|
EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 1.5 CM
|
Facility
|
OP
|
$6,409.96
|
|
|
Service Code
|
CPT 26116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
|
|
EXCISOR FISCHER CONE BIOPSY LARGE 900-152
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
5591350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.13 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
EXCISOR FISCHER CONE BIOPSY LARGE 900-152
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
5591350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.55
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$284.05
|
| Rate for Payer: Quartz Medicare Advantage |
$262.20
|
| Rate for Payer: The Alliance Commercial |
$1,748.00
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
EXCISOR FISCHER CONE BIOPSY MEDIUM 900-151
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
5591349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.13 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
EXCISOR FISCHER CONE BIOPSY MEDIUM 900-151
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
5591349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.55
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$284.05
|
| Rate for Payer: Quartz Medicare Advantage |
$262.20
|
| Rate for Payer: The Alliance Commercial |
$1,748.00
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
EXCISOR FISCHER CONE BIOPSY SMALL 900-150
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
5591348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.13 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
EXCISOR FISCHER CONE BIOPSY SMALL 900-150
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
5591348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$1,748.00 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.55
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$284.05
|
| Rate for Payer: Quartz Medicare Advantage |
$262.20
|
| Rate for Payer: The Alliance Commercial |
$1,748.00
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
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 |
$361.92 |
| Max. Negotiated Rate |
$2,390.20 |
| Rate for Payer: Aetna Commercial |
$2,390.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,163.76
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cash Price |
$754.80
|
| Rate for Payer: Cigna Commercial |
$2,390.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,509.60
|
| Rate for Payer: Health EOS Commercial |
$2,289.56
|
| Rate for Payer: HFN Commercial |
$2,390.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,460.26
|
| Rate for Payer: Multiplan Commercial |
$2,012.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.04
|
| Rate for Payer: Quartz Commercial |
$1,434.12
|
| Rate for Payer: The Alliance Commercial |
$1,258.00
|
| Rate for Payer: United Healthcare Medicaid |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$1,383.80
|
| Rate for Payer: WPS Commercial |
$1,863.60
|
|
|
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 |
$396.31 |
| Max. Negotiated Rate |
$1,689.10 |
| Rate for Payer: Aetna Commercial |
$1,689.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,529.08
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cash Price |
$533.40
|
| Rate for Payer: Cigna Commercial |
$1,689.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$396.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,066.80
|
| Rate for Payer: Health EOS Commercial |
$1,617.98
|
| Rate for Payer: HFN Commercial |
$1,689.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,329.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,329.57
|
| Rate for Payer: Multiplan Commercial |
$1,422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,689.10
|
| Rate for Payer: Quartz Beloit One Network |
$782.32
|
| Rate for Payer: Quartz Commercial |
$1,013.46
|
| Rate for Payer: The Alliance Commercial |
$889.00
|
| Rate for Payer: United Healthcare Medicaid |
$396.31
|
| Rate for Payer: WEA Trust Commercial |
$977.90
|
| Rate for Payer: WPS Commercial |
$1,316.96
|
|
|
EXERCISE BAND LF 4INX50 BLUE #5613-18
|
Facility
|
IP
|
$1,282.00
|
|
| Hospital Charge Code |
2974095
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$1,179.44 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$769.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
EXERCISE BAND LF 4INX50 BLUE #5613-18
|
Facility
|
OP
|
$1,282.00
|
|
| Hospital Charge Code |
2974095
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,128.00 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Aetna Managed Medicare |
$358.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.41
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.50
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$833.30
|
| Rate for Payer: Quartz Medicare Advantage |
$769.20
|
| Rate for Payer: The Alliance Commercial |
$5,128.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
EXERCISE BAND LF 4INX50 GREEN #5613-17
|
Facility
|
OP
|
$1,051.00
|
|
| Hospital Charge Code |
2971970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$294.28 |
| Max. Negotiated Rate |
$4,204.00 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.86
|
| Rate for Payer: Aetna Managed Medicare |
$294.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$683.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.03
