|
MA Breast Tissue Specimen Left
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$194.16 |
| Max. Negotiated Rate |
$364.54 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$237.74
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$2,300.15 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.20
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$257.56
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
MA Breast Tissue Specimen Left
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Aetna Commercial |
$488.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$488.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.26
|
| Rate for Payer: Health EOS Commercial |
$467.52
|
| Rate for Payer: HFN Commercial |
$488.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.24
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$488.07
|
| Rate for Payer: Quartz Beloit One Network |
$226.05
|
| Rate for Payer: Quartz Commercial |
$292.84
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.74 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Left
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$376.43 |
| Rate for Payer: Aetna Commercial |
$376.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$42.69
|
| Rate for Payer: Anthem Medicare Advantage |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.69
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$376.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.69
|
| Rate for Payer: Health EOS Commercial |
$360.58
|
| Rate for Payer: HFN Commercial |
$376.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.69
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$64.04
|
| Rate for Payer: Preferred Network Access Commercial |
$376.43
|
| Rate for Payer: Quartz Beloit One Network |
$174.35
|
| Rate for Payer: Quartz Commercial |
$225.86
|
| Rate for Payer: Quartz Medicare Advantage |
$42.69
|
| Rate for Payer: The Alliance Commercial |
$162.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.69
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$213.46
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.85 |
| Max. Negotiated Rate |
$2,126.59 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Aetna Managed Medicare |
$143.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,126.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,701.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,616.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.51
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.32
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: NAPHCARE Commercial |
$308.26
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$333.94
|
| Rate for Payer: Quartz Medicare Advantage |
$308.26
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Right
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711762
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$376.43 |
| Rate for Payer: Aetna Commercial |
$376.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$42.69
|
| Rate for Payer: Anthem Medicare Advantage |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.69
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$376.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.69
|
| Rate for Payer: Health EOS Commercial |
$360.58
|
| Rate for Payer: HFN Commercial |
$376.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.69
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$64.04
|
| Rate for Payer: Preferred Network Access Commercial |
$376.43
|
| Rate for Payer: Quartz Beloit One Network |
$174.35
|
| Rate for Payer: Quartz Commercial |
$225.86
|
| Rate for Payer: Quartz Medicare Advantage |
$42.69
|
| Rate for Payer: The Alliance Commercial |
$162.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.69
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$213.46
|
|
|
MA Breast Tissue Specimen Right
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
1268808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Aetna Commercial |
$488.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$488.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.26
|
| Rate for Payer: Health EOS Commercial |
$467.52
|
| Rate for Payer: HFN Commercial |
$488.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.24
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$488.07
|
| Rate for Payer: Quartz Beloit One Network |
$226.05
|
| Rate for Payer: Quartz Commercial |
$292.84
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
1268808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.85 |
| Max. Negotiated Rate |
$2,126.59 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Aetna Managed Medicare |
$143.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,126.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,701.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,616.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.51
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.32
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: NAPHCARE Commercial |
$308.26
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$333.94
|
| Rate for Payer: Quartz Medicare Advantage |
$308.26
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711762
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$2,300.15 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.20
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$257.56
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711762
|
| Min. Negotiated Rate |
$194.16 |
| Max. Negotiated Rate |
$364.54 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$237.74
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
1268808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.74 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MACI HAND-SCORING STARTER KIT
|
Facility
|
OP
|
$4,699.00
|
|
| Hospital Charge Code |
2973532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,368.35 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna Commercial |
$4,398.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,202.79
|
| Rate for Payer: Aetna Managed Medicare |
$1,368.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,176.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,443.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,590.09
|
| Rate for Payer: Cash Price |
$1,409.70
|
| Rate for Payer: Cigna Commercial |
$4,496.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,734.82
|
| Rate for Payer: Health EOS Commercial |
$4,349.39
|
| Rate for Payer: HFN Commercial |
$4,496.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,665.22
|
| Rate for Payer: Multiplan Commercial |
$3,909.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,932.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,496.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,394.61
|
| Rate for Payer: Quartz Commercial |
$3,176.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,932.18
|
| Rate for Payer: The Alliance Commercial |
$2,443.48
|
