|
EXTREMITY STUDY 9392426
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 93924 26
|
| Hospital Charge Code |
3015432
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.04 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.60
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: HFN Commercial |
$157.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: The Alliance Commercial |
$83.00
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
EXTREMITY STUDY 9397026
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
CPT 93970 26
|
| Hospital Charge Code |
3015442
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$1,019.35 |
| Rate for Payer: Aetna Commercial |
$1,019.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.78
|
| Rate for Payer: Cash Price |
$321.90
|
| Rate for Payer: Cash Price |
$321.90
|
| Rate for Payer: Cigna Commercial |
$1,019.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$536.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$643.80
|
| Rate for Payer: Health EOS Commercial |
$976.43
|
| Rate for Payer: HFN Commercial |
$1,019.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.56
|
| Rate for Payer: Multiplan Commercial |
$858.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,019.35
|
| Rate for Payer: Quartz Beloit One Network |
$472.12
|
| Rate for Payer: Quartz Commercial |
$611.61
|
| Rate for Payer: The Alliance Commercial |
$536.50
|
| Rate for Payer: WEA Trust Commercial |
$590.15
|
| Rate for Payer: WPS Commercial |
$794.77
|
|
|
EXTREMITY STUDY COMP BILAT 3 OR MORE LEVELS 9392326
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
3015431
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.72 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna Commercial |
$107.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$107.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.80
|
| Rate for Payer: Health EOS Commercial |
$102.83
|
| Rate for Payer: HFN Commercial |
$107.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.33
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Preferred Network Access Commercial |
$107.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.72
|
| Rate for Payer: Quartz Commercial |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$56.50
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
EXTREMITY STUDY LIMITED 1-2 LEVELS 9392226
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 93922 26
|
| Hospital Charge Code |
3015430
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.55 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$142.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.00
|
| Rate for Payer: Health EOS Commercial |
$136.50
|
| Rate for Payer: HFN Commercial |
$142.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$142.50
|
| Rate for Payer: Quartz Beloit One Network |
$66.00
|
| Rate for Payer: Quartz Commercial |
$85.50
|
| Rate for Payer: The Alliance Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
Ext Telemetry 72 hrs up to 7 days recording
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5753623
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Ext Telemetry 72 hrs up to 7 days recording
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5753623
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$158.56 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.00
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$65.00
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: The Alliance Commercial |
$158.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Ext Telemetry 72 hrs up to 7 days recording
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5753623
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.00
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: HFN Commercial |
$95.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.27
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: The Alliance Commercial |
$50.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.39
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Ext Telemetry 7 days up to 15 days recording
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5753624
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$158.56 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.00
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$65.00
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: The Alliance Commercial |
$158.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Ext Telemetry 7 days up to 15 days recording
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5753624
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Ext Telemetry 7 days up to 15 days recording
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5753624
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.00
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: HFN Commercial |
$95.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.27
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: The Alliance Commercial |
$50.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.39
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Eye Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Eye Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Eye Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
EYE EVISCERATION/GLOBE EYE, RUPTURE REPAIR
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
EYE EVISCERATION/GLOBE EYE, RUPTURE REPAIR
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960359
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Eye Exam & Treatment 92014DSC
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 92014
|
| Hospital Charge Code |
5551272
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.54 |
| Max. Negotiated Rate |
$264.93 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.40
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: HFN Commercial |
$179.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.93
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: The Alliance Commercial |
$94.50
|
| Rate for Payer: United Healthcare Medicaid |
$44.54
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Eye Exam with Photos 9223526
