|
US Scrotum (Contents)
|
Facility
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
630851
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,182.20 |
| Rate for Payer: Aetna Commercial |
$1,156.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$835.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$642.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$616.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.05
|
| 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 |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,182.20
|
| 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 |
$1,143.65
|
| Rate for Payer: HFN Commercial |
$1,182.20
|
| 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 |
$1,028.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,182.20
|
| Rate for Payer: Quartz Beloit One Network |
$629.65
|
| Rate for Payer: Quartz Commercial |
$835.25
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$922.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$951.80
|
|
|
US Scrotum (Contents)
|
Professional
|
$1,442.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
2544975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$1,369.90 |
| Rate for Payer: Aetna Commercial |
$1,369.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.12
|
| Rate for Payer: Aetna Managed Medicare |
$68.36
|
| Rate for Payer: Anthem Medicare Advantage |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.36
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$1,369.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$721.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.36
|
| Rate for Payer: Health EOS Commercial |
$1,312.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.36
|
| Rate for Payer: Multiplan Commercial |
$1,153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,369.90
|
| Rate for Payer: Quartz Beloit One Network |
$634.48
|
| Rate for Payer: Quartz Commercial |
$821.94
|
| Rate for Payer: Quartz Medicare Advantage |
$68.36
|
| Rate for Payer: The Alliance Commercial |
$259.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.36
|
| Rate for Payer: WEA Trust Commercial |
$793.10
|
| Rate for Payer: WPS Commercial |
$341.80
|
|
|
US Scrotum (Contents)
|
Facility
OP
|
$1,442.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
2544975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$403.76 |
| Max. Negotiated Rate |
$5,768.00 |
| Rate for Payer: Aetna Commercial |
$1,297.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.12
|
| Rate for Payer: Aetna Managed Medicare |
$403.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$764.26
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$1,326.64
|
| Rate for Payer: Health EOS Commercial |
$1,283.38
|
| Rate for Payer: HFN Commercial |
$1,326.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,081.50
|
| Rate for Payer: Multiplan Commercial |
$1,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,326.64
|
| Rate for Payer: Quartz Beloit One Network |
$706.58
|
| Rate for Payer: Quartz Commercial |
$937.30
|
| Rate for Payer: Quartz Medicare Advantage |
$865.20
|
| Rate for Payer: The Alliance Commercial |
$5,768.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$793.10
|
| Rate for Payer: WPS Commercial |
$1,068.09
|
|
|
US Scrotum (Contents)
|
Facility
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
630851
|
| Min. Negotiated Rate |
$629.65 |
| Max. Negotiated Rate |
$1,182.20 |
| Rate for Payer: Aetna Commercial |
$1,156.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.05
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,182.20
|
| Rate for Payer: Health EOS Commercial |
$1,143.65
|
| Rate for Payer: HFN Commercial |
$1,182.20
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: NAPHCARE Commercial |
$771.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,182.20
|
| Rate for Payer: Quartz Beloit One Network |
$629.65
|
| Rate for Payer: Quartz Commercial |
$771.00
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: WPS Commercial |
$951.80
|
|
|
US Scrotum (Contents)
|
Professional
|
$1,285.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
630851
|
| Min. Negotiated Rate |
$97.87 |
| Max. Negotiated Rate |
$1,220.75 |
| Rate for Payer: Aetna Commercial |
$1,220.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.10
|
| Rate for Payer: Aetna Managed Medicare |
$97.87
|
| Rate for Payer: Anthem Medicare Advantage |
$97.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.87
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,220.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$642.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.87
|
| Rate for Payer: Health EOS Commercial |
$1,169.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.87
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.75
|
| Rate for Payer: Quartz Beloit One Network |
$565.40
|
| Rate for Payer: Quartz Commercial |
$732.45
|
| Rate for Payer: Quartz Medicare Advantage |
$97.87
|
| Rate for Payer: The Alliance Commercial |
$371.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.87
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: WPS Commercial |
$489.35
|
|
|
US Scrotum (Contents)
|
Facility
IP
|
$1,442.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
2544975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$706.58 |
| Max. Negotiated Rate |
$1,326.64 |
| Rate for Payer: Aetna Commercial |
$1,297.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$764.26
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$1,326.64
|
| Rate for Payer: Health EOS Commercial |
$1,283.38
|
| Rate for Payer: HFN Commercial |
$1,326.64
|
| Rate for Payer: Multiplan Commercial |
$1,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,326.64
|
| Rate for Payer: Quartz Beloit One Network |
$706.58
|
| Rate for Payer: Quartz Commercial |
$865.20
|
| Rate for Payer: WEA Trust Commercial |
$793.10
|
| Rate for Payer: WPS Commercial |
$1,068.09
|
|
|
US Spinal Canal
|
Professional
|
$748.00
|
|
|
Service Code
|
CPT 76800 TC
|
| Hospital Charge Code |
2544977
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.14 |
| Max. Negotiated Rate |
$710.60 |
| Rate for Payer: Aetna Commercial |
$710.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$93.14
|
| Rate for Payer: Anthem Medicare Advantage |
$93.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.14
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$710.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$374.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.14
|
| Rate for Payer: Health EOS Commercial |
$680.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$290.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.14