| Rate for Payer: WEA Trust Commercial |
$2,687.83
|
| Rate for Payer: WPS Commercial |
$3,619.64
|
|
|
MACI HAND-SCORING STARTER KIT
|
Facility
|
IP
|
$4,699.00
|
|
| Hospital Charge Code |
2973532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,394.61 |
| Max. Negotiated Rate |
$4,496.00 |
| Rate for Payer: Aetna Commercial |
$4,398.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,202.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,590.09
|
| Rate for Payer: Cash Price |
$1,409.70
|
| Rate for Payer: Cigna Commercial |
$4,496.00
|
| Rate for Payer: Health EOS Commercial |
$4,349.39
|
| Rate for Payer: HFN Commercial |
$4,496.00
|
| Rate for Payer: Multiplan Commercial |
$3,909.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,496.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,394.61
|
| Rate for Payer: Quartz Commercial |
$2,932.18
|
| Rate for Payer: WEA Trust Commercial |
$2,687.83
|
| Rate for Payer: WPS Commercial |
$3,619.64
|
|
|
MAC/IV SEDATION IN GI - SET-UP CHARGE
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
4519586
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
MAC/IV SEDATION IN GI - SET-UP CHARGE
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
4519586
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
MAC/IV SEDATION IN OR - SET-UP CHARGE
|
Facility
|
IP
|
$1,303.00
|
|
| Hospital Charge Code |
4519585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$664.01 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$813.07
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
MAC/IV SEDATION IN OR - SET-UP CHARGE
|
Facility
|
OP
|
$1,303.00
|
|
| Hospital Charge Code |
4519585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$379.43 |
| Max. Negotiated Rate |
$1,246.71 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Aetna Managed Medicare |
$379.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$758.35
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.34
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: NAPHCARE Commercial |
$813.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$880.83
|
| Rate for Payer: Quartz Medicare Advantage |
$813.07
|
| Rate for Payer: The Alliance Commercial |
$677.56
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
MA Dig Diag Bilateral
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5478930
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$283.85 |
| Max. Negotiated Rate |
$532.94 |
| Rate for Payer: Aetna Commercial |
$521.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$532.94
|
| Rate for Payer: Health EOS Commercial |
$515.56
|
| Rate for Payer: HFN Commercial |
$532.94
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: Preferred Network Access Commercial |
$532.94
|
| Rate for Payer: Quartz Beloit One Network |
$283.85
|
| Rate for Payer: Quartz Commercial |
$347.57
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
|
MA Dig Diag Bilateral
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5478930
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$550.32 |
| Rate for Payer: Aetna Commercial |
$550.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Aetna Managed Medicare |
$109.70
|
| Rate for Payer: Anthem Medicare Advantage |
$109.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$109.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$109.70
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$550.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.70
|
| Rate for Payer: Health EOS Commercial |
$527.14
|
| Rate for Payer: HFN Commercial |
$550.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$403.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$109.70
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: NAPHCARE Commercial |
$164.55
|
| Rate for Payer: Preferred Network Access Commercial |
$550.32
|
| Rate for Payer: Quartz Beloit One Network |
$254.88
|
| Rate for Payer: Quartz Commercial |
$330.19
|
| Rate for Payer: Quartz Medicare Advantage |
$109.70
|
| Rate for Payer: The Alliance Commercial |
$416.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.70
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$548.50
|
|
|
MA Dig Diag Bilateral
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5478930
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$162.20 |
| Max. Negotiated Rate |
$532.94 |
| Rate for Payer: Aetna Commercial |
$521.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Aetna Managed Medicare |
$162.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$532.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.17
|
| Rate for Payer: Health EOS Commercial |
$515.56
|
| Rate for Payer: HFN Commercial |
$532.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.46
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: NAPHCARE Commercial |
$347.57
|
| Rate for Payer: Preferred Network Access Commercial |
$532.94
|
| Rate for Payer: Quartz Beloit One Network |
$283.85
|
| Rate for Payer: Quartz Commercial |
$376.53
|
| Rate for Payer: Quartz Medicare Advantage |
$347.57
|
| Rate for Payer: The Alliance Commercial |
$438.80
|
| Rate for Payer: United Healthcare PPO |
$434.46
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
|
MA Dig Diag Unilateral Left
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
CPT 77065 TC,LT
|
| Hospital Charge Code |
5478931
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$485.11 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.38
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.59
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: The Alliance Commercial |
$255.32
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MA Dig Diag Unilateral Left
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 77065 TC,LT
|
| Hospital Charge Code |
5478931
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$142.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.76
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.98
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$306.38
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$331.92
|
| Rate for Payer: Quartz Medicare Advantage |
$306.38
|
| Rate for Payer: The Alliance Commercial |
$255.32
|
| Rate for Payer: United Healthcare PPO |
$382.98
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MA Dig Diag Unilateral Left
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 77065 TC,LT
|
| Hospital Charge Code |
5478931
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$306.38
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MA Dig Diag Unilateral Right
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
CPT 77065 TC,RT
|
| Hospital Charge Code |
5478932
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$224.68 |
| Max. Negotiated Rate |
$485.11 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.38
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.59
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: The Alliance Commercial |
$255.32
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
