|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM LT 5001-0520L-S
|
Facility
|
IP
|
$29,364.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6210960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,388.36 |
| Max. Negotiated Rate |
$27,014.88 |
| Rate for Payer: Aetna Commercial |
$26,427.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,253.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,562.92
|
| Rate for Payer: Cash Price |
$8,809.20
|
| Rate for Payer: Cigna Commercial |
$27,014.88
|
| Rate for Payer: Health EOS Commercial |
$26,133.96
|
| Rate for Payer: HFN Commercial |
$27,014.88
|
| Rate for Payer: Multiplan Commercial |
$23,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$17,618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$27,014.88
|
| Rate for Payer: Quartz Beloit One Network |
$14,388.36
|
| Rate for Payer: Quartz Commercial |
$17,618.40
|
| Rate for Payer: WEA Trust Commercial |
$16,150.20
|
| Rate for Payer: WPS Commercial |
$21,749.91
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM LT 5001-0520L-S
|
Facility
|
OP
|
$29,364.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6210960
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,221.92 |
| Max. Negotiated Rate |
$117,456.00 |
| Rate for Payer: Aetna Commercial |
$26,427.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,253.04
|
| Rate for Payer: Aetna Managed Medicare |
$8,221.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,086.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,682.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,094.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,562.92
|
| Rate for Payer: Cash Price |
$8,809.20
|
| Rate for Payer: Cigna Commercial |
$27,014.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,432.09
|
| Rate for Payer: Health EOS Commercial |
$26,133.96
|
| Rate for Payer: HFN Commercial |
$27,014.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,023.00
|
| Rate for Payer: Multiplan Commercial |
$23,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$17,618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$27,014.88
|
| Rate for Payer: Quartz Beloit One Network |
$14,388.36
|
| Rate for Payer: Quartz Commercial |
$19,086.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17,618.40
|
| Rate for Payer: The Alliance Commercial |
$117,456.00
|
| Rate for Payer: WEA Trust Commercial |
$16,150.20
|
| Rate for Payer: WPS Commercial |
$21,749.91
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM RT 5001-0520R-S
|
Facility
|
IP
|
$24,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,064.29 |
| Max. Negotiated Rate |
$22,651.32 |
| Rate for Payer: Aetna Commercial |
$22,158.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,174.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,049.13
|
| Rate for Payer: Cash Price |
$7,386.30
|
| Rate for Payer: Cigna Commercial |
$22,651.32
|
| Rate for Payer: Health EOS Commercial |
$21,912.69
|
| Rate for Payer: HFN Commercial |
$22,651.32
|
| Rate for Payer: Multiplan Commercial |
$19,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$14,772.60
|
| Rate for Payer: Preferred Network Access Commercial |
$22,651.32
|
| Rate for Payer: Quartz Beloit One Network |
$12,064.29
|
| Rate for Payer: Quartz Commercial |
$14,772.60
|
| Rate for Payer: WEA Trust Commercial |
$13,541.55
|
| Rate for Payer: WPS Commercial |
$18,236.77
|
|
|
RADIAL HEAD ACUMED ARN SOLUTIONS 20.0MM RT 5001-0520R-S
|
Facility
|
OP
|
$24,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729636
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,893.88 |
| Max. Negotiated Rate |
$98,484.00 |
| Rate for Payer: Aetna Commercial |
$22,158.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,174.06
|
| Rate for Payer: Aetna Managed Medicare |
$6,893.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,003.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,310.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,818.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,049.13
|
| Rate for Payer: Cash Price |
$7,386.30
|
| Rate for Payer: Cigna Commercial |
$22,651.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,777.91
|
| Rate for Payer: Health EOS Commercial |
$21,912.69
|
| Rate for Payer: HFN Commercial |
$22,651.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,465.75
|
| Rate for Payer: Multiplan Commercial |
$19,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$14,772.60
|
| Rate for Payer: Preferred Network Access Commercial |
$22,651.32
|
| Rate for Payer: Quartz Beloit One Network |
$12,064.29
|
| Rate for Payer: Quartz Commercial |
$16,003.65
|
| Rate for Payer: Quartz Medicare Advantage |
$14,772.60
|
| Rate for Payer: The Alliance Commercial |
$98,484.00
|
| Rate for Payer: WEA Trust Commercial |
$13,541.55
|
| Rate for Payer: WPS Commercial |
$18,236.77
|
|
|
RADIAL JAW 4 ENDO BIOPSY W/O NEEDLE M00513380
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
5563607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Aetna Managed Medicare |
$49.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$113.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$87.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.93
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.25
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$113.75
|
| Rate for Payer: Quartz Medicare Advantage |
$105.00
|
| Rate for Payer: The Alliance Commercial |
$700.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
RADIAL JAW 4 ENDO BIOPSY W/O NEEDLE M00513380
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
5563607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
RADIAL JAW COLON BIOPSY M00513332
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2973547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
RADIAL JAW COLON BIOPSY M00513332
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2973547
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
RADIAL STEM ACUMED 9.0 X 2.0MM TR-S0902-S
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$388.64 |
| Max. Negotiated Rate |
$5,552.00 |
| Rate for Payer: Aetna Commercial |
$1,249.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.68
|
| Rate for Payer: Aetna Managed Medicare |
$388.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$902.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$666.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.64
