|
US Aorta Complete
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$577.71 |
| Max. Negotiated Rate |
$1,084.68 |
| Rate for Payer: Aetna Commercial |
$1,061.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.87
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,084.68
|
| Rate for Payer: Health EOS Commercial |
$1,049.31
|
| Rate for Payer: HFN Commercial |
$1,084.68
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: NAPHCARE Commercial |
$707.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.68
|
| Rate for Payer: Quartz Beloit One Network |
$577.71
|
| Rate for Payer: Quartz Commercial |
$707.40
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
US Aorta Complete
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$384.21 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,094.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.20
|
| Rate for Payer: Health EOS Commercial |
$1,048.32
|
| Rate for Payer: HFN Commercial |
$1,094.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$384.21
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.40
|
| Rate for Payer: Quartz Beloit One Network |
$506.88
|
| Rate for Payer: Quartz Commercial |
$656.64
|
| Rate for Payer: The Alliance Commercial |
$576.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$330.12 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$1,061.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.94
|
| Rate for Payer: Aetna Managed Medicare |
$330.12
|
| 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 |
$624.87
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,084.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.77
|
| Rate for Payer: Health EOS Commercial |
$1,049.31
|
| Rate for Payer: HFN Commercial |
$1,084.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$884.25
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: NAPHCARE Commercial |
$707.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.68
|
| Rate for Payer: Quartz Beloit One Network |
$577.71
|
| Rate for Payer: Quartz Commercial |
$766.35
|
| Rate for Payer: Quartz Medicare Advantage |
$707.40
|
| Rate for Payer: The Alliance Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
US Aorta Complete
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.43 |
| Max. Negotiated Rate |
$1,120.05 |
| Rate for Payer: Aetna Commercial |
$1,120.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.94
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,120.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.40
|
| Rate for Payer: Health EOS Commercial |
$1,072.89
|
| Rate for Payer: HFN Commercial |
$1,120.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Multiplan Commercial |
$943.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.05
|
| Rate for Payer: Quartz Beloit One Network |
$518.76
|
| Rate for Payer: Quartz Commercial |
$672.03
|
| Rate for Payer: The Alliance Commercial |
$589.50
|
| Rate for Payer: WEA Trust Commercial |
$648.45
|
| Rate for Payer: WPS Commercial |
$873.29
|
|
|
US Aorta Complete
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$552.96
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| 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 |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| 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 |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| 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 |
$633.60
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
US Aorta Duplex Complete
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$505.68 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$928.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.96
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$949.44
|
| Rate for Payer: Health EOS Commercial |
$918.48
|
| Rate for Payer: HFN Commercial |
$949.44
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: NAPHCARE Commercial |
$619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.44
|
| Rate for Payer: Quartz Beloit One Network |
$505.68
|
| Rate for Payer: Quartz Commercial |
$619.20
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$764.40
|
|
|
US Aorta Duplex Complete
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$288.96 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$928.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.52
|
| Rate for Payer: Aetna Managed Medicare |
$288.96
|
| 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 |
$546.96
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$949.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.51
|
| Rate for Payer: Health EOS Commercial |
$918.48
|
| Rate for Payer: HFN Commercial |
$949.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.00
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: NAPHCARE Commercial |
$619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.44
|
| Rate for Payer: Quartz Beloit One Network |
$505.68
|
| Rate for Payer: Quartz Commercial |
$670.80
|
| Rate for Payer: Quartz Medicare Advantage |
$619.20
|
| Rate for Payer: The Alliance Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$764.40
|
|
|
US Aorta Duplex Complete
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.43 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Aetna Commercial |
$980.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.52
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$980.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$516.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.20
|
| Rate for Payer: Health EOS Commercial |
$939.12
|
| Rate for Payer: HFN Commercial |
$980.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.40
|
| Rate for Payer: Quartz Beloit One Network |
$454.08
|
| Rate for Payer: Quartz Commercial |
$588.24
|
| Rate for Payer: The Alliance Commercial |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$764.40
|
|
|
US Aorta Duplex Limited
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$189.56 |
| Max. Negotiated Rate |
$2,708.00 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Aetna Managed Medicare |
$189.56
|
| 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 |
$358.81
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$622.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.85
|
| Rate for Payer: Health EOS Commercial |
$602.53
|
| Rate for Payer: HFN Commercial |
$622.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.75
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: NAPHCARE Commercial |
$406.20
|
| Rate for Payer: Preferred Network Access Commercial |
$622.84
|
| Rate for Payer: Quartz Beloit One Network |
$331.73
|
| Rate for Payer: Quartz Commercial |
$440.05
|
| Rate for Payer: Quartz Medicare Advantage |
$406.20
|
| Rate for Payer: The Alliance Commercial |
$2,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
US Aorta Duplex Limited
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$643.15 |
| Rate for Payer: Aetna Commercial |
$643.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$643.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$338.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.20
|
| Rate for Payer: Health EOS Commercial |
$616.07
|
| Rate for Payer: HFN Commercial |
$643.15
|
| 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 |
$541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$643.15
|
| Rate for Payer: Quartz Beloit One Network |
$297.88
|
| Rate for Payer: Quartz Commercial |
$385.89
|
| Rate for Payer: The Alliance Commercial |
