|
US Biopsy Breast Left
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| Min. Negotiated Rate |
$518.84 |
| Max. Negotiated Rate |
$7,412.00 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$518.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,204.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$926.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,036.94
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,389.75
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,204.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,111.80
|
| Rate for Payer: The Alliance Commercial |
$7,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast Left
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| Min. Negotiated Rate |
$907.97 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,111.80
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast Left
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| Min. Negotiated Rate |
$196.90 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,760.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$926.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.80
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| Rate for Payer: HFN Commercial |
$1,760.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.35
|
| Rate for Payer: Quartz Beloit One Network |
$815.32
|
| Rate for Payer: Quartz Commercial |
$1,056.21
|
| Rate for Payer: The Alliance Commercial |
$926.50
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast Left
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$3,714.50 |
| Rate for Payer: Aetna Commercial |
$3,714.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,714.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,346.00
|
| Rate for Payer: Health EOS Commercial |
$3,558.10
|
| Rate for Payer: HFN Commercial |
$3,714.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.46
|
| Rate for Payer: Multiplan Commercial |
$3,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,714.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,720.40
|
| Rate for Payer: Quartz Commercial |
$2,228.70
|
| Rate for Payer: The Alliance Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Medicaid |
$122.98
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Left
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$3,519.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,072.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,597.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$3,479.90
|
| Rate for Payer: HFN Commercial |
$3,597.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$3,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,597.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.90
|
| Rate for Payer: Quartz Commercial |
$2,541.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Left
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,915.90 |
| Max. Negotiated Rate |
$3,597.20 |
| Rate for Payer: Aetna Commercial |
$3,519.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,072.30
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,597.20
|
| Rate for Payer: Health EOS Commercial |
$3,479.90
|
| Rate for Payer: HFN Commercial |
$3,597.20
|
| Rate for Payer: Multiplan Commercial |
$3,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,346.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,597.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.90
|
| Rate for Payer: Quartz Commercial |
$2,346.00
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Left ea add
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna Commercial |
$1,855.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,855.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,171.80
|
| Rate for Payer: Health EOS Commercial |
$1,777.23
|
| Rate for Payer: HFN Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.36
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,855.35
|
| Rate for Payer: Quartz Beloit One Network |
$859.32
|
| Rate for Payer: Quartz Commercial |
$1,113.21
|
| Rate for Payer: The Alliance Commercial |
$976.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.82
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast Left ea add
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$956.97 |
| Max. Negotiated Rate |
$1,796.76 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,171.80
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast Left ea add
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Aetna Managed Medicare |
$546.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.75
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,269.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.80
|
| Rate for Payer: The Alliance Commercial |
$7,812.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast Right
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627690
|
| Min. Negotiated Rate |
$907.97 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,111.80
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast Right
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
2544809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$3,519.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,072.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,597.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$3,479.90
|
| Rate for Payer: HFN Commercial |
$3,597.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$3,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,597.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.90
|
| Rate for Payer: Quartz Commercial |
$2,541.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Right
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
2544809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,915.90 |
| Max. Negotiated Rate |
$3,597.20 |
| Rate for Payer: Aetna Commercial |
$3,519.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,072.30
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,597.20
|
| Rate for Payer: Health EOS Commercial |
$3,479.90
|
| Rate for Payer: HFN Commercial |
$3,597.20
|
| Rate for Payer: Multiplan Commercial |
$3,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,346.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,597.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,915.90
|
| Rate for Payer: Quartz Commercial |
$2,346.00
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Right
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
2980119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna Commercial |
$1,855.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,855.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,171.80
|
| Rate for Payer: Health EOS Commercial |
$1,777.23
|
| Rate for Payer: HFN Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.36
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,855.35
|
| Rate for Payer: Quartz Beloit One Network |
$859.32
|
| Rate for Payer: Quartz Commercial |
$1,113.21
|
| Rate for Payer: The Alliance Commercial |
$976.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.82
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast Right
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
2980119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Aetna Managed Medicare |
$546.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.75
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,269.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.80
|
| Rate for Payer: The Alliance Commercial |
$7,812.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast Right
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
