|
US Needle Placement Renal Right
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544934
|
|
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 Right
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544934
|
|
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 Right
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544934
|
|
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 Right
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980121
|
|
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 Right
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631005
|
| 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 Right
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980121
|
|
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 Right
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631005
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,760.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$926.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.07
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.35
|
| Rate for Payer: Quartz Beloit One Network |
$815.32
|
| Rate for Payer: Quartz Commercial |
$1,056.21
|
| Rate for Payer: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Needle Placement Renal Right
|
Facility
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631005
|
| 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 Right
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980121
|
|
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 Non OB Tranvaginal
|
Professional
|
$1,168.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
4500658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.13 |
| Max. Negotiated Rate |
$1,109.60 |
| Rate for Payer: Aetna Commercial |
$1,109.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,004.48
|
| Rate for Payer: Aetna Managed Medicare |
$84.13
|
| Rate for Payer: Anthem Medicare Advantage |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.13
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$1,109.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$584.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.13
|
| Rate for Payer: Health EOS Commercial |
$1,062.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.13
|
| Rate for Payer: Multiplan Commercial |
$934.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.60
|
| Rate for Payer: Quartz Beloit One Network |
$513.92
|
| Rate for Payer: Quartz Commercial |
$665.76
|
| Rate for Payer: Quartz Medicare Advantage |
$84.13
|
| Rate for Payer: The Alliance Commercial |
$319.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.13
|
| Rate for Payer: WEA Trust Commercial |
$642.40
|
| Rate for Payer: WPS Commercial |
$420.65
|
|
|
US Non OB Tranvaginal
|
Facility
OP
|
$1,168.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
4500658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$327.04 |
| Max. Negotiated Rate |
$4,672.00 |
| Rate for Payer: Aetna Commercial |
$1,051.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,004.48
|
| Rate for Payer: Aetna Managed Medicare |
$327.04
|
| 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 |
$619.04
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$1,074.56
|
| Rate for Payer: Health EOS Commercial |
$1,039.52
|
| Rate for Payer: HFN Commercial |
$1,074.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$876.00
|
| Rate for Payer: Multiplan Commercial |
$934.40
|
| Rate for Payer: NAPHCARE Commercial |
$700.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,074.56
|
| Rate for Payer: Quartz Beloit One Network |
$572.32
|
| Rate for Payer: Quartz Commercial |
$759.20
|
| Rate for Payer: Quartz Medicare Advantage |
$700.80
|
| Rate for Payer: The Alliance Commercial |
$4,672.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$642.40
|
| Rate for Payer: WPS Commercial |
$865.14
|
|
|
US Non OB Tranvaginal
|
Facility
IP
|
$1,168.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
4500658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$1,074.56 |
| Rate for Payer: Aetna Commercial |
$1,051.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.04
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cigna Commercial |
$1,074.56
|
| Rate for Payer: Health EOS Commercial |
$1,039.52
|
| Rate for Payer: HFN Commercial |
$1,074.56
|
| Rate for Payer: Multiplan Commercial |
$934.40
|
| Rate for Payer: NAPHCARE Commercial |
$700.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,074.56
|
| Rate for Payer: Quartz Beloit One Network |
$572.32
|
| Rate for Payer: Quartz Commercial |
$700.80
|
| Rate for Payer: WEA Trust Commercial |
$642.40
|
| Rate for Payer: WPS Commercial |
$865.14
|
|
|
US OR Guidance
|
Facility
IP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
6179833
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$976.57 |
| Max. Negotiated Rate |
$1,833.56 |
| Rate for Payer: Aetna Commercial |
$1,793.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.29
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,833.56
|
| Rate for Payer: Health EOS Commercial |
$1,773.77
|
| Rate for Payer: HFN Commercial |
$1,833.56
|
| Rate for Payer: Multiplan Commercial |
$1,594.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,195.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,833.56
|
| Rate for Payer: Quartz Beloit One Network |
$976.57
|
| Rate for Payer: Quartz Commercial |
$1,195.80
|
| Rate for Payer: WEA Trust Commercial |
$1,096.15
|
| Rate for Payer: WPS Commercial |
$1,476.22
|
|
|
US OR Guidance
|
Facility
OP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
6179833
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$558.04 |
| Max. Negotiated Rate |
$1,833.56 |
| Rate for Payer: Aetna Commercial |
$1,793.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,713.98
|
| Rate for Payer: Aetna Managed Medicare |
$558.04
|
| 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 |
$1,056.29
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,833.56
|
| Rate for Payer: Health EOS Commercial |
$1,773.77
|
| Rate for Payer: HFN Commercial |
$1,833.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,494.75
|
| Rate for Payer: Multiplan Commercial |
$1,594.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,195.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,833.56
|
| Rate for Payer: Quartz Beloit One Network |
$976.57
|
| Rate for Payer: Quartz Commercial |
$1,295.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,195.80
|
| Rate for Payer: The Alliance Commercial |
$763.60
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,096.15
|
| Rate for Payer: WPS Commercial |
$1,476.22
|
|
|
US OR Guidance
|
Professional
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
6179833
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.69 |
| Max. Negotiated Rate |
$1,893.35 |
| Rate for Payer: Aetna Commercial |