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$966.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.14
|
| Rate for Payer: Health EOS Commercial |
$935.39
|
| Rate for Payer: HFN Commercial |
$966.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.25
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: NAPHCARE Commercial |
$630.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.92
|
| Rate for Payer: Quartz Beloit One Network |
$514.99
|
| Rate for Payer: Quartz Commercial |
$683.15
|
| Rate for Payer: Quartz Medicare Advantage |
$630.60
|
| Rate for Payer: The Alliance Commercial |
$4,204.00
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
EXERCISE BAND LF 4INX50 GREEN #5613-17
|
Facility
|
IP
|
$1,051.00
|
|
| Hospital Charge Code |
2971970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$514.99 |
| Max. Negotiated Rate |
$966.92 |
| Rate for Payer: Aetna Commercial |
$945.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$903.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.03
|
| Rate for Payer: Cash Price |
$315.30
|
| Rate for Payer: Cigna Commercial |
$966.92
|
| Rate for Payer: Health EOS Commercial |
$935.39
|
| Rate for Payer: HFN Commercial |
$966.92
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: NAPHCARE Commercial |
$630.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.92
|
| Rate for Payer: Quartz Beloit One Network |
$514.99
|
| Rate for Payer: Quartz Commercial |
$630.60
|
| Rate for Payer: WEA Trust Commercial |
$578.05
|
| Rate for Payer: WPS Commercial |
$778.48
|
|
|
EXERCISE BAND LF 4INX50 ORANGE #5613-16
|
Facility
|
IP
|
$1,226.00
|
|
| Hospital Charge Code |
2972127
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$600.74 |
| Max. Negotiated Rate |
$1,127.92 |
| Rate for Payer: Aetna Commercial |
$1,103.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.78
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,127.92
|
| Rate for Payer: Health EOS Commercial |
$1,091.14
|
| Rate for Payer: HFN Commercial |
$1,127.92
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: NAPHCARE Commercial |
$735.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.92
|
| Rate for Payer: Quartz Beloit One Network |
$600.74
|
| Rate for Payer: Quartz Commercial |
$735.60
|
| Rate for Payer: WEA Trust Commercial |
$674.30
|
| Rate for Payer: WPS Commercial |
$908.10
|
|
|
EXERCISE BAND LF 4INX50 ORANGE #5613-16
|
Facility
|
OP
|
$1,226.00
|
|
| Hospital Charge Code |
2972127
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$343.28 |
| Max. Negotiated Rate |
$4,904.00 |
| Rate for Payer: Aetna Commercial |
$1,103.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.36
|
| Rate for Payer: Aetna Managed Medicare |
$343.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$796.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.78
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cigna Commercial |
$1,127.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.07
|
| Rate for Payer: Health EOS Commercial |
$1,091.14
|
| Rate for Payer: HFN Commercial |
$1,127.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$919.50
|
| Rate for Payer: Multiplan Commercial |
$980.80
|
| Rate for Payer: NAPHCARE Commercial |
$735.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.92
|
| Rate for Payer: Quartz Beloit One Network |
$600.74
|
| Rate for Payer: Quartz Commercial |
$796.90
|
| Rate for Payer: Quartz Medicare Advantage |
$735.60
|
| Rate for Payer: The Alliance Commercial |
$4,904.00
|
| Rate for Payer: WEA Trust Commercial |
$674.30
|
| Rate for Payer: WPS Commercial |
$908.10
|
|
|
EXERCISE BAND LF 4INX50 PEACH #5613-15
|
Facility
|
OP
|
$1,125.00
|
|
| Hospital Charge Code |
2972194
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$1,012.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.50
|
| Rate for Payer: Aetna Managed Medicare |
$315.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$731.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$1,035.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.55
|
| Rate for Payer: Health EOS Commercial |
$1,001.25
|
| Rate for Payer: HFN Commercial |
$1,035.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.75
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: NAPHCARE Commercial |
$675.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.00
|
| Rate for Payer: Quartz Beloit One Network |
$551.25
|
| Rate for Payer: Quartz Commercial |
$731.25
|
| Rate for Payer: Quartz Medicare Advantage |
$675.00
|
| Rate for Payer: The Alliance Commercial |
$4,500.00
|
| Rate for Payer: WEA Trust Commercial |
$618.75
|
| Rate for Payer: WPS Commercial |
$833.29
|
|
|
EXERCISE BAND LF 4INX50 PEACH #5613-15
|
Facility
|
IP
|
$1,125.00
|
|
| Hospital Charge Code |
2972194
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$551.25 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Aetna Commercial |
$1,012.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.25
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$1,035.00
|
| Rate for Payer: Health EOS Commercial |
$1,001.25
|
| Rate for Payer: HFN Commercial |
$1,035.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: NAPHCARE Commercial |
$675.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.00
|
| Rate for Payer: Quartz Beloit One Network |
$551.25
|
| Rate for Payer: Quartz Commercial |
$675.00
|
| Rate for Payer: WEA Trust Commercial |
$618.75