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$1,276.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$776.72
|
| Rate for Payer: Health EOS Commercial |
$1,235.32
|
| Rate for Payer: HFN Commercial |
$1,276.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,041.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$832.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.96
|
| Rate for Payer: Quartz Beloit One Network |
$680.12
|
| Rate for Payer: Quartz Commercial |
$902.20
|
| Rate for Payer: Quartz Medicare Advantage |
$832.80
|
| Rate for Payer: The Alliance Commercial |
$5,552.00
|
| Rate for Payer: WEA Trust Commercial |
$763.40
|
| Rate for Payer: WPS Commercial |
$1,028.09
|
|
|
RADIAL STEM ACUMED 9.0 X 2.0MM TR-S0902-S
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$680.12 |
| Max. Negotiated Rate |
$1,276.96 |
| Rate for Payer: Aetna Commercial |
$1,249.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.64
|
| Rate for Payer: Cash Price |
$416.40
|
| Rate for Payer: Cigna Commercial |
$1,276.96
|
| Rate for Payer: Health EOS Commercial |
$1,235.32
|
| Rate for Payer: HFN Commercial |
$1,276.96
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: NAPHCARE Commercial |
$832.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.96
|
| Rate for Payer: Quartz Beloit One Network |
$680.12
|
| Rate for Payer: Quartz Commercial |
$832.80
|
| Rate for Payer: WEA Trust Commercial |
$763.40
|
| Rate for Payer: WPS Commercial |
$1,028.09
|
|
|
Radiation Physics
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
3040391
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$612.01 |
| Max. Negotiated Rate |
$1,149.08 |
| Rate for Payer: Aetna Commercial |
$1,124.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,074.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.97
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,149.08
|
| Rate for Payer: Health EOS Commercial |
$1,111.61
|
| Rate for Payer: HFN Commercial |
$1,149.08
|
| Rate for Payer: Multiplan Commercial |
$999.20
|
| Rate for Payer: NAPHCARE Commercial |
$749.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,149.08
|
| Rate for Payer: Quartz Beloit One Network |
$612.01
|
| Rate for Payer: Quartz Commercial |
$749.40
|
| Rate for Payer: WEA Trust Commercial |
$686.95
|
| Rate for Payer: WPS Commercial |
$925.13
|
|
|
Radiation Physics
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
3040391
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$1,149.08 |
| Rate for Payer: Aetna Commercial |
$1,124.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,074.14
|
| Rate for Payer: Aetna Managed Medicare |
$134.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$502.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$402.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$382.21
|
| Rate for Payer: Anthem Medicare Advantage |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.11
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,149.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$134.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$698.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$134.11
|
| Rate for Payer: Health EOS Commercial |
$1,111.61
|
| Rate for Payer: HFN Commercial |
$1,149.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$134.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$134.11
|
| Rate for Payer: Multiplan Commercial |
$999.20
|
| Rate for Payer: NAPHCARE Commercial |
$201.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,149.08
|
| Rate for Payer: Quartz Beloit One Network |
$612.01
|
| Rate for Payer: Quartz Commercial |
$811.85
|
| Rate for Payer: Quartz Medicare Advantage |
$134.11
|
| Rate for Payer: The Alliance Commercial |
$536.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.11
|
| Rate for Payer: United Healthcare PPO |
$936.75
|
| Rate for Payer: WEA Trust Commercial |
$686.95
|
| Rate for Payer: Wellcare Medicare |
$134.11
|
| Rate for Payer: WPS Commercial |
$925.13
|
|
|
Radiation Treatment Complex
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
3040399
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$265.63 |
| Max. Negotiated Rate |
$1,473.84 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Aetna Managed Medicare |
$265.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$996.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$757.05
|
| Rate for Payer: Anthem Medicare Advantage |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$265.63
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$265.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$896.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$265.63
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$988.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$265.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$265.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$265.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$265.63
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$398.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$1,041.30
|
| Rate for Payer: Quartz Medicare Advantage |
$265.63
|
| Rate for Payer: The Alliance Commercial |
$1,062.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.63
|
| Rate for Payer: United Healthcare PPO |
$1,201.50
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: Wellcare Medicare |
$265.63
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
Radiation Treatment Complex
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 77412
|
| Hospital Charge Code |
3040399
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$784.98 |
| Max. Negotiated Rate |
$1,473.84 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$961.20
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
Radiation TX Complex
|
Facility
|
IP
|
$1,303.00
|
|
| Hospital Charge Code |
3040402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$638.47 |
| Max. Negotiated Rate |
$1,198.76 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$781.80
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
Radiation TX Complex
|
Facility
|
OP
|
$1,303.00
|
|
| Hospital Charge Code |
3040402
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$364.84 |
| Max. Negotiated Rate |
$5,212.00 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Aetna Managed Medicare |
$364.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$625.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$729.16