$1,893.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,713.98
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,893.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$996.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,195.80
|
| Rate for Payer: Health EOS Commercial |
$1,813.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.69
|
| Rate for Payer: Multiplan Commercial |
$1,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,893.35
|
| Rate for Payer: Quartz Beloit One Network |
$876.92
|
| Rate for Payer: Quartz Commercial |
$1,136.01
|
| Rate for Payer: The Alliance Commercial |
$996.50
|
| Rate for Payer: WEA Trust Commercial |
$1,096.15
|
| Rate for Payer: WPS Commercial |
$1,476.22
|
|
|
US Pancreas
|
Facility
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552809
|
| Min. Negotiated Rate |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
US Pancreas
|
Facility
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587175
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,001.56 |
| Max. Negotiated Rate |
$1,880.48 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,226.40
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
US Pancreas
|
Professional
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552809
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna Commercial |
$1,492.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$56.89
|
| Rate for Payer: Anthem Medicare Advantage |
$56.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.89
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,492.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$785.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.89
|
| Rate for Payer: Health EOS Commercial |
$1,429.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$199.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.89
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.45
|
| Rate for Payer: Quartz Beloit One Network |
$691.24
|
| Rate for Payer: Quartz Commercial |
$895.47
|
| Rate for Payer: Quartz Medicare Advantage |
$56.89
|
| Rate for Payer: The Alliance Commercial |
$216.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.89
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$284.45
|
|
|
US Pancreas
|
Facility
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552809
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| 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 |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| 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 |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| 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 |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$6.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
US Pancreas
|
Facility
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587175
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$8,176.00 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Aetna Managed Medicare |
$572.32
|
| 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 |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.00
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,328.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,226.40
|
| Rate for Payer: The Alliance Commercial |
$8,176.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
US Pancreas
|
Professional
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587175
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$1,941.80 |
| Rate for Payer: Aetna Commercial |
$1,941.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Aetna Managed Medicare |
$30.37
|
| Rate for Payer: Anthem Medicare Advantage |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.37
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,941.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,022.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.37
|
| Rate for Payer: Health EOS Commercial |
$1,860.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.37
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.80
|
| Rate for Payer: Quartz Beloit One Network |
$899.36
|
| Rate for Payer: Quartz Commercial |
$1,165.08
|
| Rate for Payer: Quartz Medicare Advantage |
$30.37
|
| Rate for Payer: The Alliance Commercial |
$115.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.37
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$151.85
|
|
|
US Paracentesis
|
Facility
OP
|
$1,754.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
661684
|
| Min. Negotiated Rate |
$841.92 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,140.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$877.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.92
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,140.10
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
US Paracentesis
|
Facility
IP
|
$1,754.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
661684
|
| Min. Negotiated Rate |
$859.46 |
| Max. Negotiated Rate |
$1,613.68 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,052.40
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
US Paracentesis
|
Facility
IP
|
$2,281.00
|
|
|
Service Code
|
CPT 49083 TC
|
| Hospital Charge Code |
2544936
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,117.69 |
| Max. Negotiated Rate |
$2,098.52 |
| Rate for Payer: Aetna Commercial |
$2,052.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.93
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cigna Commercial |
$2,098.52
|
| Rate for Payer: Health EOS Commercial |
$2,030.09
|
| Rate for Payer: HFN Commercial |
$2,098.52
|
| Rate for Payer: Multiplan Commercial |
$1,824.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,368.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,098.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.69
|
| Rate for Payer: Quartz Commercial |
$1,368.60
|
| Rate for Payer: WEA Trust Commercial |
$1,254.55
|
| Rate for Payer: WPS Commercial |
$1,689.54
|
|
|
US Paracentesis
|
Professional
|
$2,281.00
|
|
|
Service Code
|
CPT 49083 TC
|
| Hospital Charge Code |
2544936
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,003.64 |
| Max. Negotiated Rate |
$2,166.95 |
| Rate for Payer: Aetna Commercial |
$2,166.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,961.66
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cigna Commercial |
$2,166.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,140.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,368.60
|
| Rate for Payer: Health EOS Commercial |
$2,075.71
|
| Rate for Payer: Multiplan Commercial |
$1,824.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,166.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,003.64
|
| Rate for Payer: Quartz Commercial |
$1,300.17
|
| Rate for Payer: The Alliance Commercial |
$1,140.50
|
| Rate for Payer: WEA Trust Commercial |
$1,254.55
|
| Rate for Payer: WPS Commercial |
$1,689.54
|
|
