|
US Lower Extremity Non-Vascular Bilat
|
Professional
|
$1,128.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$496.32 |
| Max. Negotiated Rate |
$1,071.60 |
| Rate for Payer: Aetna Commercial |
$1,071.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.08
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$1,071.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$564.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$676.80
|
| Rate for Payer: Health EOS Commercial |
$1,026.48
|
| Rate for Payer: Multiplan Commercial |
$902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.60
|
| Rate for Payer: Quartz Beloit One Network |
$496.32
|
| Rate for Payer: Quartz Commercial |
$642.96
|
| Rate for Payer: The Alliance Commercial |
$564.00
|
| Rate for Payer: WEA Trust Commercial |
$620.40
|
| Rate for Payer: WPS Commercial |
$835.51
|
|
|
US Lower Extremity Non-Vascular Left
|
Facility
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544924
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Lower Extremity Non-Vascular Left
|
Professional
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544924
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$1,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,047.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.80
|
| Rate for Payer: Health EOS Commercial |
$1,003.73
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.85
|
| Rate for Payer: Quartz Beloit One Network |
$485.32
|
| Rate for Payer: Quartz Commercial |
$628.71
|
| Rate for Payer: The Alliance Commercial |
$551.50
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Lower Extremity Non-Vascular Left
|
Facility
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544924
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Lower Extremity Non-Vascular Right
|
Professional
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544927
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$1,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,047.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.80
|
| Rate for Payer: Health EOS Commercial |
$1,003.73
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.85
|
| Rate for Payer: Quartz Beloit One Network |
$485.32
|
| Rate for Payer: Quartz Commercial |
$628.71
|
| Rate for Payer: The Alliance Commercial |
$551.50
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
5585844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$4,172.00 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Aetna Managed Medicare |
$292.04
|
| 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 |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.25
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$677.95
|
| Rate for Payer: Quartz Medicare Advantage |
$625.80
|
| Rate for Payer: The Alliance Commercial |
$4,172.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544927
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544927
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544928
|
|
Hospital Revenue Code
|
402
|
| 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 Lower Extremity Non-Vascular Right
|
Professional
|
$1,043.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
5585844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$458.92 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$990.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$521.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.80
|
| Rate for Payer: Health EOS Commercial |
$949.13
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: Preferred Network Access Commercial |
$990.85
|
| Rate for Payer: Quartz Beloit One Network |
$458.92
|
| Rate for Payer: Quartz Commercial |
$594.51
|
| Rate for Payer: The Alliance Commercial |
$521.50
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544928
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| 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 |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| 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 |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
5585844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$511.07 |
| Max. Negotiated Rate |
$959.56 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$625.80
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
US & MNTR Parenchymal Tissue Ablation 7694026
|
Professional
|
$1,056.00
|
|
|
Service Code
|
CPT 76940 26
|
| Hospital Charge Code |
5375540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.54 |
| Max. Negotiated Rate |
$1,003.20 |
| Rate for Payer: Aetna Commercial |
$1,003.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.16
|
| Rate for Payer: Aetna Managed Medicare |
$92.54
|
| Rate for Payer: Anthem Medicare Advantage |
$92.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.54
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna Commercial |
$1,003.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$528.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Health EOS Commercial |
$960.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.54
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,003.20
|
| Rate for Payer: Quartz Beloit One Network |
$464.64
|
| Rate for Payer: Quartz Commercial |
$601.92
|
| Rate for Payer: Quartz Medicare Advantage |
$92.54
|
| Rate for Payer: The Alliance Commercial |
$351.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.54
|
| Rate for Payer: WEA Trust Commercial |
$580.80
|
| Rate for Payer: WPS Commercial |
$462.70
|
|
|
US Needle Placement Renal Bilateral
|
Facility
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631017
|
| Min. Negotiated Rate |
$1,815.94 |
| Max. Negotiated Rate |
$3,409.52 |
| Rate for Payer: Aetna Commercial |
$3,335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.18
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,409.52
|
| Rate for Payer: Health EOS Commercial |
$3,298.34
|
| Rate for Payer: HFN Commercial |
$3,409.52
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.94
|
| Rate for Payer: Quartz Commercial |
$2,223.60
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
US Needle Placement Renal Bilateral
|
Professional
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631017
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$3,520.70 |
| Rate for Payer: Aetna Commercial |
$3,520.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,520.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,853.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$3,372.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.07
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,520.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.64
|
| Rate for Payer: Quartz Commercial |
$2,112.42
|
| Rate for Payer: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Needle Placement Renal Bilateral
|
Facility
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631017
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$3,409.52 |
| Rate for Payer: Aetna Commercial |
$3,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,408.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,778.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.18
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,409.52
|
| Rate for Payer: Health EOS Commercial |
$3,298.34
|
| Rate for Payer: HFN Commercial |
$3,409.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.50
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.94
|
| Rate for Payer: Quartz Commercial |
$2,408.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.60
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
US Needle Placement Renal Bilateral
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544930
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$7,708.00 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Needle Placement Renal Bilateral
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544930
|
|
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 Needle Placement Renal Bilateral
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544930
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$847.88 |
| 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: 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 |
$1,156.20
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| 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: The Alliance Commercial |
$963.50
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Needle Placement Renal Left
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544932
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$7,708.00 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Needle Placement Renal Left
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544932
|
|
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 Needle Placement Renal Left
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631013
|
| 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 Needle Placement Renal Left
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544932
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$847.88 |
| 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: 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 |
$1,156.20
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| 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: The Alliance Commercial |
$963.50
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Needle Placement Renal Left
|
Facility
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631013
|
| 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 Needle Placement Renal Left
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631013
|
| 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
|
|
