|
US Breast Uni Real Time with Image Limited 76642
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
4538775
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$205.48 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Aetna Commercial |
$443.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.62
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$443.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$233.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.20
|
| Rate for Payer: Health EOS Commercial |
$424.97
|
| Rate for Payer: HFN Commercial |
$443.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$299.06
|
| Rate for Payer: Multiplan Commercial |
$373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$443.65
|
| Rate for Payer: Quartz Beloit One Network |
$205.48
|
| Rate for Payer: Quartz Commercial |
$266.19
|
| Rate for Payer: The Alliance Commercial |
$233.50
|
| Rate for Payer: WEA Trust Commercial |
$256.85
|
| Rate for Payer: WPS Commercial |
$345.91
|
|
|
US Breast Uni Real Time with Image Limited 7664226
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
CPT 76642 26
|
| Hospital Charge Code |
4538776
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.23 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Aetna Commercial |
$443.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.62
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$443.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$233.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.20
|
| Rate for Payer: Health EOS Commercial |
$424.97
|
| Rate for Payer: HFN Commercial |
$443.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.23
|
| Rate for Payer: Multiplan Commercial |
$373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$443.65
|
| Rate for Payer: Quartz Beloit One Network |
$205.48
|
| Rate for Payer: Quartz Commercial |
$266.19
|
| Rate for Payer: The Alliance Commercial |
$233.50
|
| Rate for Payer: WEA Trust Commercial |
$256.85
|
| Rate for Payer: WPS Commercial |
$345.91
|
|
|
US Breast Uni Real Time with Image Limited 76642PP
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
4780607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$299.06 |
| Max. Negotiated Rate |
$1,166.60 |
| Rate for Payer: Aetna Commercial |
$1,166.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,056.08
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$1,166.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$614.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.80
|
| Rate for Payer: Health EOS Commercial |
$1,117.48
|
| Rate for Payer: HFN Commercial |
$1,166.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$299.06
|
| Rate for Payer: Multiplan Commercial |
$982.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,166.60
|
| Rate for Payer: Quartz Beloit One Network |
$540.32
|
| Rate for Payer: Quartz Commercial |
$699.96
|
| Rate for Payer: The Alliance Commercial |
$614.00
|
| Rate for Payer: WEA Trust Commercial |
$675.40
|
| Rate for Payer: WPS Commercial |
$909.58
|
|
|
US Chest
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2544825
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,268.68 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.94
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| 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 |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,268.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,227.31
|
| Rate for Payer: HFN Commercial |
$1,268.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.68
|
| Rate for Payer: Quartz Beloit One Network |
$675.71
|
| Rate for Payer: Quartz Commercial |
$896.35
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$758.45
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,021.43
|
|
|
US Chest
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2544825
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$1,310.05 |
| Rate for Payer: Aetna Commercial |
$1,310.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.94
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,310.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$689.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$827.40
|
| Rate for Payer: Health EOS Commercial |
$1,254.89
|
| Rate for Payer: HFN Commercial |
$1,310.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.46
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.05
|
| Rate for Payer: Quartz Beloit One Network |
$606.76
|
| Rate for Payer: Quartz Commercial |
$786.03
|
| Rate for Payer: The Alliance Commercial |
$689.50
|
| Rate for Payer: WEA Trust Commercial |
$758.45
|
| Rate for Payer: WPS Commercial |
$1,021.43
|
|
|
US Chest
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2544825
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$675.71 |
| Max. Negotiated Rate |
$1,268.68 |
| Rate for Payer: Aetna Commercial |
$1,241.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.87
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,268.68
|
| Rate for Payer: Health EOS Commercial |
$1,227.31
|
| Rate for Payer: HFN Commercial |
$1,268.68
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: NAPHCARE Commercial |
$827.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.68
|
| Rate for Payer: Quartz Beloit One Network |
$675.71
|
| Rate for Payer: Quartz Commercial |
$827.40
|
| Rate for Payer: WEA Trust Commercial |
$758.45
|
| Rate for Payer: WPS Commercial |
$1,021.43
|
|
|
US Chest
|
Facility
|
OP
|
$1,061.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
629714
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$976.12 |
| Rate for Payer: Aetna Commercial |
$954.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.46