2980119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$956.97 |
| Max. Negotiated Rate |
$1,796.76 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,171.80
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast Right
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627690
|
| Min. Negotiated Rate |
$196.90 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,760.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$926.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.80
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| Rate for Payer: HFN Commercial |
$1,760.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.35
|
| Rate for Payer: Quartz Beloit One Network |
$815.32
|
| Rate for Payer: Quartz Commercial |
$1,056.21
|
| Rate for Payer: The Alliance Commercial |
$926.50
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast Right
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
2544809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$3,714.50 |
| Rate for Payer: Aetna Commercial |
$3,714.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,714.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,346.00
|
| Rate for Payer: Health EOS Commercial |
$3,558.10
|
| Rate for Payer: HFN Commercial |
$3,714.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.46
|
| Rate for Payer: Multiplan Commercial |
$3,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,714.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,720.40
|
| Rate for Payer: Quartz Commercial |
$2,228.70
|
| Rate for Payer: The Alliance Commercial |
$1,955.00
|
| Rate for Payer: United Healthcare Medicaid |
$122.98
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Right
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627690
|
| Min. Negotiated Rate |
$518.84 |
| Max. Negotiated Rate |
$7,412.00 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$518.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,204.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$926.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,036.94
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,389.75
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,204.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,111.80
|
| Rate for Payer: The Alliance Commercial |
$7,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast RT ea add
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 RT
|
| Hospital Charge Code |
5156614
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$956.97 |
| Max. Negotiated Rate |
$1,796.76 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,171.80
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast RT ea add
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 RT
|
| Hospital Charge Code |
5156614
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$546.84 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Aetna Commercial |
$1,757.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Aetna Managed Medicare |
$546.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.09
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,796.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$1,738.17
|
| Rate for Payer: HFN Commercial |
$1,796.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.75
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.76
|
| Rate for Payer: Quartz Beloit One Network |
$956.97
|
| Rate for Payer: Quartz Commercial |
$1,269.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.80
|
| Rate for Payer: The Alliance Commercial |
$7,812.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast RT ea add
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 RT
|
| Hospital Charge Code |
5156614
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.82 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna Commercial |
$1,855.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,855.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,171.80
|
| Rate for Payer: Health EOS Commercial |
$1,777.23
|
| Rate for Payer: HFN Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.36
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,855.35
|
| Rate for Payer: Quartz Beloit One Network |
$859.32
|
| Rate for Payer: Quartz Commercial |
$1,113.21
|
| Rate for Payer: The Alliance Commercial |
$976.50
|
| Rate for Payer: United Healthcare Medicaid |
$59.82
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
US Biopsy Breast w/device 1st lesion 19083
|
Professional
|
Both
|
$3,474.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
4522607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.98 |
| Max. Negotiated Rate |
$3,300.30 |
| Rate for Payer: Aetna Commercial |
$3,300.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,987.64
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cigna Commercial |
$3,300.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,084.40
|
| Rate for Payer: Health EOS Commercial |
$3,161.34
|
| Rate for Payer: HFN Commercial |
$3,300.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.46
|
| Rate for Payer: Multiplan Commercial |
$2,779.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,300.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,528.56
|
| Rate for Payer: Quartz Commercial |
$1,980.18
|
| Rate for Payer: The Alliance Commercial |
$1,737.00
|
| Rate for Payer: United Healthcare Medicaid |
$122.98
|
| Rate for Payer: WEA Trust Commercial |
$1,910.70
|
| Rate for Payer: WPS Commercial |
$2,573.19
|
|
|
US Biopsy Liver
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544811
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$707.56 |
| Max. Negotiated Rate |
$1,328.48 |
| Rate for Payer: Aetna Commercial |
$1,299.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,241.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$765.32
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,328.48
|
| Rate for Payer: Health EOS Commercial |
$1,285.16
|
| Rate for Payer: HFN Commercial |
$1,328.48
|
| Rate for Payer: Multiplan Commercial |
$1,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$866.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,328.48
|
| Rate for Payer: Quartz Beloit One Network |
$707.56
|
| Rate for Payer: Quartz Commercial |
$866.40
|
| Rate for Payer: WEA Trust Commercial |
$794.20
|
| Rate for Payer: WPS Commercial |
$1,069.57
|
|
|
US Biopsy Liver
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631303
|
| Min. Negotiated Rate |
$518.84 |
| Max. Negotiated Rate |
$7,412.00 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$518.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,204.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$926.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,036.94
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,389.75
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,204.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,111.80
|
| Rate for Payer: The Alliance Commercial |
$7,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Liver
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631303
|
| Min. Negotiated Rate |
$196.90 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,760.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$926.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.80
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| Rate for Payer: HFN Commercial |
$1,760.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.35
|
| Rate for Payer: Quartz Beloit One Network |
$815.32
|
| Rate for Payer: Quartz Commercial |
$1,056.21
|
| Rate for Payer: The Alliance Commercial |
$926.50
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