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
CPT 92235 26
|
| Hospital Charge Code |
3190204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.11 |
| Max. Negotiated Rate |
$512.05 |
| Rate for Payer: Aetna Commercial |
$512.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.54
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cash Price |
$161.70
|
| Rate for Payer: Cigna Commercial |
$512.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.40
|
| Rate for Payer: Health EOS Commercial |
$490.49
|
| Rate for Payer: HFN Commercial |
$512.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.11
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.05
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$307.23
|
| Rate for Payer: The Alliance Commercial |
$269.50
|
| Rate for Payer: WEA Trust Commercial |
$296.45
|
| Rate for Payer: WPS Commercial |
$399.24
|
|
|
Eye Exam with Photos 9225026
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 92250 26
|
| Hospital Charge Code |
3165648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.80
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: HFN Commercial |
$154.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.82
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: The Alliance Commercial |
$81.50
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
EYELID REPAIR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960042
|
|
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
|
|
|
EYELID REPAIR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| 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: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| 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 |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Eyelids: Correction of trichiasis; epilation, by forceps only
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
1188898
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$269.80 |
| Rate for Payer: Aetna Commercial |
$269.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$244.24
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cash Price |
$85.20
|
| Rate for Payer: Cigna Commercial |
$269.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.40
|
| Rate for Payer: Health EOS Commercial |
$258.44
|
| Rate for Payer: HFN Commercial |
$269.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.11
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Preferred Network Access Commercial |
$269.80
|
| Rate for Payer: Quartz Beloit One Network |
$124.96
|
| Rate for Payer: Quartz Commercial |
$161.88
|
| Rate for Payer: The Alliance Commercial |
$142.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.10
|
| Rate for Payer: WEA Trust Commercial |
$156.20
|
| Rate for Payer: WPS Commercial |
$210.36
|
|
|
Eyelids: Correction of trichiasis; epilation, by other than forceps
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
1188899
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna Commercial |
$499.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$499.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.60
|
| Rate for Payer: Health EOS Commercial |
$478.66
|
| Rate for Payer: HFN Commercial |
$499.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$408.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$408.74
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.70
|
| Rate for Payer: Quartz Beloit One Network |
$231.44
|
| Rate for Payer: Quartz Commercial |
$299.82
|
| Rate for Payer: The Alliance Commercial |
$263.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
Eyelids: Corrections of trichiasis; epilation, by forceps only 6782050
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 67820
|
| Hospital Charge Code |
5673626
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.10 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$538.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.20
|
| Rate for Payer: Health EOS Commercial |
$515.97
|
| Rate for Payer: HFN Commercial |
$538.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.11
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$538.65
|
| Rate for Payer: Quartz Beloit One Network |
$249.48
|
| Rate for Payer: Quartz Commercial |
$323.19
|
| Rate for Payer: The Alliance Commercial |
$283.50
|
| Rate for Payer: United Healthcare Medicaid |
$24.10
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Eyelids; Excision of Chalazion, Multiple Different Lids
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
1188897
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$748.60 |
| Rate for Payer: Aetna Commercial |
$748.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$748.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$472.80
|
| Rate for Payer: Health EOS Commercial |
$717.08
|
| Rate for Payer: HFN Commercial |
$748.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: Preferred Network Access Commercial |
$748.60
|
| Rate for Payer: Quartz Beloit One Network |
$346.72
|
| Rate for Payer: Quartz Commercial |
$449.16
|
| Rate for Payer: The Alliance Commercial |
$394.00
|
| Rate for Payer: United Healthcare Medicaid |
$89.78
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
Eyelids; Excision of Chalazion, Multiple Same Lid
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
1188896
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$831.25 |
| Rate for Payer: Aetna Commercial |
$831.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$831.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$525.00
|
| Rate for Payer: Health EOS Commercial |
$796.25
|
| Rate for Payer: HFN Commercial |
$831.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.79
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Preferred Network Access Commercial |
$831.25
|
| Rate for Payer: Quartz Beloit One Network |
$385.00
|
| Rate for Payer: Quartz Commercial |
$498.75
|
| Rate for Payer: The Alliance Commercial |
$437.50
|
| Rate for Payer: United Healthcare Medicaid |
$82.25
|
| Rate for Payer: WEA Trust Commercial |
$481.25
|
| Rate for Payer: WPS Commercial |
$648.11
|
|