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.28
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$976.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$944.29
|
| Rate for Payer: HFN Commercial |
$976.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$976.12
|
| Rate for Payer: Quartz Beloit One Network |
$519.89
|
| Rate for Payer: Quartz Commercial |
$689.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$583.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$785.88
|
|
|
US Chest
|
Facility
|
IP
|
$1,061.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
629714
|
| Min. Negotiated Rate |
$519.89 |
| Max. Negotiated Rate |
$976.12 |
| Rate for Payer: Aetna Commercial |
$954.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.33
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$976.12
|
| Rate for Payer: Health EOS Commercial |
$944.29
|
| Rate for Payer: HFN Commercial |
$976.12
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: NAPHCARE Commercial |
$636.60
|
| Rate for Payer: Preferred Network Access Commercial |
$976.12
|
| Rate for Payer: Quartz Beloit One Network |
$519.89
|
| Rate for Payer: Quartz Commercial |
$636.60
|
| Rate for Payer: WEA Trust Commercial |
$583.55
|
| Rate for Payer: WPS Commercial |
$785.88
|
|
|
US Chest
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
629714
|
| Min. Negotiated Rate |
$227.65 |
| Max. Negotiated Rate |
$1,007.95 |
| Rate for Payer: Aetna Commercial |
$1,007.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.46
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,007.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.60
|
| Rate for Payer: Health EOS Commercial |
$965.51
|
| Rate for Payer: HFN Commercial |
$1,007.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.65
|
| Rate for Payer: Multiplan Commercial |
$848.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.95
|
| Rate for Payer: Quartz Beloit One Network |
$466.84
|
| Rate for Payer: Quartz Commercial |
$604.77
|
| Rate for Payer: The Alliance Commercial |
$530.50
|
| Rate for Payer: WEA Trust Commercial |
$583.55
|
| Rate for Payer: WPS Commercial |
$785.88
|
|
|
US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL 7693626
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 76936 26
|
| Hospital Charge Code |
5416647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.90 |
| Max. Negotiated Rate |
$905.35 |
| Rate for Payer: Aetna Commercial |
$905.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.58
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$905.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$476.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.80
|
| Rate for Payer: Health EOS Commercial |
$867.23
|
| Rate for Payer: HFN Commercial |
$905.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$318.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$318.90
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Preferred Network Access Commercial |
$905.35
|
| Rate for Payer: Quartz Beloit One Network |
$419.32
|
| Rate for Payer: Quartz Commercial |
$543.21
|
| Rate for Payer: The Alliance Commercial |
$476.50
|
| Rate for Payer: WEA Trust Commercial |
$524.15
|
| Rate for Payer: WPS Commercial |
$705.89
|
|
|
US Doppler
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
6187358
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$225.36 |
| Max. Negotiated Rate |
$836.95 |
| Rate for Payer: Aetna Commercial |
$836.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.66
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$836.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.60
|
| Rate for Payer: Health EOS Commercial |
$801.71
|
| Rate for Payer: HFN Commercial |
$836.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.14
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: Preferred Network Access Commercial |
$836.95
|
| Rate for Payer: Quartz Beloit One Network |
$387.64
|
| Rate for Payer: Quartz Commercial |
$502.17
|
| Rate for Payer: The Alliance Commercial |
$440.50
|
| Rate for Payer: United Healthcare Medicaid |
$225.36
|
| Rate for Payer: WEA Trust Commercial |
$484.55
|
| Rate for Payer: WPS Commercial |
$652.56
|
|
|
US Doppler
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
6187358
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$431.69 |
| Max. Negotiated Rate |
$810.52 |
| Rate for Payer: Aetna Commercial |
$792.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.93
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$810.52
|
| Rate for Payer: Health EOS Commercial |
$784.09
|
| Rate for Payer: HFN Commercial |
$810.52
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: NAPHCARE Commercial |
$528.60
|
| Rate for Payer: Preferred Network Access Commercial |
$810.52
|
| Rate for Payer: Quartz Beloit One Network |
$431.69
|
| Rate for Payer: Quartz Commercial |
$528.60
|
| Rate for Payer: WEA Trust Commercial |
$484.55
|
| Rate for Payer: WPS Commercial |
$652.56
|
|
|
US Doppler
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
6187358
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$968.80 |
| Rate for Payer: Aetna Commercial |
$792.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$757.66
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| 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 |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$466.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$810.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$493.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$784.09
|
| Rate for Payer: HFN Commercial |
$810.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$704.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$810.52
