|
US Breast Unilateral Right
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
4498608
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$951.44 |
| Rate for Payer: Aetna Commercial |
$951.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$66.00
|
| Rate for Payer: Anthem Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.00
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$951.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$911.38
|
| Rate for Payer: HFN Commercial |
$951.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$951.44
|
| Rate for Payer: Quartz Beloit One Network |
$440.67
|
| Rate for Payer: Quartz Commercial |
$570.87
|
| Rate for Payer: Quartz Medicare Advantage |
$66.00
|
| Rate for Payer: The Alliance Commercial |
$250.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$329.99
|
|
|
US Breast Unilateral Right
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
4498608
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$490.74 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$600.91
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Breast Unilateral Right
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
4498608
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.99 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$280.43
|
| 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 |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.47
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.14
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$600.91
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$650.99
|
| Rate for Payer: Quartz Medicare Advantage |
$600.91
|
| Rate for Payer: The Alliance Commercial |
$263.99
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Breast Uni Real Time with Image 76641
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 76641
|
| Hospital Charge Code |
4521339
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$501.90 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$99.74
|
| Rate for Payer: Anthem Medicare Advantage |
$99.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.74
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.74
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.74
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$99.74
|
| Rate for Payer: The Alliance Commercial |
$379.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.74
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$498.68
|
|
|
US Breast Uni Real Time with Image 7664126
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 76641 26
|
| Hospital Charge Code |
4521340
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$501.90 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$33.75
|
| Rate for Payer: Anthem Medicare Advantage |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.75
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.75
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$50.62
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: Quartz Medicare Advantage |
$33.75
|
| Rate for Payer: The Alliance Commercial |
$128.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.75
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$168.74
|
|
|
US Breast Uni Real Time with Image Limited 76642
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
4538775
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.03 |
| Max. Negotiated Rate |
$461.40 |
| Rate for Payer: Aetna Commercial |
$461.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.68
|
| Rate for Payer: Aetna Managed Medicare |
$83.03
|
| Rate for Payer: Anthem Medicare Advantage |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.03
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$461.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.03
|
| Rate for Payer: Health EOS Commercial |
$441.97
|
| Rate for Payer: HFN Commercial |
$461.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.03
|
| Rate for Payer: Multiplan Commercial |
$388.54
|
| Rate for Payer: NAPHCARE Commercial |
$124.55
|
| Rate for Payer: Preferred Network Access Commercial |
$461.40
|
| Rate for Payer: Quartz Beloit One Network |
$213.70
|
| Rate for Payer: Quartz Commercial |
$276.84
|
| Rate for Payer: Quartz Medicare Advantage |
$83.03
|
| Rate for Payer: The Alliance Commercial |
$315.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.03
|
| Rate for Payer: WEA Trust Commercial |
$267.12
|
| Rate for Payer: WPS Commercial |
$415.17
|
|
|
US Breast Uni Real Time with Image Limited 7664226
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
CPT 76642 26
|
| Hospital Charge Code |
4538776
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.35 |
| Max. Negotiated Rate |
$461.40 |
| Rate for Payer: Aetna Commercial |
$461.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.68
|
| Rate for Payer: Aetna Managed Medicare |
$31.35
|
| Rate for Payer: Anthem Medicare Advantage |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.35
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$461.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.35
|
| Rate for Payer: Health EOS Commercial |
$441.97
|
| Rate for Payer: HFN Commercial |
$461.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.35
|
| Rate for Payer: Multiplan Commercial |
$388.54
|
| Rate for Payer: NAPHCARE Commercial |
$47.02
|
| Rate for Payer: Preferred Network Access Commercial |
$461.40
|
| Rate for Payer: Quartz Beloit One Network |
$213.70
|
| Rate for Payer: Quartz Commercial |
$276.84
|
| Rate for Payer: Quartz Medicare Advantage |
$31.35
|
| Rate for Payer: The Alliance Commercial |
$119.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.35
|
| Rate for Payer: WEA Trust Commercial |
$267.12
|
| Rate for Payer: WPS Commercial |
$156.73
|
|
|
US Breast Uni Real Time with Image Limited 76642PP
