|
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
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$8.80
|
| Rate for Payer: Anthem Medicare Advantage |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.80
|
| Rate for Payer: Health EOS Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$242.88
|
| Rate for Payer: Quartz Commercial |
$314.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8.80
|
| Rate for Payer: The Alliance Commercial |
$33.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.80
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$44.00
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
IP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| 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: 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 |
$331.20
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
US ED Vascular Access
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.76 |
| Max. Negotiated Rate |
$2,268.00 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$158.76
|
| 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 |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.25
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$340.20
|
| Rate for Payer: The Alliance Commercial |
$2,268.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
US ED Vascular Access
|
Professional
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$24.47
|
| Rate for Payer: Anthem Medicare Advantage |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.47
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$538.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.47
|
| Rate for Payer: Health EOS Commercial |
$515.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.47
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$538.65
|
| Rate for Payer: Quartz Beloit One Network |
$249.48
|
| Rate for Payer: Quartz Commercial |
$323.19
|
| Rate for Payer: Quartz Medicare Advantage |
$24.47
|
| Rate for Payer: The Alliance Commercial |
$92.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.47
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$122.35
|
|
|
US ED Vascular Access
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
US Exam Abdo Back Wall, Comp 7677026
|
Professional
|
$371.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
3403595
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$352.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.87
|
| Rate for Payer: Anthem Medicare Advantage |
$33.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.87
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$352.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.87
|
| Rate for Payer: Health EOS Commercial |
$337.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.87
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.45
|
| Rate for Payer: Quartz Beloit One Network |
$163.24
|
| Rate for Payer: Quartz Commercial |
$211.47
|
| Rate for Payer: Quartz Medicare Advantage |
$33.87
|
| Rate for Payer: The Alliance Commercial |
$128.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.87
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$169.35
|
|
|
US Exam,Chest 7660426
|
Professional
|
$308.00
|
|
|
Service Code
|
CPT 76604 26
|
| Hospital Charge Code |
3221485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.54 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Aetna Managed Medicare |
$26.54
|
| Rate for Payer: Anthem Medicare Advantage |
$26.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.54
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$292.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.54
|
| Rate for Payer: Health EOS Commercial |
$280.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.54
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$292.60
|
| Rate for Payer: Quartz Beloit One Network |
$135.52
|
| Rate for Payer: Quartz Commercial |
$175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$26.54
|
| Rate for Payer: The Alliance Commercial |
$100.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.54
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$132.70
|
|
|
US Exam of Head and Neck 7653626
|
Professional
|
$439.00
|
|
|
Service Code
|
CPT 76536 26
|
| Hospital Charge Code |
3206218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.16
|
| Rate for Payer: Aetna Commercial |
$417.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Aetna Managed Medicare |
$26.16
|
| Rate for Payer: Anthem Medicare Advantage |
$26.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.16
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$417.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.50
|
| Rate for Payer: Health EOS Commercial |
$399.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.16
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: Preferred Network Access Commercial |
$417.05
|
| Rate for Payer: Quartz Beloit One Network |
$193.16
|
| Rate for Payer: Quartz Commercial |
$250.23
|
| Rate for Payer: Quartz Medicare Advantage |
$26.16
|
| Rate for Payer: The Alliance Commercial |
$99.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.16
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$130.80
|
|
|
US Exam of Head and Neck 76536PP
|
Professional
|
$1,737.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
4512616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$1,650.15 |
| Rate for Payer: Aetna Commercial |
$1,650.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,493.82
|
| 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 |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,650.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$868.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.72
|
| Rate for Payer: Health EOS Commercial |
$1,580.67
|
| 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 |
$1,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.15
|
| Rate for Payer: Quartz Beloit One Network |
$764.28
|
| Rate for Payer: Quartz Commercial |
$990.09
|
| 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 |
$955.35
|
| Rate for Payer: WPS Commercial |
$538.60
|
|
|
US Exam Thyroid/Soft 76536
|
Professional
|
$146.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
3147564
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.24 |
| Max. Negotiated Rate |
$538.60 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| 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 |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.72
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| 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 |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| 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 |
$80.30
|
| Rate for Payer: WPS Commercial |
$538.60
|
|
|
US Extremity Non-Vascular Bilateral
|
Facility
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Bilateral
|
Facility
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Bilateral
|
Professional
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
IP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$457.66 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$560.40
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Left
|
Facility
OP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$607.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$467.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$448.32
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| 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 |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| 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 |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| 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 |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$607.10
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$188.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$52.28 |
| Max. Negotiated Rate |
$887.30 |
| Rate for Payer: Aetna Commercial |
$887.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Aetna Managed Medicare |
$52.28
|
| Rate for Payer: Anthem Medicare Advantage |
$52.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.28
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$887.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$467.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.28
|
| Rate for Payer: Health EOS Commercial |
$849.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.28
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$887.30
|
| Rate for Payer: Quartz Beloit One Network |
$410.96
|
| Rate for Payer: Quartz Commercial |
$532.38
|
| Rate for Payer: Quartz Medicare Advantage |
$52.28
|
| Rate for Payer: The Alliance Commercial |
$198.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.28
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$261.40
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity, Nonvascular, Realtime Image Complete 76881
|
Professional
|
$304.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
3545508
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$52.28 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Aetna Managed Medicare |
$52.28
|
| Rate for Payer: Anthem Medicare Advantage |
$52.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.28
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.28
|
| Rate for Payer: Health EOS Commercial |
$276.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.28
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$288.80
|
| Rate for Payer: Quartz Beloit One Network |
$133.76
|
| Rate for Payer: Quartz Commercial |
$173.28
|
| Rate for Payer: Quartz Medicare Advantage |
$52.28
|
| Rate for Payer: The Alliance Commercial |
$198.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.28
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: WPS Commercial |
$261.40
|
|
|
US Extremity, Nonvascular, Realtime Image Complete 7688126
|
Professional
|
$304.00
|
|
|
Service Code
|
CPT 76881 26
|
| Hospital Charge Code |
3015310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Aetna Managed Medicare |
$41.87
|
| Rate for Payer: Anthem Medicare Advantage |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.87
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.87
|
| Rate for Payer: Health EOS Commercial |
$276.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.87
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$288.80
|
| Rate for Payer: Quartz Beloit One Network |
$133.76
|
| Rate for Payer: Quartz Commercial |
$173.28
|
| Rate for Payer: Quartz Medicare Advantage |
$41.87
|
| Rate for Payer: The Alliance Commercial |
$159.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: WPS Commercial |
$209.35
|
|
