|
US Guided Intraoperative Prostate
|
Facility
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$780.57 |
| Max. Negotiated Rate |
$1,465.56 |
| Rate for Payer: Aetna Commercial |
$1,433.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.29
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,465.56
|
| Rate for Payer: Health EOS Commercial |
$1,417.77
|
| Rate for Payer: HFN Commercial |
$1,465.56
|
| Rate for Payer: Multiplan Commercial |
$1,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$955.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.56
|
| Rate for Payer: Quartz Beloit One Network |
$780.57
|
| Rate for Payer: Quartz Commercial |
$955.80
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
|
US Guided Intraoperative Prostate
|
Facility
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.04 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna Commercial |
$1,433.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.98
|
| Rate for Payer: Aetna Managed Medicare |
$446.04
|
| 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 |
$844.29
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,465.56
|
| Rate for Payer: Health EOS Commercial |
$1,417.77
|
| Rate for Payer: HFN Commercial |
$1,465.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$955.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.56
|
| Rate for Payer: Quartz Beloit One Network |
$780.57
|
| Rate for Payer: Quartz Commercial |
$1,035.45
|
| Rate for Payer: Quartz Medicare Advantage |
$955.80
|
| Rate for Payer: The Alliance Commercial |
$6,372.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
|
US Guided Marker Placement
|
Facility
OP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$391.95
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
US Guided Marker Placement
|
Facility
OP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
US Guided Marker Placement
|
Professional
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$254.76 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Aetna Commercial |
$550.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$550.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.40
|
| Rate for Payer: Health EOS Commercial |
$526.89
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$550.05
|
| Rate for Payer: Quartz Beloit One Network |
$254.76
|
| Rate for Payer: Quartz Commercial |
$330.03
|
| Rate for Payer: The Alliance Commercial |
$289.50
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
US Guided Marker Placement
|
Professional
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Aetna Commercial |
$572.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Aetna Managed Medicare |
$79.48
|
| Rate for Payer: Anthem Medicare Advantage |
$79.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.48
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$572.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.48
|
| Rate for Payer: Health EOS Commercial |
$548.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.48
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$572.85
|
| Rate for Payer: Quartz Beloit One Network |
$265.32
|
| Rate for Payer: Quartz Commercial |
$343.71
|
| Rate for Payer: Quartz Medicare Advantage |
$79.48
|
| Rate for Payer: The Alliance Commercial |
$337.79
|
| Rate for Payer: United Healthcare Medicaid |
$65.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.48
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$357.66
|
|
|
US Guided Marker Placement
|
Facility
IP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
US Guided Marker Placement
|
Facility
IP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$554.76 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$361.80
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
US Guided Marker Placement ea add
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
US Guided Marker Placement ea add
|
Professional
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$39.85
|
| Rate for Payer: Anthem Medicare Advantage |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.85
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.85
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.85
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: Quartz Medicare Advantage |
$39.85
|
| Rate for Payer: The Alliance Commercial |
$169.36
|
| Rate for Payer: United Healthcare Medicaid |
$31.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.85
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$179.32
|
|
|
US Guided Marker Placement ea add
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.16 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.16
|
| 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 |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.75
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$298.20
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
US Guided Marker Placement ea add
|
Professional
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Aetna Commercial |
$472.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$39.85
|
| Rate for Payer: Anthem Medicare Advantage |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.85
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$472.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.85
|
| Rate for Payer: Health EOS Commercial |
$452.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.85
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$472.15
|
| Rate for Payer: Quartz Beloit One Network |
$218.68
|
| Rate for Payer: Quartz Commercial |
$283.29
|
| Rate for Payer: Quartz Medicare Advantage |
$39.85
|
| Rate for Payer: The Alliance Commercial |
$169.36
|
| Rate for Payer: United Healthcare Medicaid |
$31.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.85
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$179.32
|
|
|
US Guided Marker Placement ea add
|
Facility