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.25
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$846.95
|
| Rate for Payer: Quartz Medicare Advantage |
$781.80
|
| Rate for Payer: The Alliance Commercial |
$5,212.00
|
| Rate for Payer: United Healthcare PPO |
$977.25
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
Radiation Tx Intermediate
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
3040398
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$943.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$615.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
Radiation Tx Intermediate
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 77407
|
| Hospital Charge Code |
3040398
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$265.63 |
| Max. Negotiated Rate |
$1,062.52 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$265.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$996.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$757.05
|
| Rate for Payer: Anthem Medicare Advantage |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$265.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$265.63
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$265.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$265.63
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$988.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$265.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$265.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$265.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$265.63
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$398.44
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$666.25
|
| Rate for Payer: Quartz Medicare Advantage |
$265.63
|
| Rate for Payer: The Alliance Commercial |
$1,062.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$265.63
|
| Rate for Payer: United Healthcare PPO |
$768.75
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: Wellcare Medicare |
$265.63
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
Radiation Tx Simple
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
3040394
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
Radiation Tx Simple
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT 77402
|
| Hospital Charge Code |
3040394
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$118.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$337.78
|
| Rate for Payer: Anthem Medicare Advantage |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.52
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$118.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$118.52
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$118.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$118.52
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$177.78
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$118.52
|
| Rate for Payer: The Alliance Commercial |
$474.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.52
|
| Rate for Payer: United Healthcare PPO |
$762.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: Wellcare Medicare |
$118.52
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARM TENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR WITHOUT TRANSPOSITION OF DORSAL RETINACULUM
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 25116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER
|
Facility
|
OP
|
$11,234.20
|
|
|
Service Code
|
CPT 22905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.55 |
| Max. Negotiated Rate |
$11,234.20 |
| Rate for Payer: Aetna Managed Medicare |
$2,808.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,808.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,808.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,808.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,447.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,808.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,808.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,808.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,808.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.55
|
| Rate for Payer: The Alliance Commercial |
$11,234.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,808.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$2,808.55
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER
|
Facility
|
OP
|
$11,234.20
|
|
|
Service Code
|
CPT 21936
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.55 |
| Max. Negotiated Rate |
$11,234.20 |
| Rate for Payer: Aetna Managed Medicare |
$2,808.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,808.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,808.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,808.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,447.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,808.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,808.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,808.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,808.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.55
|
| Rate for Payer: The Alliance Commercial |
$11,234.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,808.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$2,808.55
|
|
|
RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER
|
Facility
|
OP
|
$11,234.20
|
|
|
Service Code
|
CPT 21016
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.55 |
| Max. Negotiated Rate |
$11,234.20 |
| Rate for Payer: Aetna Managed Medicare |
$2,808.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,808.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,808.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,808.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,808.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,447.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,808.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,808.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,808.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,808.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,808.55
|
| Rate for Payer: The Alliance Commercial |
$11,234.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,808.55
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$2,808.55
|
|
|
RADIOFREQUENCY VEIN ABLATION
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
4494794
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
