|
US Aspiration/Inject/Biopsy Left
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2430817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,426.67 |
| Rate for Payer: Aetna Commercial |
$1,426.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| 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 |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,426.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$750.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,366.60
|
| Rate for Payer: HFN Commercial |
$1,426.67
|
| 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 |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.67
|
| Rate for Payer: Quartz Beloit One Network |
$660.77
|
| Rate for Payer: Quartz Commercial |
$856.00
|
| 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 |
$825.97
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Aspiration/Inject/Biopsy Left
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2430817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Aetna Managed Medicare |
$420.49
|
| 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 |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$840.41
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,126.32
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$901.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$976.14
|
| Rate for Payer: Quartz Medicare Advantage |
$901.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Aspiration/Inject/Biopsy Left
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2430817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$735.86 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$901.06
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Aspiration/Inject/Biopsy Right
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980131
|
|
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 Right
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980131
|
|
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 Right
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2430819
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,426.67 |
| Rate for Payer: Aetna Commercial |
$1,426.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| 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 |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,426.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$750.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,366.60
|
| Rate for Payer: HFN Commercial |
$1,426.67
|
| 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 |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.67
|
| Rate for Payer: Quartz Beloit One Network |
$660.77
|
| Rate for Payer: Quartz Commercial |
$856.00
|
| 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 |
$825.97
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Aspiration/Inject/Biopsy Right
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2430819
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$735.86 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$901.06
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Aspiration/Inject/Biopsy Right
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627598
|
| 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
|
|
|
US Aspiration/Inject/Biopsy Right
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627598
|
| 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 Right
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627598
|
| 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 Right
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980131
|
|
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 Right
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2430819
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Aetna Managed Medicare |
$420.49
|
| 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 |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$840.41
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,126.32
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$901.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$976.14
|
| Rate for Payer: Quartz Medicare Advantage |
$901.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Biopsy
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$735.86 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$901.06
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Biopsy
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552804
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Aetna Managed Medicare |
$418.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.75
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.08
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$896.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$970.74
|
| Rate for Payer: Quartz Medicare Advantage |
$896.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
US Biopsy
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552804
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,418.77 |
| Rate for Payer: Aetna Commercial |
$1,418.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| 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 |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,418.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$746.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,359.03
|
| Rate for Payer: HFN Commercial |
$1,418.77
|
| 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 |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.77
|
| Rate for Payer: Quartz Beloit One Network |
$657.11
|
| Rate for Payer: Quartz Commercial |
$851.26
|
| 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 |
$821.39
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Biopsy
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Aetna Managed Medicare |
$420.49
|
| 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 |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$840.41
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,126.32
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$901.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$976.14
|
| Rate for Payer: Quartz Medicare Advantage |
$901.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Biopsy
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,426.67 |
| Rate for Payer: Aetna Commercial |
$1,426.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| 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 |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,426.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$750.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,366.60
|
| Rate for Payer: HFN Commercial |
$1,426.67
|
| 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 |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.67
|
| Rate for Payer: Quartz Beloit One Network |
$660.77
|
| Rate for Payer: Quartz Commercial |
$856.00
|
| 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 |
$825.97
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Biopsy
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552804
|
| Min. Negotiated Rate |
$731.79 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$896.06
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
US Biopsy Abdomen
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| 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: 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 |
$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 |
$63.94
|
| 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: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| 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: 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 |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Biopsy Abdomen
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
625594
|
| 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
|
|
|
US Biopsy Abdomen
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| 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 |
$255.76
|
| 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 Biopsy Abdomen
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544803
|
|
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 Biopsy Abdomen
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
625594
|
| 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 Biopsy Abdomen
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
625594
|
| 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 Biopsy Breast Bilateral
|
Facility
|
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627686
|
| 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
|
|
