: Health EOS Commercial |
$972.81
|
| Rate for Payer: HFN Commercial |
$1,005.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.78
|
| Rate for Payer: Multiplan Commercial |
$874.43
|
| Rate for Payer: NAPHCARE Commercial |
$655.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.60
|
| Rate for Payer: Quartz Beloit One Network |
$535.59
|
| Rate for Payer: Quartz Commercial |
$710.48
|
| Rate for Payer: Quartz Medicare Advantage |
$655.82
|
| Rate for Payer: The Alliance Commercial |
$546.52
|
| Rate for Payer: WEA Trust Commercial |
$601.17
|
| Rate for Payer: WPS Commercial |
$809.59
|
|
|
EXERCISE BAND LF 4INX50 ORANGE #5613-16
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
2972127
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$624.77 |
| Max. Negotiated Rate |
$1,173.04 |
| Rate for Payer: Aetna Commercial |
$1,147.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.77
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,173.04
|
| Rate for Payer: Health EOS Commercial |
$1,134.79
|
| Rate for Payer: HFN Commercial |
$1,173.04
|
| Rate for Payer: Multiplan Commercial |
$1,020.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$624.77
|
| Rate for Payer: Quartz Commercial |
$765.02
|
| Rate for Payer: WEA Trust Commercial |
$701.27
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
EXERCISE BAND LF 4INX50 ORANGE #5613-16
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
2972127
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$357.01 |
| Max. Negotiated Rate |
$1,173.04 |
| Rate for Payer: Aetna Commercial |
$1,147.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.53
|
| Rate for Payer: Aetna Managed Medicare |
$357.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.77
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,173.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$713.53
|
| Rate for Payer: Health EOS Commercial |
$1,134.79
|
| Rate for Payer: HFN Commercial |
$1,173.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$956.28
|
| Rate for Payer: Multiplan Commercial |
$1,020.03
|
| Rate for Payer: NAPHCARE Commercial |
$765.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$624.77
|
| Rate for Payer: Quartz Commercial |
$828.78
|
| Rate for Payer: Quartz Medicare Advantage |
$765.02
|
| Rate for Payer: The Alliance Commercial |
$637.52
|
| Rate for Payer: WEA Trust Commercial |
$701.27
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
EXERCISE BAND LF 4INX50 PEACH #5613-15
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
2972194
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$573.30 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,006.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$620.10
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$1,076.40
|
| Rate for Payer: Health EOS Commercial |
$1,041.30
|
| Rate for Payer: HFN Commercial |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,076.40
|
| Rate for Payer: Quartz Beloit One Network |
$573.30
|
| Rate for Payer: Quartz Commercial |
$702.00
|
| Rate for Payer: WEA Trust Commercial |
$643.50
|
| Rate for Payer: WPS Commercial |
$866.59
|
|
|
EXERCISE BAND LF 4INX50 PEACH #5613-15
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
2972194
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,006.20
|
| Rate for Payer: Aetna Managed Medicare |
$327.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$760.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$561.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$620.10
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$1,076.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$654.75
|
| Rate for Payer: Health EOS Commercial |
$1,041.30
|
| Rate for Payer: HFN Commercial |
$1,076.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$877.50
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: NAPHCARE Commercial |
$702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,076.40
|
| Rate for Payer: Quartz Beloit One Network |
$573.30
|
| Rate for Payer: Quartz Commercial |
$760.50
|
| Rate for Payer: Quartz Medicare Advantage |
$702.00
|
| Rate for Payer: The Alliance Commercial |
$585.00
|
| Rate for Payer: WEA Trust Commercial |
$643.50
|
| Rate for Payer: WPS Commercial |
$866.59
|
|
|
EXERCISE BAND LF 4INX50 PLUM #5613-19
|
Facility
|
OP
|
$1,685.00
|
|
| Hospital Charge Code |
2972621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$490.67 |
| Max. Negotiated Rate |
$1,612.21 |
| Rate for Payer: Aetna Commercial |
$1,577.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.06
|
| Rate for Payer: Aetna Managed Medicare |
$490.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.77
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,612.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.67
|
| Rate for Payer: Health EOS Commercial |
$1,559.64
|
| Rate for Payer: HFN Commercial |
$1,612.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.30
|
| Rate for Payer: Multiplan Commercial |
$1,401.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.21
|
| Rate for Payer: Quartz Beloit One Network |
$858.68
|
| Rate for Payer: Quartz Commercial |
$1,139.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.44
|
| Rate for Payer: The Alliance Commercial |
$876.20
|
| Rate for Payer: WEA Trust Commercial |
$963.82
|
| Rate for Payer: WPS Commercial |
$1,297.96
|
|
|
EXERCISE BAND LF 4INX50 PLUM #5613-19
|
Facility
|
IP
|
$1,685.00
|
|
| Hospital Charge Code |
2972621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$858.68 |
| Max. Negotiated Rate |
$1,612.21 |
| Rate for Payer: Aetna Commercial |
$1,577.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.77
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,612.21
|
| Rate for Payer: Health EOS Commercial |
$1,559.64
|
| Rate for Payer: HFN Commercial |
$1,612.21
|
| Rate for Payer: Multiplan Commercial |
$1,401.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.21
|
| Rate for Payer: Quartz Beloit One Network |
$858.68
|
| Rate for Payer: Quartz Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$963.82
|
| Rate for Payer: WPS Commercial |
$1,297.96
|
|
|
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
|
$36.85
|
|
|
Service Code
|
EAPG 00080
|
| Min. Negotiated Rate |
$35.43 |
| Max. Negotiated Rate |
$36.85 |
| Rate for Payer: Anthem Medicaid |
$35.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.43
|
| Rate for Payer: Dean Health Medicaid |
$35.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.43
|
| Rate for Payer: Managed Health Services Medicaid |
$36.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.43
|
| Rate for Payer: United Healthcare Medicaid |
$35.43
|
|
|
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
|
$8.79
|
|
|
Service Code
|
EAPG 00448
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.79 |
| Rate for Payer: Anthem Medicaid |
$8.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.45
|
| Rate for Payer: Dean Health Medicaid |
$8.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.45
|
| Rate for Payer: United Healthcare Medicaid |
$8.45
|
|
