|
US Aorta Complete
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$1,138.18 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Aetna Managed Medicare |
$105.75
|
| Rate for Payer: Anthem Medicare Advantage |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.75
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,138.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$599.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.75
|
| Rate for Payer: Health EOS Commercial |
$1,090.25
|
| Rate for Payer: HFN Commercial |
$1,138.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: NAPHCARE Commercial |
$158.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.18
|
| Rate for Payer: Quartz Beloit One Network |
$527.16
|
| Rate for Payer: Quartz Commercial |
$682.91
|
| Rate for Payer: Quartz Medicare Advantage |
$105.75
|
| Rate for Payer: The Alliance Commercial |
$401.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.75
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$528.74
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.08
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| 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 |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| 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 |
$958.46
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$778.75
|
| 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 |
$658.94
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
US Aorta Complete
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$600.82 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$735.70
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
US Aorta Complete
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$718.85
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
US Aorta Duplex Complete
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$643.97
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
US Aorta Duplex Complete
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Aetna Managed Medicare |
$300.52
|
| 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 |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.62
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.96
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$643.97
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$697.63
|
| Rate for Payer: Quartz Medicare Advantage |
$643.97
|
| Rate for Payer: The Alliance Commercial |
$286.62
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
US Aorta Duplex Complete
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$1,019.62 |
| Rate for Payer: Aetna Commercial |
$1,019.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| 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 |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$1,019.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$536.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.66
|
| Rate for Payer: Health EOS Commercial |
$976.68
|
| Rate for Payer: HFN Commercial |
$1,019.62
|
| 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 |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$107.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,019.62
|
| Rate for Payer: Quartz Beloit One Network |
$472.24
|
| Rate for Payer: Quartz Commercial |
$611.77
|
| 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 |
$590.30
|
| Rate for Payer: WPS Commercial |
$358.28
|
|
|
US Aorta Duplex Limited
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$647.75 |
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.16
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$647.75
|
| Rate for Payer: Health EOS Commercial |
$626.63
|
| Rate for Payer: HFN Commercial |
$647.75
|
| Rate for Payer: Multiplan Commercial |
$563.26
|
| Rate for Payer: Preferred Network Access Commercial |
$647.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.00
|
| Rate for Payer: Quartz Commercial |
$422.45
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: WPS Commercial |
$521.49
|
|
|
US Aorta Duplex Limited
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$668.88 |
| Rate for Payer: Aetna Commercial |
$668.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| 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 |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$668.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$640.71
|
| Rate for Payer: HFN Commercial |
$668.88
|
| 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 |
$563.26
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$668.88
|
| Rate for Payer: Quartz Beloit One Network |
$309.80
|
| Rate for Payer: Quartz Commercial |
$401.33
|
| 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 |
$387.24
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
US Aorta Duplex Limited
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Aetna Managed Medicare |
$197.14
|
| 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 |
$373.16
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$647.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.01
|
| Rate for Payer: Health EOS Commercial |
$626.63
|
| Rate for Payer: HFN Commercial |
$647.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.06
|
| Rate for Payer: Multiplan Commercial |
$563.26
|
| Rate for Payer: NAPHCARE Commercial |
$422.45
|
| Rate for Payer: Preferred Network Access Commercial |
$647.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.00
|
| Rate for Payer: Quartz Commercial |
$457.65
|
| Rate for Payer: Quartz Medicare Advantage |
$422.45
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: WPS Commercial |
$521.49
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Aetna Commercial |
$1,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,383.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$728.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$1,324.96
|
| Rate for Payer: HFN Commercial |
$1,383.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$640.64
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$407.68
|
| 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 |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.80
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$873.60
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Aetna Commercial |
$1,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,383.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$728.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$1,324.96
|
| Rate for Payer: HFN Commercial |
$1,383.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$640.64
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$407.68
|
| 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 |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.80
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$873.60
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2430815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.78 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| 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 |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,202.45
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| Rate for Payer: The Alliance Commercial |
$1,002.04
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2430815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$561.14 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$561.14
|
| 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 |
$1,062.16
|
| 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 |
$1,843.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,121.51
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.06
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,202.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,302.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,202.45
|
| Rate for Payer: The Alliance Commercial |
$1,002.04
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627594
|
| Min. Negotiated Rate |
$1,888.58 |
| Max. Negotiated Rate |
$3,545.90 |
| Rate for Payer: Aetna Commercial |
$3,468.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,042.75
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,545.90
|
| Rate for Payer: Health EOS Commercial |
$3,430.27
|
| Rate for Payer: HFN Commercial |
$3,545.90
|
| Rate for Payer: Multiplan Commercial |
$3,083.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,545.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.58
|
| Rate for Payer: Quartz Commercial |
$2,312.54
|
| Rate for Payer: WEA Trust Commercial |
$2,119.83
|
| Rate for Payer: WPS Commercial |
$2,854.73
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2430815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,202.45
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627594
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$3,545.90 |
| Rate for Payer: Aetna Commercial |
$3,468.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,079.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,505.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,927.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,850.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,042.75
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,545.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,156.89
|
| Rate for Payer: Health EOS Commercial |
$3,430.27
|
| Rate for Payer: HFN Commercial |
$3,545.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,890.68
|
| Rate for Payer: Multiplan Commercial |
$3,083.39
|
| Rate for Payer: NAPHCARE Commercial |
$2,312.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,545.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.58
|
| Rate for Payer: Quartz Commercial |
$2,505.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,312.54
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$2,119.83
|
| Rate for Payer: WPS Commercial |
$2,854.73
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Professional
|
Both
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627594
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$3,661.53 |
| Rate for Payer: Aetna Commercial |
$3,661.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.65
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,661.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,927.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$3,507.36
|
| Rate for Payer: HFN Commercial |
$3,661.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$3,083.39
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$3,661.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.87
|
| Rate for Payer: Quartz Commercial |
$2,196.92
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$2,119.83
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Aspiration/Inject/Biopsy Left
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627596
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Aspiration/Inject/Biopsy Left
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627596
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.45
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Aspiration/Inject/Biopsy Left
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627596
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,830.76 |
| Rate for Payer: Aetna Commercial |
$1,830.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,830.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,753.68
|
| Rate for Payer: HFN Commercial |
$1,830.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.76
|
| Rate for Payer: Quartz Beloit One Network |
$847.93
|
| Rate for Payer: Quartz Commercial |
$1,098.46
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
