|
UROSTOMY STERILE KIT 19252
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
2963705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
UroVysion, Detection of Bladder Cancer
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.27 |
| Max. Negotiated Rate |
$2,110.16 |
| Rate for Payer: Aetna Commercial |
$1,897.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Anthem Commercial |
$38.27
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,897.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$998.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.20
|
| Rate for Payer: Health EOS Commercial |
$1,817.27
|
| Rate for Payer: HFN Commercial |
$1,897.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,110.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,110.16
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.15
|
| Rate for Payer: Quartz Beloit One Network |
$878.68
|
| Rate for Payer: Quartz Commercial |
$1,138.29
|
| Rate for Payer: The Alliance Commercial |
$998.50
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
UroVysion, Detection of Bladder Cancer
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$978.53 |
| Max. Negotiated Rate |
$1,837.24 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,198.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,198.20
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
UroVysion, Detection of Bladder Cancer
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$1,837.24 |
| Rate for Payer: Aetna Commercial |
$1,797.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.42
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,837.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$1,777.33
|
| Rate for Payer: HFN Commercial |
$1,837.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$1,597.60
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.24
|
| Rate for Payer: Quartz Beloit One Network |
$978.53
|
| Rate for Payer: Quartz Commercial |
$1,298.05
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$1,497.75
|
| Rate for Payer: WEA Trust Commercial |
$1,098.35
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$1,479.18
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$1,652.05 |
| Rate for Payer: Aetna Commercial |
$1,652.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,652.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$869.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,043.40
|
| Rate for Payer: Health EOS Commercial |
$1,582.49
|
| Rate for Payer: HFN Commercial |
$1,652.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.16
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.05
|
| Rate for Payer: Quartz Beloit One Network |
$765.16
|
| Rate for Payer: Quartz Commercial |
$991.23
|
| Rate for Payer: The Alliance Commercial |
$869.50
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$416.05 |
| Max. Negotiated Rate |
$1,355.65 |
| Rate for Payer: Aetna Commercial |
$1,355.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.22
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,355.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$713.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.20
|
| Rate for Payer: Health EOS Commercial |
$1,298.57
|
| Rate for Payer: HFN Commercial |
$1,355.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.05
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,355.65
|
| Rate for Payer: Quartz Beloit One Network |
$627.88
|
| Rate for Payer: Quartz Commercial |
$813.39
|
| Rate for Payer: The Alliance Commercial |
$713.50
|
| Rate for Payer: WEA Trust Commercial |
$784.85
|
| Rate for Payer: WPS Commercial |
$1,056.98
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,312.84 |
| Rate for Payer: Aetna Commercial |
$1,284.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.22
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$927.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.96
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,312.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$798.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,270.03
|
| Rate for Payer: HFN Commercial |
$1,312.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.84
|
| Rate for Payer: Quartz Beloit One Network |
$699.23
|
| Rate for Payer: Quartz Commercial |
$927.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$784.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,056.98
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$699.23 |
| Max. Negotiated Rate |
$1,312.84 |
| Rate for Payer: Aetna Commercial |
$1,284.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.31
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,312.84
|
| Rate for Payer: Health EOS Commercial |
$1,270.03
|
| Rate for Payer: HFN Commercial |
$1,312.84
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: NAPHCARE Commercial |
$856.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.84
|
| Rate for Payer: Quartz Beloit One Network |
$699.23
|
| Rate for Payer: Quartz Commercial |
$856.20
|
| Rate for Payer: WEA Trust Commercial |
$784.85
|
| Rate for Payer: WPS Commercial |
$1,056.98
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$852.11 |
| Max. Negotiated Rate |
$1,599.88 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,043.40
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$852.11 |
| Max. Negotiated Rate |
$1,599.88 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,043.40
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$486.92 |
| Max. Negotiated Rate |
$6,956.00 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Managed Medicare |
$486.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.14
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,304.25
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,130.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,043.40
|
| Rate for Payer: The Alliance Commercial |
$6,956.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$1,652.05 |
| Rate for Payer: Aetna Commercial |
$1,652.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,652.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$869.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,043.40
|
| Rate for Payer: Health EOS Commercial |
$1,582.49
|
| Rate for Payer: HFN Commercial |
$1,652.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.16
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.05
|
| Rate for Payer: Quartz Beloit One Network |
$765.16
|
| Rate for Payer: Quartz Commercial |
$991.23
|
| Rate for Payer: The Alliance Commercial |
$869.50
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$486.92 |
| Max. Negotiated Rate |
$6,956.00 |
| Rate for Payer: Aetna Commercial |
$1,565.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,495.54
