|
UroVysion, Detection of Bladder Cancer
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,017.67 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,246.13
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
UroVysion, Detection of Bladder Cancer
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,162.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,349.97
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$1,557.66
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$113.61 |
| Max. Negotiated Rate |
$1,409.88 |
| Rate for Payer: Aetna Commercial |
$1,409.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Aetna Managed Medicare |
$113.61
|
| Rate for Payer: Anthem Medicare Advantage |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.61
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,409.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$742.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.61
|
| Rate for Payer: Health EOS Commercial |
$1,350.51
|
| Rate for Payer: HFN Commercial |
$1,409.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$432.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.61
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: NAPHCARE Commercial |
$170.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,409.88
|
| Rate for Payer: Quartz Beloit One Network |
$653.00
|
| Rate for Payer: Quartz Commercial |
$845.93
|
| Rate for Payer: Quartz Medicare Advantage |
$113.61
|
| Rate for Payer: The Alliance Commercial |
$431.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.61
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$568.05
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.35 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$506.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.10
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.42
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.14
|
| Rate for Payer: The Alliance Commercial |
$304.35
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.35 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$506.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.10
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.42
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.14
|
| Rate for Payer: The Alliance Commercial |
$304.35
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$886.19 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,085.14
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$1,718.13 |
| Rate for Payer: Aetna Commercial |
$1,718.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$76.09
|
| Rate for Payer: Anthem Medicare Advantage |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.09
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,718.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$904.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.09
|
| Rate for Payer: Health EOS Commercial |
$1,645.79
|
| Rate for Payer: HFN Commercial |
$1,718.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.09
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$114.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,718.13
|
| Rate for Payer: Quartz Beloit One Network |
$795.77
|
| Rate for Payer: Quartz Commercial |
$1,030.88
|
| Rate for Payer: Quartz Medicare Advantage |
$76.09
|
| Rate for Payer: The Alliance Commercial |
$289.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.09
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$380.43
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,365.35 |
| Rate for Payer: Aetna Commercial |
$1,335.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$964.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$742.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$712.36
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$830.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,320.83
|
| Rate for Payer: HFN Commercial |
$1,365.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.35
|
| Rate for Payer: Quartz Beloit One Network |
$727.20
|
| Rate for Payer: Quartz Commercial |
$964.65
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,099.22
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$886.19 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,085.14
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$1,718.13 |
| Rate for Payer: Aetna Commercial |
$1,718.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$76.09
|
| Rate for Payer: Anthem Medicare Advantage |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.09
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,718.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$904.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.09
|
| Rate for Payer: Health EOS Commercial |
$1,645.79
|
| Rate for Payer: HFN Commercial |
$1,718.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.09
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$114.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,718.13
|
| Rate for Payer: Quartz Beloit One Network |
$795.77
|
| Rate for Payer: Quartz Commercial |
$1,030.88
|
| Rate for Payer: Quartz Medicare Advantage |
$76.09
|
| Rate for Payer: The Alliance Commercial |
$289.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.09
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$380.43
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$727.20 |
| Max. Negotiated Rate |
$1,365.35 |
| Rate for Payer: Aetna Commercial |
$1,335.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.56
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: Health EOS Commercial |
$1,320.83
|
| Rate for Payer: HFN Commercial |
$1,365.35
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.35
|
| Rate for Payer: Quartz Beloit One Network |
$727.20
|
| Rate for Payer: Quartz Commercial |
$890.45
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$1,099.22
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| 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 |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Abdomen Limited
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Abdomen Limited
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| 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 |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Abdominal Aorta
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
US Abdominal Aorta
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$703.25 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$703.25
|
| Rate for Payer: Health EOS Commercial |
$680.32
|
| Rate for Payer: HFN Commercial |
$703.25
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: Preferred Network Access Commercial |
$703.25
|
| Rate for Payer: Quartz Beloit One Network |
$374.56
|
| Rate for Payer: Quartz Commercial |
$458.64
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$566.17
|
|
|
US Abdominal Aorta
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$60.50
|
| Rate for Payer: Anthem Medicare Advantage |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.50
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.50
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$207.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$90.75
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$60.50
|
| Rate for Payer: The Alliance Commercial |
$229.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$302.48
|
|
|
US Abdominal Aorta
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.74
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
US Abdominal Aorta
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Aetna Managed Medicare |
$214.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$703.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.77
|
| Rate for Payer: Health EOS Commercial |
$680.32
|
| Rate for Payer: HFN Commercial |
$703.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.30
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: NAPHCARE Commercial |
$458.64
|
| Rate for Payer: Preferred Network Access Commercial |
$703.25
|
| Rate for Payer: Quartz Beloit One Network |
$374.56
|
| Rate for Payer: Quartz Commercial |
$496.86
|
| Rate for Payer: Quartz Medicare Advantage |
$458.64
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$566.17
|
|
|
US Abdominal Aorta
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$726.18 |
| Rate for Payer: Aetna Commercial |
$726.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$726.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$382.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$695.60
|
| Rate for Payer: HFN Commercial |
$726.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$726.18
|
| Rate for Payer: Quartz Beloit One Network |
$336.34
|
| Rate for Payer: Quartz Commercial |
$435.71
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Aetna Managed Medicare |
$343.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.18
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$919.62
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: NAPHCARE Commercial |
$735.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$797.00
|
| Rate for Payer: Quartz Medicare Advantage |
$735.70
|
| Rate for Payer: The Alliance Commercial |
$286.62
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
US Aorta Complete
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$1,164.85 |
| Rate for Payer: Aetna Commercial |
$1,164.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Aetna Managed Medicare |
$71.66
|
| Rate for Payer: Anthem Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.66
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,164.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.66
|
| Rate for Payer: Health EOS Commercial |
$1,115.81
|
| Rate for Payer: HFN Commercial |
$1,164.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: NAPHCARE Commercial |
$107.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.85
|
| Rate for Payer: Quartz Beloit One Network |
$539.51
|
| Rate for Payer: Quartz Commercial |
$698.91
|
| Rate for Payer: Quartz Medicare Advantage |
$71.66
|
| Rate for Payer: The Alliance Commercial |
$272.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.66
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$358.28
|
|