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: Preferred Network Access Commercial |
$710.60
|
| Rate for Payer: Quartz Beloit One Network |
$329.12
|
| Rate for Payer: Quartz Commercial |
$426.36
|
| Rate for Payer: Quartz Medicare Advantage |
$93.14
|
| Rate for Payer: The Alliance Commercial |
$353.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.14
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$465.70
|
|
|
US Spinal Canal
|
Facility
IP
|
$693.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
630847
|
| Min. Negotiated Rate |
$339.57 |
| Max. Negotiated Rate |
$637.56 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.29
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$637.56
|
| Rate for Payer: Health EOS Commercial |
$616.77
|
| Rate for Payer: HFN Commercial |
$637.56
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: NAPHCARE Commercial |
$415.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.56
|
| Rate for Payer: Quartz Beloit One Network |
$339.57
|
| Rate for Payer: Quartz Commercial |
$415.80
|
| Rate for Payer: WEA Trust Commercial |
$381.15
|
| Rate for Payer: WPS Commercial |
$513.31
|
|
|
US Spinal Canal
|
Facility
OP
|
$693.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
630847
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$11,493.32 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.98
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.64
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.29
|
| 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 |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$637.56
|
| 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 |
$616.77
|
| Rate for Payer: HFN Commercial |
$637.56
|
| 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 |
$554.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$637.56
|
| Rate for Payer: Quartz Beloit One Network |
$339.57
|
| Rate for Payer: Quartz Commercial |
$450.45
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$11,493.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$381.15
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$513.31
|
|
|
US Spinal Canal
|
Facility
OP
|
$748.00
|
|
|
Service Code
|
CPT 76800 TC
|
| Hospital Charge Code |
2544977
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$209.44 |
| Max. Negotiated Rate |
$2,992.00 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.28
|
| Rate for Payer: Aetna Managed Medicare |
$209.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$486.20
|
| Rate for Payer: Quartz Medicare Advantage |
$448.80
|
| Rate for Payer: The Alliance Commercial |
$2,992.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
US Spinal Canal
|
Professional
|
$693.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
630847
|
| Min. Negotiated Rate |
$149.13 |
| Max. Negotiated Rate |
$745.65 |
| Rate for Payer: Aetna Commercial |
$658.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$595.98
|
| Rate for Payer: Aetna Managed Medicare |
$149.13
|
| Rate for Payer: Anthem Medicare Advantage |
$149.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$149.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$149.13
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$658.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$346.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.13
|
| Rate for Payer: Health EOS Commercial |
$630.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$481.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$481.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$149.13
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: Preferred Network Access Commercial |
$658.35
|
| Rate for Payer: Quartz Beloit One Network |
$304.92
|
| Rate for Payer: Quartz Commercial |
$395.01
|
| Rate for Payer: Quartz Medicare Advantage |
$149.13
|
| Rate for Payer: The Alliance Commercial |
$566.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.13
|
| Rate for Payer: WEA Trust Commercial |
$381.15
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
|
US Spinal Canal
|
Facility
IP
|
$748.00
|
|
|
Service Code
|
CPT 76800 TC
|
| Hospital Charge Code |
2544977
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$688.16 |
| Rate for Payer: Aetna Commercial |
$673.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.44
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$688.16
|
| Rate for Payer: Health EOS Commercial |
$665.72
|
| Rate for Payer: HFN Commercial |
$688.16
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: NAPHCARE Commercial |
$448.80
|
| Rate for Payer: Preferred Network Access Commercial |
$688.16
|
| Rate for Payer: Quartz Beloit One Network |
$366.52
|
| Rate for Payer: Quartz Commercial |
$448.80
|
| Rate for Payer: WEA Trust Commercial |
$411.40
|
| Rate for Payer: WPS Commercial |
$554.04
|
|
|
US Spleen
|
Facility
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552817
|
| Min. Negotiated Rate |
$734.51 |
| Max. Negotiated Rate |
$1,379.08 |
| Rate for Payer: Aetna Commercial |
$1,349.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.47
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,379.08
|
| Rate for Payer: Health EOS Commercial |
$1,334.11
|
| Rate for Payer: HFN Commercial |
$1,379.08
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: NAPHCARE Commercial |
$899.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.08
|
| Rate for Payer: Quartz Beloit One Network |
$734.51
|
| Rate for Payer: Quartz Commercial |
$899.40
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Spleen
|
Facility
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552817
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$1,379.08 |
| Rate for Payer: Aetna Commercial |
$1,349.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$974.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.47
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,379.08
|
| 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 |
$1,334.11
|
| Rate for Payer: HFN Commercial |
$1,379.08
|
| 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 |
$1,199.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.08
|
| Rate for Payer: Quartz Beloit One Network |
$734.51
|
| Rate for Payer: Quartz Commercial |
$974.35
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Spleen
|
Facility
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$863.87 |
| Max. Negotiated Rate |
$1,621.96 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,057.80
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Spleen
|
Professional
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$1,674.85 |
| Rate for Payer: Aetna Commercial |
$1,674.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Aetna Managed Medicare |
