|
US Biopsy Breast Bilateral
|
Professional
|
Both
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627686
|
| 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 Biopsy Breast Bilateral
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627686
|
| 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 Biopsy Breast Bilateral
|
Professional
|
Both
|
$2,989.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$2,953.13 |
| Rate for Payer: Aetna Commercial |
$2,953.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,673.36
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,953.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,865.14
|
| Rate for Payer: Health EOS Commercial |
$2,828.79
|
| Rate for Payer: HFN Commercial |
$2,953.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.40
|
| Rate for Payer: Multiplan Commercial |
$2,486.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,953.13
|
| Rate for Payer: Quartz Beloit One Network |
$1,367.77
|
| Rate for Payer: Quartz Commercial |
$1,771.88
|
| Rate for Payer: The Alliance Commercial |
$1,554.28
|
| Rate for Payer: United Healthcare Medicaid |
$127.90
|
| Rate for Payer: WEA Trust Commercial |
$1,709.71
|
| Rate for Payer: WPS Commercial |
$2,302.43
|
|
|
US Biopsy Breast Bilateral
|
Facility
|
OP
|
$2,989.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,797.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,673.36
|
| Rate for Payer: Aetna Managed Medicare |
$870.40
|
| 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 |
$1,647.54
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,859.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,766.62
|
| Rate for Payer: HFN Commercial |
$2,859.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,331.42
|
| Rate for Payer: Multiplan Commercial |
$2,486.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,865.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,859.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.19
|
| Rate for Payer: Quartz Commercial |
$2,020.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,865.14
|
| Rate for Payer: The Alliance Commercial |
$1,554.28
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,709.71
|
| Rate for Payer: WPS Commercial |
$2,302.43
|
|
|
US Biopsy Breast Bilateral
|
Facility
|
IP
|
$2,989.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,523.19 |
| Max. Negotiated Rate |
$2,859.88 |
| Rate for Payer: Aetna Commercial |
$2,797.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,673.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,647.54
|
| Rate for Payer: Cash Price |
$896.70
|
| Rate for Payer: Cigna Commercial |
$2,859.88
|
| Rate for Payer: Health EOS Commercial |
$2,766.62
|
| Rate for Payer: HFN Commercial |
$2,859.88
|
| Rate for Payer: Multiplan Commercial |
$2,486.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,859.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.19
|
| Rate for Payer: Quartz Commercial |
$1,865.14
|
| Rate for Payer: WEA Trust Commercial |
$1,709.71
|
| Rate for Payer: WPS Commercial |
$2,302.43
|
|
|
US Biopsy Breast Left
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| 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 Breast Left
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$3,863.08 |
| Rate for Payer: Aetna Commercial |
$3,863.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,497.10
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,863.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,439.84
|
| Rate for Payer: Health EOS Commercial |
$3,700.42
|
| Rate for Payer: HFN Commercial |
$3,863.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.40
|
| Rate for Payer: Multiplan Commercial |
$3,253.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,863.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,789.22
|
| Rate for Payer: Quartz Commercial |
$2,317.85
|
| Rate for Payer: The Alliance Commercial |
$2,033.20
|
| Rate for Payer: United Healthcare Medicaid |
$127.90
|
| Rate for Payer: WEA Trust Commercial |
$2,236.52
|
| Rate for Payer: WPS Commercial |
$3,011.87
|
|
|
US Biopsy Breast Left
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$3,659.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,497.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,138.59
|
| 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 |
$2,155.19
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,741.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$3,619.10
|
| Rate for Payer: HFN Commercial |
$3,741.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,049.80
|
| Rate for Payer: Multiplan Commercial |
$3,253.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,741.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.54
|
| Rate for Payer: Quartz Commercial |
$2,643.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,439.84
|
| Rate for Payer: The Alliance Commercial |
$2,033.20
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$2,236.52
|
| Rate for Payer: WPS Commercial |
$3,011.87
|
|
|
US Biopsy Breast Left
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| 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 Left
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627688
|
| 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 Breast Left
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 LT
|
| Hospital Charge Code |
2544807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,992.54 |
| Max. Negotiated Rate |
$3,741.09 |
| Rate for Payer: Aetna Commercial |
$3,659.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,497.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,155.19
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,741.09
|
| Rate for Payer: Health EOS Commercial |
$3,619.10
|
| Rate for Payer: HFN Commercial |
$3,741.09
|
| Rate for Payer: Multiplan Commercial |
$3,253.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,741.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.54
|
| Rate for Payer: Quartz Commercial |
$2,439.84
|
| Rate for Payer: WEA Trust Commercial |
$2,236.52
|
| Rate for Payer: WPS Commercial |
$3,011.87
|
|
|
US Biopsy Breast Left ea add
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,929.56 |
| Rate for Payer: Aetna Commercial |
$1,929.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,929.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,218.67
|
| Rate for Payer: Health EOS Commercial |
$1,848.32
|
| Rate for Payer: HFN Commercial |
$1,929.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.81
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,929.56
|
| Rate for Payer: Quartz Beloit One Network |
$893.69
|
| Rate for Payer: Quartz Commercial |
$1,157.74
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: United Healthcare Medicaid |
$62.21
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast Left ea add
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$995.25 |
| Max. Negotiated Rate |
$1,868.63 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,218.67
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast Left ea add
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 LT
|
| Hospital Charge Code |