|
| Rate for Payer: Quartz Beloit One Network |
$431.69
|
| Rate for Payer: Quartz Commercial |
$572.65
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$484.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$652.56
|
|
|
US Doppler Limited
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
6187360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
US Doppler Limited
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
6187360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| 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 |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
US Doppler Limited
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
6187360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$178.91 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.60
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: HFN Commercial |
$594.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.57
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: The Alliance Commercial |
$313.00
|
| Rate for Payer: United Healthcare Medicaid |
$178.91
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
US Drainage Abscess or Cyst
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$404.32 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$1,299.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,241.84
|
| Rate for Payer: Aetna Managed Medicare |
$404.32
|
| 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 |
$765.32
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,328.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$808.06
|
| Rate for Payer: Health EOS Commercial |
$1,285.16
|
| Rate for Payer: HFN Commercial |
$1,328.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,083.00
|
| 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 |
$938.60
|
| Rate for Payer: Quartz Medicare Advantage |
$866.40
|
| Rate for Payer: The Alliance Commercial |
$5,776.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$794.20
|
| Rate for Payer: WPS Commercial |
$1,069.57
|
|
|
US Drainage Abscess or Cyst
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.90 |
| Max. Negotiated Rate |
$1,371.80 |
| Rate for Payer: Aetna Commercial |
$1,371.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,241.84
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,371.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$722.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$866.40
|
| Rate for Payer: Health EOS Commercial |
$1,314.04
|
| Rate for Payer: HFN Commercial |
$1,371.80
|
| 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 |
$1,155.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.80
|
| Rate for Payer: Quartz Beloit One Network |
$635.36
|
| Rate for Payer: Quartz Commercial |
$823.08
|
| Rate for Payer: The Alliance Commercial |
$722.00
|
| Rate for Payer: WEA Trust Commercial |
$794.20
|
| Rate for Payer: WPS Commercial |
$1,069.57
|
|
|
US Drainage Abscess or Cyst
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544829
|
|
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 Drainage Gallbladder
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
5963643
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,350.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
US Drainage Gallbladder
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
5963643
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$630.00
|
| 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 |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,259.10
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,462.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.00
|
| Rate for Payer: The Alliance Commercial |
$9,000.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
US Drainage Gallbladder
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
5963643
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$213.88 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,137.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.00
|
| Rate for Payer: Health EOS Commercial |
$2,047.50
|
| Rate for Payer: HFN Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.88
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.50
|
| Rate for Payer: Quartz Beloit One Network |
$990.00
|
| Rate for Payer: Quartz Commercial |
$1,282.50
|
| Rate for Payer: The Alliance Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
US Drainage Liver
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
2544831
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$213.88 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,137.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.00
|
| Rate for Payer: Health EOS Commercial |
$2,047.50
|
| Rate for Payer: HFN Commercial |
$2,137.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.88
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.50
|
| Rate for Payer: Quartz Beloit One Network |
$990.00
|
| Rate for Payer: Quartz Commercial |
$1,282.50
|
| Rate for Payer: The Alliance Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
US Drainage Liver
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
2544831
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,350.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
US Drainage Liver
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
2544831
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$630.00
|
| 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 |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,259.10
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,462.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.00
|
| Rate for Payer: The Alliance Commercial |
$9,000.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