$58.05
|
| Rate for Payer: Anthem Medicare Advantage |
$58.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.05
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,674.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$881.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.05
|
| Rate for Payer: Health EOS Commercial |
$1,604.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.05
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.85
|
| Rate for Payer: Quartz Beloit One Network |
$775.72
|
| Rate for Payer: Quartz Commercial |
$1,004.91
|
| Rate for Payer: Quartz Medicare Advantage |
$58.05
|
| Rate for Payer: The Alliance Commercial |
$220.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.05
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$290.25
|
|
|
US Spleen
|
Professional
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552817
|
| Min. Negotiated Rate |
$85.23 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Aetna Commercial |
$1,424.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Aetna Managed Medicare |
$85.23
|
| Rate for Payer: Anthem Medicare Advantage |
$85.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.23
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,424.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$749.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.23
|
| Rate for Payer: Health EOS Commercial |
$1,364.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.23
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,424.05
|
| Rate for Payer: Quartz Beloit One Network |
$659.56
|
| Rate for Payer: Quartz Commercial |
$854.43
|
| Rate for Payer: Quartz Medicare Advantage |
$85.23
|
| Rate for Payer: The Alliance Commercial |
$323.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.23
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$426.15
|
|
|
US Spleen
|
Facility
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587202
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$493.64 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Aetna Managed Medicare |
$493.64
|
| 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 |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.25
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,145.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.80
|
| Rate for Payer: The Alliance Commercial |
$7,052.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
Ustekinumab and Anti-Ustekinumab Antibody
|
Professional
|
$180.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5542685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$171.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$163.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$171.00
|
| Rate for Payer: Quartz Beloit One Network |
$79.20
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Ustekinumab and Anti-Ustekinumab Antibody
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5542685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
Ustekinumab and Anti-Ustekinumab Antibody
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5542685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$117.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$720.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
US Thoracentesis
|
Facility
OP
|
$2,950.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2544979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Commercial |
$2,655.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,537.00
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| 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 |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,714.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$2,625.50
|
| Rate for Payer: HFN Commercial |
$2,714.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$2,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,714.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,445.50
|
| Rate for Payer: Quartz Commercial |
$1,917.50
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,622.50
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$2,185.06
|
|
|
US Thoracentesis
|
Facility
OP
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$620.92 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Commercial |
$2,043.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.20
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,475.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,089.60
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,088.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$2,020.30
|
| Rate for Payer: HFN Commercial |
$2,088.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.30
|
| Rate for Payer: Quartz Commercial |
$1,475.50
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: WEA Trust Commercial |
$1,248.50
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$1,681.39
|
|
|
US Thoracentesis
|
Facility
IP
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$1,112.30 |
| Max. Negotiated Rate |
$2,088.40 |
| Rate for Payer: Aetna Commercial |
$2,043.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.10
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,088.40
|
| Rate for Payer: Health EOS Commercial |
$2,020.30
|
| Rate for Payer: HFN Commercial |
$2,088.40
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,362.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,088.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.30
|
| Rate for Payer: Quartz Commercial |
$1,362.00
|
| Rate for Payer: WEA Trust Commercial |
$1,248.50
|
| Rate for Payer: WPS Commercial |
$1,681.39
|
|
|
US Thoracentesis
|
Professional
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$2,156.50 |
| Rate for Payer: Aetna Commercial |
$2,156.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.20
|
| Rate for Payer: Aetna Managed Medicare |
$102.87
|
| Rate for Payer: Anthem Medicare Advantage |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.87
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,156.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,135.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.87
|
| Rate for Payer: Health EOS Commercial |
$2,065.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$373.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.87
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,156.50
|
| Rate for Payer: Quartz Beloit One Network |
$998.80
|
| Rate for Payer: Quartz Commercial |
$1,293.90
|
| Rate for Payer: Quartz Medicare Advantage |
$102.87
|
| Rate for Payer: The Alliance Commercial |
$437.20
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.87
|
| Rate for Payer: WEA Trust Commercial |
$1,248.50
|
| Rate for Payer: WPS Commercial |
$462.92
|
|