OP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| 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 |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
US Guided Marker Placement ea add
|
Facility
IP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
US Guided Needle Placement
|
Facility
OP
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$1,029.48 |
| Rate for Payer: Aetna Commercial |
$1,007.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.34
|
| Rate for Payer: Aetna Managed Medicare |
$313.32
|
| 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 |
$593.07
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,029.48
|
| Rate for Payer: Health EOS Commercial |
$995.91
|
| Rate for Payer: HFN Commercial |
$1,029.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$839.25
|
| Rate for Payer: Multiplan Commercial |
$895.20
|
| Rate for Payer: NAPHCARE Commercial |
$671.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.48
|
| Rate for Payer: Quartz Beloit One Network |
$548.31
|
| Rate for Payer: Quartz Commercial |
$727.35
|
| Rate for Payer: Quartz Medicare Advantage |
$671.40
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$615.45
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
|
US Guided Needle Placement
|
Professional
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$1,063.05 |
| Rate for Payer: Aetna Commercial |
$1,063.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.34
|
| 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 |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,063.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$559.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,018.29
|
| 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 |
$895.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,063.05
|
| Rate for Payer: Quartz Beloit One Network |
$492.36
|
| Rate for Payer: Quartz Commercial |
$637.83
|
| 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 |
$615.45
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Guided Needle Placement
|
Facility
IP
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$548.31 |
| Max. Negotiated Rate |
$1,029.48 |
| Rate for Payer: Aetna Commercial |
$1,007.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.07
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,029.48
|
| Rate for Payer: Health EOS Commercial |
$995.91
|
| Rate for Payer: HFN Commercial |
$1,029.48
|
| Rate for Payer: Multiplan Commercial |
$895.20
|
| Rate for Payer: NAPHCARE Commercial |
$671.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.48
|
| Rate for Payer: Quartz Beloit One Network |
$548.31
|
| Rate for Payer: Quartz Commercial |
$671.40
|
| Rate for Payer: WEA Trust Commercial |
$615.45
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
|
US Guided Needle Placement
|
Facility
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$1,321.12 |
| Rate for Payer: Aetna Commercial |
$1,292.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$933.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$718.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$689.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.08
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,321.12
|
| Rate for Payer: Health EOS Commercial |
$1,278.04
|
| Rate for Payer: HFN Commercial |
$1,321.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,077.00
|
| Rate for Payer: Multiplan Commercial |
$1,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,321.12
|
| Rate for Payer: Quartz Beloit One Network |
$703.64
|
| Rate for Payer: Quartz Commercial |
$933.40
|
| Rate for Payer: Quartz Medicare Advantage |
$861.60
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$789.80
|
| Rate for Payer: WPS Commercial |
$1,063.65
|
|
|
US Guided Needle Placement
|
Facility
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$703.64 |
| Max. Negotiated Rate |
$1,321.12 |
| Rate for Payer: Aetna Commercial |
$1,292.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$761.08
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,321.12
|
| Rate for Payer: Health EOS Commercial |
$1,278.04
|
| Rate for Payer: HFN Commercial |
$1,321.12
|
| Rate for Payer: Multiplan Commercial |
$1,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,321.12
|
| Rate for Payer: Quartz Beloit One Network |
$703.64
|
| Rate for Payer: Quartz Commercial |
$861.60
|
| Rate for Payer: WEA Trust Commercial |
$789.80
|
| Rate for Payer: WPS Commercial |
$1,063.65
|
|
|
US Guided Needle Placement
|
Professional
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$1,364.20 |
| Rate for Payer: Aetna Commercial |
$1,364.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.96
|
| 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 |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,364.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$718.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,306.76
|
| 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 |
$1,148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.20
|
| Rate for Payer: Quartz Beloit One Network |
$631.84
|
| Rate for Payer: Quartz Commercial |
$818.52
|
| 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 |
$789.80
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Guided Needle Placement S&I
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
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 Guided Needle Placement S&I
|
Facility
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| 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 Guided Needle Placement S&I
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
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 Guided Needle Placement S&I
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| 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 Guided Needle Placement S&I
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| 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
|
|
