|
US ED Soft Tissue Lower Extremity
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587139
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$154.56
|
| 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 |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$331.20
|
| Rate for Payer: The Alliance Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
US ED Soft Tissue Neck
|
Facility
OP
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587142
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$183.96 |
| Max. Negotiated Rate |
$2,628.00 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.02
|
| Rate for Payer: Aetna Managed Medicare |
$183.96
|
| 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 |
$348.21
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$604.44
|
| Rate for Payer: Health EOS Commercial |
$584.73
|
| Rate for Payer: HFN Commercial |
$604.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.75
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: NAPHCARE Commercial |
$394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$604.44
|
| Rate for Payer: Quartz Beloit One Network |
$321.93
|
| Rate for Payer: Quartz Commercial |
$427.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.20
|
| Rate for Payer: The Alliance Commercial |
$2,628.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$361.35
|
| Rate for Payer: WPS Commercial |
$486.64
|
|
|
US ED Soft Tissue Neck
|
Professional
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587142
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Aetna Commercial |
$624.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.02
|
| Rate for Payer: Aetna Managed Medicare |
$81.55
|
| Rate for Payer: Anthem Medicare Advantage |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.55
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$624.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.55
|
| Rate for Payer: Health EOS Commercial |
$597.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.55
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$624.15
|
| Rate for Payer: Quartz Beloit One Network |
$289.08
|
| Rate for Payer: Quartz Commercial |
$374.49
|
| Rate for Payer: Quartz Medicare Advantage |
$81.55
|
| Rate for Payer: The Alliance Commercial |
$309.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.55
|
| Rate for Payer: WEA Trust Commercial |
$361.35
|
| Rate for Payer: WPS Commercial |
$407.75
|
|
|
US ED Soft Tissue Neck
|
Facility
IP
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587142
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.93 |
| Max. Negotiated Rate |
$604.44 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.21
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$604.44
|
| Rate for Payer: Health EOS Commercial |
$584.73
|
| Rate for Payer: HFN Commercial |
$604.44
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: NAPHCARE Commercial |
$394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$604.44
|
| Rate for Payer: Quartz Beloit One Network |
$321.93
|
| Rate for Payer: Quartz Commercial |
$394.20
|
| Rate for Payer: WEA Trust Commercial |
$361.35
|
| Rate for Payer: WPS Commercial |
$486.64
|
|
|
US ED Soft Tissue Neck
|
Facility
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2552818
|
| Min. Negotiated Rate |
$491.47 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$601.80
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
US ED Soft Tissue Neck
|
Facility
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2552818
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| 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 |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| 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 |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$651.95
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$35.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
US ED Soft Tissue Neck
|
Professional
|
$1,003.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
2552818
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Aetna Commercial |
$952.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$107.72
|
| Rate for Payer: Anthem Medicare Advantage |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.72
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$501.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.72
|
| Rate for Payer: Health EOS Commercial |
$912.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Preferred Network Access Commercial |
$952.85
|
| Rate for Payer: Quartz Beloit One Network |
$441.32
|
| Rate for Payer: Quartz Commercial |
$571.71
|
| Rate for Payer: Quartz Medicare Advantage |
$107.72
|
| Rate for Payer: The Alliance Commercial |
$409.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.72
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$538.60
|
|
|
US ED Soft Tissue Other
|
Facility
IP
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587145
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.93 |
| Max. Negotiated Rate |
$604.44 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.21
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$604.44
|
| Rate for Payer: Health EOS Commercial |
$584.73
|
| Rate for Payer: HFN Commercial |
$604.44
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: NAPHCARE Commercial |
$394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$604.44
|
| Rate for Payer: Quartz Beloit One Network |
$321.93
|
| Rate for Payer: Quartz Commercial |
$394.20
|
| Rate for Payer: WEA Trust Commercial |
$361.35
|
| Rate for Payer: WPS Commercial |
$486.64
|
|
|
US ED Soft Tissue Other
|
Facility
OP
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587145
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$183.96 |
| Max. Negotiated Rate |
$2,628.00 |
