|
US Biopsy
|
Facility
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587079
|
|
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: 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
|
Facility
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3.68 |
| 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: 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: 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 |
$3.68
|
| 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 Biopsy Abdomen
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
625594
|
| Min. Negotiated Rate |
$3.68 |
| 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: 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: 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: 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 |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Abdomen
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna Commercial |
$1,830.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,830.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| 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: Independent Care Health Plan Medicare |
$56.07
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.65
|
| Rate for Payer: Quartz Beloit One Network |
$847.88
|
| Rate for Payer: Quartz Commercial |
$1,098.39
|
| Rate for Payer: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Biopsy Abdomen
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$1,772.84 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| 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 |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Abdomen
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
625594
|
| Min. Negotiated Rate |
$56.07 |
| 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: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| 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 |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| 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: Independent Care Health Plan Medicare |
$56.07
|
| 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: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Biopsy Abdomen
|
Facility
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
625594
|
| Min. Negotiated Rate |
$907.97 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| 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 Abdomen
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$944.23 |
| Max. Negotiated Rate |
$1,772.84 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,156.20
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Breast Bilateral
|
Facility
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627686
|
| Min. Negotiated Rate |
$1,815.94 |
| Max. Negotiated Rate |
$3,409.52 |
| Rate for Payer: Aetna Commercial |
$3,335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.18
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,409.52
|
| Rate for Payer: Health EOS Commercial |
$3,298.34
|
| Rate for Payer: HFN Commercial |
$3,409.52
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.94
|
| Rate for Payer: Quartz Commercial |
$2,223.60
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
US Biopsy Breast Bilateral
|
Facility
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627686
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$3,409.52 |
| Rate for Payer: Aetna Commercial |
$3,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,408.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,778.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.18
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,409.52
|
| Rate for Payer: Health EOS Commercial |
$3,298.34
|
| Rate for Payer: HFN Commercial |
$3,409.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.50
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.94
|
| Rate for Payer: Quartz Commercial |
$2,408.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.60
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
US Biopsy Breast Bilateral
|
Facility
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$11,956.00 |
| Rate for Payer: Aetna Commercial |
$2,690.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,570.54
|
| Rate for Payer: Aetna Managed Medicare |
$836.92
|
| 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 |
$1,584.17
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,749.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,672.64
|
| Rate for Payer: Health EOS Commercial |
$2,660.21
|
| Rate for Payer: HFN Commercial |
$2,749.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,241.75
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,793.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,749.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,464.61
|
| Rate for Payer: Quartz Commercial |
$1,942.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,793.40
|
| Rate for Payer: The Alliance Commercial |
$11,956.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,643.95
|
| Rate for Payer: WPS Commercial |
$2,213.95
|
|
|
US Biopsy Breast Bilateral
|
Professional
|
$2,989.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,315.16 |
| Max. Negotiated Rate |
$2,839.55 |
| Rate for Payer: Aetna Commercial |
$2,839.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,570.54
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,839.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,494.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,793.40
|
| Rate for Payer: Health EOS Commercial |
$2,719.99
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,315.16
|
| Rate for Payer: Quartz Commercial |
$1,703.73
|
| Rate for Payer: The Alliance Commercial |
$1,494.50
|
| Rate for Payer: WEA Trust Commercial |
$1,643.95
|
| Rate for Payer: WPS Commercial |
$2,213.95
|
|
|
US Biopsy Breast Bilateral
|
Professional
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627686
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$3,520.70 |
| Rate for Payer: Aetna Commercial |
$3,520.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,520.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,853.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$3,372.46
|
| 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: Independent Care Health Plan Medicare |
$56.07
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,520.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.64
|
| Rate for Payer: Quartz Commercial |
$2,112.42
|
| Rate for Payer: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Biopsy Breast Bilateral
|
Facility
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,464.61 |
| Max. Negotiated Rate |
$2,749.88 |
| Rate for Payer: Aetna Commercial |
$2,690.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,584.17
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,749.88
|
| Rate for Payer: Health EOS Commercial |
$2,660.21
|
| Rate for Payer: HFN Commercial |
$2,749.88
|
| Rate for Payer: Multiplan Commercial |
$2,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,793.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,749.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,464.61
|
| Rate for Payer: Quartz Commercial |
$1,793.40
|
| Rate for Payer: WEA Trust Commercial |
$1,643.95
|
| Rate for Payer: WPS Commercial |
$2,213.95
|
|
|
US Biopsy Breast Left
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| Min. Negotiated Rate |
$3.68 |
| 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: 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: 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: 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 |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Breast Left
|
Professional
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,720.40 |
| 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: Cigna Commercial |
$3,714.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,955.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,346.00
|
| Rate for Payer: Health EOS Commercial |
$3,558.10
|
| 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: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
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: 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
|
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 |
$15,640.00 |
| Rate for Payer: Aetna Commercial |
$3,519.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,362.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,094.80
|
| 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 |
$2,072.30
|
| 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: Dean Health DHI/DHP/ASO |
$2,188.04
|
| 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 |
$2,932.50
|
| 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 |
$2,541.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,346.00
|
| Rate for Payer: The Alliance Commercial |
$15,640.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$2,150.50
|
| Rate for Payer: WPS Commercial |
$2,896.14
|
|
|
US Biopsy Breast Left
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| Min. Negotiated Rate |
$56.07 |
| 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: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| 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 |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| 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: Independent Care Health Plan Medicare |
$56.07
|
| 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: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
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: 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
|
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 |
$1,092.90
|
| 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 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: 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
|
Professional
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$859.32 |
| 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: Cigna Commercial |
$1,855.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$976.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,171.80
|
| Rate for Payer: Health EOS Commercial |
$1,777.23
|
| 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: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
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: 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
|
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: 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
|
|