4125859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Aetna Managed Medicare |
$568.71
|
| 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 |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.34
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,320.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.67
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast Right
|
Facility
|
IP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
2544809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,992.54 |
| Max. Negotiated Rate |
$3,741.09 |
| Rate for Payer: Aetna Commercial |
$3,659.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,497.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,155.19
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,741.09
|
| Rate for Payer: Health EOS Commercial |
$3,619.10
|
| Rate for Payer: HFN Commercial |
$3,741.09
|
| Rate for Payer: Multiplan Commercial |
$3,253.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,741.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.54
|
| Rate for Payer: Quartz Commercial |
$2,439.84
|
| Rate for Payer: WEA Trust Commercial |
$2,236.52
|
| Rate for Payer: WPS Commercial |
$3,011.87
|
|
|
US Biopsy Breast Right
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627690
|
| 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 Right
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
2544809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.90 |
| Max. Negotiated Rate |
$3,863.08 |
| Rate for Payer: Aetna Commercial |
$3,863.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,497.10
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,863.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,439.84
|
| Rate for Payer: Health EOS Commercial |
$3,700.42
|
| Rate for Payer: HFN Commercial |
$3,863.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.40
|
| Rate for Payer: Multiplan Commercial |
$3,253.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,863.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,789.22
|
| Rate for Payer: Quartz Commercial |
$2,317.85
|
| Rate for Payer: The Alliance Commercial |
$2,033.20
|
| Rate for Payer: United Healthcare Medicaid |
$127.90
|
| Rate for Payer: WEA Trust Commercial |
$2,236.52
|
| Rate for Payer: WPS Commercial |
$3,011.87
|
|
|
US Biopsy Breast Right
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627690
|
| 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 Breast Right
|
Facility
|
OP
|
$3,910.00
|
|
|
Service Code
|
CPT 19083 RT
|
| Hospital Charge Code |
2544809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$3,659.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,497.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,138.59
|
| 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 |
$2,155.19
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cash Price |
$1,173.00
|
| Rate for Payer: Cigna Commercial |
$3,741.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$3,619.10
|
| Rate for Payer: HFN Commercial |
$3,741.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,049.80
|
| Rate for Payer: Multiplan Commercial |
$3,253.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,741.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.54
|
| Rate for Payer: Quartz Commercial |
$2,643.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,439.84
|
| Rate for Payer: The Alliance Commercial |
$2,033.20
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$2,236.52
|
| Rate for Payer: WPS Commercial |
$3,011.87
|
|
|
US Biopsy Breast Right
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627690
|
| 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 Breast Right
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
2980119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,929.56 |
| Rate for Payer: Aetna Commercial |
$1,929.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,929.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,218.67
|
| Rate for Payer: Health EOS Commercial |
$1,848.32
|
| Rate for Payer: HFN Commercial |
$1,929.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.81
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,929.56
|
| Rate for Payer: Quartz Beloit One Network |
$893.69
|
| Rate for Payer: Quartz Commercial |
$1,157.74
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: United Healthcare Medicaid |
$62.21
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast Right
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
2980119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Aetna Managed Medicare |
$568.71
|
| 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 |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.34
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,320.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.67
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast Right
|
Facility
|
IP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
2980119
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$995.25 |
| Max. Negotiated Rate |
$1,868.63 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,218.67
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast RT ea add
|
Facility
|
OP
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 RT
|
| Hospital Charge Code |
5156614
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$568.71 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,828.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Aetna Managed Medicare |
$568.71
|
| 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 |
$1,076.49
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,868.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,807.70
|
| Rate for Payer: HFN Commercial |
$1,868.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,523.34
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,218.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,868.63
|
| Rate for Payer: Quartz Beloit One Network |
$995.25
|
| Rate for Payer: Quartz Commercial |
$1,320.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,218.67
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
|
US Biopsy Breast RT ea add
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 19084 RT
|
| Hospital Charge Code |
5156614
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.21 |
| Max. Negotiated Rate |
$1,929.56 |
| Rate for Payer: Aetna Commercial |
$1,929.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,746.76
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,929.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,218.67
|
| Rate for Payer: Health EOS Commercial |
$1,848.32
|
| Rate for Payer: HFN Commercial |
$1,929.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.81
|
| Rate for Payer: Multiplan Commercial |
$1,624.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,929.56
|
| Rate for Payer: Quartz Beloit One Network |
$893.69
|
| Rate for Payer: Quartz Commercial |
$1,157.74
|
| Rate for Payer: The Alliance Commercial |
$1,015.56
|
| Rate for Payer: United Healthcare Medicaid |
$62.21
|
| Rate for Payer: WEA Trust Commercial |
$1,117.12
|
| Rate for Payer: WPS Commercial |
$1,504.40
|
|