| Rate for Payer: Aetna Commercial |
$591.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.02
|
| Rate for Payer: Aetna Managed Medicare |
$183.96
|
| 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 |
$348.21
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$604.44
|
| Rate for Payer: Health EOS Commercial |
$584.73
|
| Rate for Payer: HFN Commercial |
$604.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.75
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: NAPHCARE Commercial |
$394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$604.44
|
| Rate for Payer: Quartz Beloit One Network |
$321.93
|
| Rate for Payer: Quartz Commercial |
$427.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.20
|
| Rate for Payer: The Alliance Commercial |
$2,628.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$361.35
|
| Rate for Payer: WPS Commercial |
$486.64
|
|
|
US ED Soft Tissue Other
|
Professional
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587145
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$624.15 |
| Rate for Payer: Aetna Commercial |
$624.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.02
|
| Rate for Payer: Aetna Managed Medicare |
$81.55
|
| Rate for Payer: Anthem Medicare Advantage |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.55
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$624.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.55
|
| Rate for Payer: Health EOS Commercial |
$597.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.55
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$624.15
|
| Rate for Payer: Quartz Beloit One Network |
$289.08
|
| Rate for Payer: Quartz Commercial |
$374.49
|
| Rate for Payer: Quartz Medicare Advantage |
$81.55
|
| Rate for Payer: The Alliance Commercial |
$309.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.55
|
| Rate for Payer: WEA Trust Commercial |
$361.35
|
| Rate for Payer: WPS Commercial |
$407.75
|
|
|
US ED Soft Tissue Pelvic Wall
|
Facility
OP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587148
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Aetna Commercial |
$348.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.36
|
| 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 |
$205.11
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$356.04
|
| Rate for Payer: Health EOS Commercial |
$344.43
|
| Rate for Payer: HFN Commercial |
$356.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.25
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: NAPHCARE Commercial |
$232.20
|
| Rate for Payer: Preferred Network Access Commercial |
$356.04
|
| Rate for Payer: Quartz Beloit One Network |
$189.63
|
| Rate for Payer: Quartz Commercial |
$251.55
|
| Rate for Payer: Quartz Medicare Advantage |
$232.20
|
| Rate for Payer: The Alliance Commercial |
$1,548.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$212.85
|
| Rate for Payer: WPS Commercial |
$286.65
|
|
|
US ED Soft Tissue Pelvic Wall
|
Facility
IP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587148
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.63 |
| Max. Negotiated Rate |
$356.04 |
| Rate for Payer: Aetna Commercial |
$348.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.11
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$356.04
|
| Rate for Payer: Health EOS Commercial |
$344.43
|
| Rate for Payer: HFN Commercial |
$356.04
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: NAPHCARE Commercial |
$232.20
|
| Rate for Payer: Preferred Network Access Commercial |
$356.04
|
| Rate for Payer: Quartz Beloit One Network |
$189.63
|
| Rate for Payer: Quartz Commercial |
$232.20
|
| Rate for Payer: WEA Trust Commercial |
$212.85
|
| Rate for Payer: WPS Commercial |
$286.65
|
|
|
US ED Soft Tissue Pelvic Wall
|
Professional
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587148
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.25
|
| Rate for Payer: Anthem Medicare Advantage |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.25
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$367.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.25
|
| Rate for Payer: Health EOS Commercial |
$352.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.25
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Preferred Network Access Commercial |
$367.65
|
| Rate for Payer: Quartz Beloit One Network |
$170.28
|
| Rate for Payer: Quartz Commercial |
$220.59
|
| Rate for Payer: Quartz Medicare Advantage |
$24.25
|
| Rate for Payer: The Alliance Commercial |
$92.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.25
|
| Rate for Payer: WEA Trust Commercial |
$212.85
|
| Rate for Payer: WPS Commercial |
$121.25
|
|
|
US ED Soft Tissue Perineum
|
Facility
IP
|
$471.00
|
|
| Hospital Charge Code |
2587151
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$230.79 |
| Max. Negotiated Rate |
$433.32 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.63
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$282.60
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$282.60
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
US ED Soft Tissue Perineum
|
Professional
|
$471.00
|
|
| Hospital Charge Code |
2587151
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$207.24 |
| Max. Negotiated Rate |
$447.45 |
| Rate for Payer: Cigna Commercial |
$447.45
|
| Rate for Payer: Aetna Commercial |
$447.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.60
|
| Rate for Payer: Health EOS Commercial |
$428.61
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: Preferred Network Access Commercial |
$447.45
|
| Rate for Payer: Quartz Beloit One Network |
$207.24
|
| Rate for Payer: Quartz Commercial |
$268.47
|
| Rate for Payer: The Alliance Commercial |
$235.50
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