$338.50
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
US Aorta Duplex Limited
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$331.73 |
| Max. Negotiated Rate |
$622.84 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.81
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$622.84
|
| Rate for Payer: Health EOS Commercial |
$602.53
|
| Rate for Payer: HFN Commercial |
$622.84
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: NAPHCARE Commercial |
$406.20
|
| Rate for Payer: Preferred Network Access Commercial |
$622.84
|
| Rate for Payer: Quartz Beloit One Network |
$331.73
|
| Rate for Payer: Quartz Commercial |
$406.20
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$1,330.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,330.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$700.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$840.00
|
| Rate for Payer: Health EOS Commercial |
$1,274.00
|
| Rate for Payer: HFN Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.86
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,330.00
|
| Rate for Payer: Quartz Beloit One Network |
$616.00
|
| Rate for Payer: Quartz Commercial |
$798.00
|
| Rate for Payer: The Alliance Commercial |
$700.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Aetna Managed Medicare |
$392.00
|
| 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 |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.44
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$910.00
|
| Rate for Payer: Quartz Medicare Advantage |
$840.00
|
| Rate for Payer: The Alliance Commercial |
$5,600.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: Aetna Commercial |
$1,330.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,330.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$700.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$840.00
|
| Rate for Payer: Health EOS Commercial |
$1,274.00
|
| Rate for Payer: HFN Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.86
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,330.00
|
| Rate for Payer: Quartz Beloit One Network |
$616.00
|
| Rate for Payer: Quartz Commercial |
$798.00
|
| Rate for Payer: The Alliance Commercial |
$700.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Aetna Managed Medicare |
$392.00
|
| 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 |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.44
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$910.00
|
| Rate for Payer: Quartz Medicare Advantage |
$840.00
|
| Rate for Payer: The Alliance Commercial |
$5,600.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2430815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$7,708.00 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| 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 |
$1,021.31
|
| 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 |
$1,772.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.35
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
OP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627594
|
| Min. Negotiated Rate |
$1,037.68 |
| Max. Negotiated Rate |
$14,824.00 |
| Rate for Payer: Aetna Commercial |
$3,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,408.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,778.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.18
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,409.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,073.88
|
| Rate for Payer: Health EOS Commercial |
$3,298.34
|
| Rate for Payer: HFN Commercial |
$3,409.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.50
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.94
|
| Rate for Payer: Quartz Commercial |
$2,408.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.60
|
| Rate for Payer: The Alliance Commercial |
$14,824.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
IP
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627594
|
| Min. Negotiated Rate |
$1,815.94 |
| Max. Negotiated Rate |
$3,409.52 |
| Rate for Payer: Aetna Commercial |
$3,335.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.18
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,409.52
|
| Rate for Payer: Health EOS Commercial |
$3,298.34
|
| Rate for Payer: HFN Commercial |
$3,409.52
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,409.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,815.94
|
| Rate for Payer: Quartz Commercial |
$2,223.60
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2430815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$944.23 |
| Max. Negotiated Rate |
$1,772.84 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,156.20
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2430815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$847.88 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna Commercial |
$1,830.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,830.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,156.20
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| Rate for Payer: HFN Commercial |
$1,830.65
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.65
|
| Rate for Payer: Quartz Beloit One Network |
$847.88
|
| Rate for Payer: Quartz Commercial |
$1,098.39
|
| Rate for Payer: The Alliance Commercial |
$963.50
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Aspiration/Inject/Biopsy Bilateral
|
Professional
|
Both
|
$3,706.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
627594
|
| Min. Negotiated Rate |
$196.90 |
| Max. Negotiated Rate |
$3,520.70 |
| Rate for Payer: Aetna Commercial |
$3,520.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.16
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cash Price |
$1,111.80
|
| Rate for Payer: Cigna Commercial |
$3,520.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,853.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,223.60
|
| Rate for Payer: Health EOS Commercial |
$3,372.46
|
| Rate for Payer: HFN Commercial |
$3,520.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Multiplan Commercial |
$2,964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,520.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.64
|
| Rate for Payer: Quartz Commercial |
$2,112.42
|
| Rate for Payer: The Alliance Commercial |
$1,853.00
|
| Rate for Payer: WEA Trust Commercial |
$2,038.30
|
| Rate for Payer: WPS Commercial |
$2,745.03
|
|
|
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 |
$404.32 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$1,299.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,241.84
|
| Rate for Payer: Aetna Managed Medicare |
$404.32
|
| 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 |
$765.32
|
| 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 |
$1,328.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$808.06
|
| Rate for Payer: Health EOS Commercial |
$1,285.16
|
| Rate for Payer: HFN Commercial |
$1,328.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,083.00
|
| Rate for Payer: Multiplan Commercial |
$1,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$866.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,328.48
|
| Rate for Payer: Quartz Beloit One Network |
$707.56
|
| Rate for Payer: Quartz Commercial |
$938.60
|
| Rate for Payer: Quartz Medicare Advantage |
$866.40
|
| Rate for Payer: The Alliance Commercial |
$5,776.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$794.20
|
| Rate for Payer: WPS Commercial |
$1,069.57
|
|