|
| Rate for Payer: WPS Commercial |
$833.29
|
|
|
EXERCISE BAND LF 4INX50 PLUM #5613-19
|
Facility
|
IP
|
$1,685.00
|
|
| Hospital Charge Code |
2972621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$825.65 |
| Max. Negotiated Rate |
$1,550.20 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,011.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
|
EXERCISE BAND LF 4INX50 PLUM #5613-19
|
Facility
|
OP
|
$1,685.00
|
|
| Hospital Charge Code |
2972621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$6,740.00 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.10
|
| Rate for Payer: Aetna Managed Medicare |
$471.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,095.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.93
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.75
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,095.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,011.00
|
| Rate for Payer: The Alliance Commercial |
$6,740.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
|
EXERCISE STRESS TEST #91929
|
Facility
|
OP
|
$919.00
|
|
| Hospital Charge Code |
2971363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.32 |
| Max. Negotiated Rate |
$3,676.00 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.34
|
| Rate for Payer: Aetna Managed Medicare |
$257.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$597.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$441.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.07
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$845.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$514.27
|
| Rate for Payer: Health EOS Commercial |
$817.91
|
| Rate for Payer: HFN Commercial |
$845.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$689.25
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: NAPHCARE Commercial |
$551.40
|
| Rate for Payer: Preferred Network Access Commercial |
$845.48
|
| Rate for Payer: Quartz Beloit One Network |
$450.31
|
| Rate for Payer: Quartz Commercial |
$597.35
|
| Rate for Payer: Quartz Medicare Advantage |
$551.40
|
| Rate for Payer: The Alliance Commercial |
$3,676.00
|
| Rate for Payer: WEA Trust Commercial |
$505.45
|
| Rate for Payer: WPS Commercial |
$680.70
|
|
|
EXERCISE STRESS TEST #91929
|
Facility
|
IP
|
$919.00
|
|
| Hospital Charge Code |
2971363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.31 |
| Max. Negotiated Rate |
$845.48 |
| Rate for Payer: Aetna Commercial |
$827.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$790.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.07
|
| Rate for Payer: Cash Price |
$275.70
|
| Rate for Payer: Cigna Commercial |
$845.48
|
| Rate for Payer: Health EOS Commercial |
$817.91
|
| Rate for Payer: HFN Commercial |
$845.48
|
| Rate for Payer: Multiplan Commercial |
$735.20
|
| Rate for Payer: NAPHCARE Commercial |
$551.40
|
| Rate for Payer: Preferred Network Access Commercial |
$845.48
|
| Rate for Payer: Quartz Beloit One Network |
$450.31
|
| Rate for Payer: Quartz Commercial |
$551.40
|
| Rate for Payer: WEA Trust Commercial |
$505.45
|
| Rate for Payer: WPS Commercial |
$680.70
|
|
|
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 |
$126.26 |
| Max. Negotiated Rate |
$1,045.12 |
| Rate for Payer: Aetna Commercial |
$1,022.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$738.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$568.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.28
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,045.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$1,011.04
|
| Rate for Payer: HFN Commercial |
$1,045.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.12
|
| Rate for Payer: Quartz Beloit One Network |
$556.64
|
| Rate for Payer: Quartz Commercial |
$738.40
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$852.00
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
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 |
$556.64 |
| Max. Negotiated Rate |
$1,045.12 |
| Rate for Payer: Aetna Commercial |
$1,022.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.08
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,045.12
|
| Rate for Payer: Health EOS Commercial |
$1,011.04
|
| Rate for Payer: HFN Commercial |
$1,045.12
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: NAPHCARE Commercial |
$681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.12
|
| Rate for Payer: Quartz Beloit One Network |
$556.64
|
| Rate for Payer: Quartz Commercial |
$681.60
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
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 |
$74.73 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$195.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.16
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$195.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.60
|
| Rate for Payer: Health EOS Commercial |
$187.46
|
| Rate for Payer: HFN Commercial |
$195.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.73
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.70
|
| Rate for Payer: Quartz Beloit One Network |
$90.64
|
| Rate for Payer: Quartz Commercial |
$117.42
|
| Rate for Payer: The Alliance Commercial |
$103.00
|
| Rate for Payer: WEA Trust Commercial |
$113.30
|
| Rate for Payer: WPS Commercial |
$152.58
|
|
|
EXOSTECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