|
| Rate for Payer: Aetna Managed Medicare |
$486.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.67
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,599.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.14
|
| Rate for Payer: Health EOS Commercial |
$1,547.71
|
| Rate for Payer: HFN Commercial |
$1,599.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,304.25
|
| Rate for Payer: Multiplan Commercial |
$1,391.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.88
|
| Rate for Payer: Quartz Beloit One Network |
$852.11
|
| Rate for Payer: Quartz Commercial |
$1,130.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,043.40
|
| Rate for Payer: The Alliance Commercial |
$6,956.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$956.45
|
| Rate for Payer: WPS Commercial |
$1,288.08
|
|
|
US Abdomen Limited
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.55 |
| Max. Negotiated Rate |
$1,674.85 |
| Rate for Payer: Aetna Commercial |
$1,674.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,674.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$881.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.80
|
| Rate for Payer: Health EOS Commercial |
$1,604.33
|
| Rate for Payer: HFN Commercial |
$1,674.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.55
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.85
|
| Rate for Payer: Quartz Beloit One Network |
$775.72
|
| Rate for Payer: Quartz Commercial |
$1,004.91
|
| Rate for Payer: The Alliance Commercial |
$881.50
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,379.08 |
| Rate for Payer: Aetna Commercial |
$1,349.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$974.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,379.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,334.11
|
| Rate for Payer: HFN Commercial |
$1,379.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.08
|
| Rate for Payer: Quartz Beloit One Network |
$734.51
|
| Rate for Payer: Quartz Commercial |
$974.35
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$734.51 |
| Max. Negotiated Rate |
$1,379.08 |
| Rate for Payer: Aetna Commercial |
$1,349.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.47
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,379.08
|
| Rate for Payer: Health EOS Commercial |
$1,334.11
|
| Rate for Payer: HFN Commercial |
$1,379.08
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: NAPHCARE Commercial |
$899.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.08
|
| Rate for Payer: Quartz Beloit One Network |
$734.51
|
| Rate for Payer: Quartz Commercial |
$899.40
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Abdomen Limited
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$310.04 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Aetna Commercial |
$1,424.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,424.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$749.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.40
|
| Rate for Payer: Health EOS Commercial |
$1,364.09
|
| Rate for Payer: HFN Commercial |
$1,424.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,424.05
|
| Rate for Payer: Quartz Beloit One Network |
$659.56
|
| Rate for Payer: Quartz Commercial |
$854.43
|
| Rate for Payer: The Alliance Commercial |
$749.50
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$493.64 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Aetna Managed Medicare |
$493.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$986.57
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.25
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,145.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.80
|
| Rate for Payer: The Alliance Commercial |
$7,052.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$863.87 |
| Max. Negotiated Rate |
$1,621.96 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,057.80
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Abdominal Aorta
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Aetna Managed Medicare |
$205.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$676.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.31
|
| Rate for Payer: Health EOS Commercial |
$654.15
|
| Rate for Payer: HFN Commercial |
$676.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.25
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: NAPHCARE Commercial |
$441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$676.20
|
| Rate for Payer: Quartz Beloit One Network |
$360.15
|
| Rate for Payer: Quartz Commercial |
$477.75
|
| Rate for Payer: Quartz Medicare Advantage |
$441.00
|
| Rate for Payer: The Alliance Commercial |
$2,940.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
US Abdominal Aorta
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$698.25 |
| Rate for Payer: Aetna Commercial |
$698.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$698.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.00
|
| Rate for Payer: Health EOS Commercial |
$668.85
|
| Rate for Payer: HFN Commercial |
$698.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.48
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$698.25
|
| Rate for Payer: Quartz Beloit One Network |
$323.40
|
| Rate for Payer: Quartz Commercial |
$418.95
|
| Rate for Payer: The Alliance Commercial |
$367.50
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
US Abdominal Aorta
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$360.15 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$676.20
|
| Rate for Payer: Health EOS Commercial |
$654.15
|
| Rate for Payer: HFN Commercial |
$676.20
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: NAPHCARE Commercial |
$441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$676.20
|
| Rate for Payer: Quartz Beloit One Network |
$360.15
|
| Rate for Payer: Quartz Commercial |
$441.00
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
US Abdominal Aorta
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$434.68 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
US Abdominal Aorta
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$141.68 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$305.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$293.02
|
| Rate for Payer: HFN Commercial |
$305.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$199.73
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$305.90
|
| Rate for Payer: Quartz Beloit One Network |
$141.68
|
| Rate for Payer: Quartz Commercial |
$183.54
|
| Rate for Payer: The Alliance Commercial |
$161.00
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
US Abdominal Aorta
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