US ED Soft Tissue Perineum
|
Facility
OP
|
$471.00
|
|
| Hospital Charge Code |
2587151
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$423.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.06
|
| Rate for Payer: Aetna Managed Medicare |
$131.88
|
| 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 |
$249.63
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$433.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.57
|
| Rate for Payer: Health EOS Commercial |
$419.19
|
| Rate for Payer: HFN Commercial |
$433.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$353.25
|
| Rate for Payer: Multiplan Commercial |
$376.80
|
| Rate for Payer: NAPHCARE Commercial |
$282.60
|
| Rate for Payer: Preferred Network Access Commercial |
$433.32
|
| Rate for Payer: Quartz Beloit One Network |
$230.79
|
| Rate for Payer: Quartz Commercial |
$306.15
|
| Rate for Payer: Quartz Medicare Advantage |
$282.60
|
| Rate for Payer: The Alliance Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$259.05
|
| Rate for Payer: WPS Commercial |
$348.87
|
|
|
US ED Soft Tissue Upper Back
|
Facility
IP
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
US ED Soft Tissue Upper Back
|
Facility
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552822
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,089.48 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| 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 |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| 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 |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$2,089.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
US ED Soft Tissue Upper Back
|
Professional
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552822
|
| Min. Negotiated Rate |
$54.65 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$969.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$54.65
|
| Rate for Payer: Anthem Medicare Advantage |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.65
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$510.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.65
|
| Rate for Payer: Health EOS Commercial |
$928.20
|
| 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: Independent Care Health Plan Medicare |
$54.65
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Preferred Network Access Commercial |
$969.00
|
| Rate for Payer: Quartz Beloit One Network |
$448.80
|
| Rate for Payer: Quartz Commercial |
$581.40
|
| Rate for Payer: Quartz Medicare Advantage |
$54.65
|
| Rate for Payer: The Alliance Commercial |
$207.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.65
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$273.25
|
|
|
US ED Soft Tissue Upper Back
|
Professional
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Aetna Commercial |
$366.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$28.11
|
| Rate for Payer: Anthem Medicare Advantage |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.11
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$366.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.11
|
| Rate for Payer: Health EOS Commercial |
$351.26
|
| 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: Independent Care Health Plan Medicare |
$28.11
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.70
|
| Rate for Payer: Quartz Beloit One Network |
$169.84
|
| Rate for Payer: Quartz Commercial |
$220.02
|
| Rate for Payer: Quartz Medicare Advantage |
$28.11
|
| Rate for Payer: The Alliance Commercial |
$106.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.11
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$140.55
|
|
|
US ED Soft Tissue Upper Back
|
Facility
OP
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$1,544.00 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$108.08
|
| 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 |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.50
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$231.60
|
| Rate for Payer: The Alliance Commercial |
$1,544.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
US ED Soft Tissue Upper Back
|
Facility
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552822
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
IP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| Min. Negotiated Rate |
$472.36 |
| Max. Negotiated Rate |
$886.88 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$578.40
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
US ED Soft Tissue Upper Extremity
|
Professional
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Aetna Commercial |
$915.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Aetna Managed Medicare |
$40.65
|
| Rate for Payer: Anthem Medicare Advantage |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.65
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$915.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$482.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.65
|
| Rate for Payer: Health EOS Commercial |
$877.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.65
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$915.80
|
| Rate for Payer: Quartz Beloit One Network |
$424.16
|
| Rate for Payer: Quartz Commercial |
$549.48
|
| Rate for Payer: Quartz Medicare Advantage |
$40.65
|
| Rate for Payer: The Alliance Commercial |
$154.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.65
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$203.25
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
OP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$154.56
|
| 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 |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$331.20
|
| Rate for Payer: The Alliance Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