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
CPT 76642
|
| Hospital Charge Code |
4780607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.03 |
| Max. Negotiated Rate |
$1,213.26 |
| Rate for Payer: Aetna Commercial |
$1,213.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,098.32
|
| Rate for Payer: Aetna Managed Medicare |
$83.03
|
| Rate for Payer: Anthem Medicare Advantage |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.03
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cash Price |
$368.40
|
| Rate for Payer: Cigna Commercial |
$1,213.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$638.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.03
|
| Rate for Payer: Health EOS Commercial |
$1,162.18
|
| Rate for Payer: HFN Commercial |
$1,213.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.03
|
| Rate for Payer: Multiplan Commercial |
$1,021.70
|
| Rate for Payer: NAPHCARE Commercial |
$124.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.26
|
| Rate for Payer: Quartz Beloit One Network |
$561.93
|
| Rate for Payer: Quartz Commercial |
$727.96
|
| Rate for Payer: Quartz Medicare Advantage |
$83.03
|
| Rate for Payer: The Alliance Commercial |
$315.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.03
|
| Rate for Payer: WEA Trust Commercial |
$702.42
|
| Rate for Payer: WPS Commercial |
$415.17
|
|
|
US Chest
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
629714
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$1,048.27 |
| Rate for Payer: Aetna Commercial |
$1,048.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.96
|
| Rate for Payer: Aetna Managed Medicare |
$60.61
|
| Rate for Payer: Anthem Medicare Advantage |
$60.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.61
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,048.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.61
|
| Rate for Payer: Health EOS Commercial |
$1,004.13
|
| Rate for Payer: HFN Commercial |
$1,048.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.61
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: NAPHCARE Commercial |
$90.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,048.27
|
| Rate for Payer: Quartz Beloit One Network |
$485.51
|
| Rate for Payer: Quartz Commercial |
$628.96
|
| Rate for Payer: Quartz Medicare Advantage |
$60.61
|
| Rate for Payer: The Alliance Commercial |
$230.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.61
|
| Rate for Payer: WEA Trust Commercial |
$606.89
|
| Rate for Payer: WPS Commercial |
$303.06
|
|
|
US Chest
|
Facility
|
IP
|
$1,379.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2544825
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$702.74 |
| Max. Negotiated Rate |
$1,319.43 |
| Rate for Payer: Aetna Commercial |
$1,290.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.10
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,319.43
|
| Rate for Payer: Health EOS Commercial |
$1,276.40
|
| Rate for Payer: HFN Commercial |
$1,319.43
|
| Rate for Payer: Multiplan Commercial |
$1,147.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.43
|
| Rate for Payer: Quartz Beloit One Network |
$702.74
|
| Rate for Payer: Quartz Commercial |
$860.50
|
| Rate for Payer: WEA Trust Commercial |
$788.79
|
| Rate for Payer: WPS Commercial |
$1,062.24
|
|
|
US Chest
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2544825
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$1,319.43 |
| Rate for Payer: Aetna Commercial |
$1,290.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.38
|
| Rate for Payer: Aetna Managed Medicare |
$401.56
|
| 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 |
$760.10
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,319.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$802.58
|
| Rate for Payer: Health EOS Commercial |
$1,276.40
|
| Rate for Payer: HFN Commercial |
$1,319.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,075.62
|
| Rate for Payer: Multiplan Commercial |
$1,147.33
|
| Rate for Payer: NAPHCARE Commercial |
$860.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.43
|
| Rate for Payer: Quartz Beloit One Network |
$702.74
|
| Rate for Payer: Quartz Commercial |
$932.20
|
| Rate for Payer: Quartz Medicare Advantage |
$860.50
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$788.79
|
| Rate for Payer: WPS Commercial |
$1,062.24
|
|
|
US Chest
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2544825
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$1,362.45 |
| Rate for Payer: Aetna Commercial |
$1,362.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,233.38
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cash Price |
$413.70
|
| Rate for Payer: Cigna Commercial |
$1,362.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$717.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$1,305.09
|
| Rate for Payer: HFN Commercial |
$1,362.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$1,147.33
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.45
|
| Rate for Payer: Quartz Beloit One Network |
$631.03
|
| Rate for Payer: Quartz Commercial |
$817.47
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$788.79
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
US Chest
|
Facility
|
OP
|
$1,061.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
629714
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,015.16 |
| Rate for Payer: Aetna Commercial |
$993.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.96
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$717.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$551.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.65
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,015.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$982.06
|
| Rate for Payer: HFN Commercial |
$1,015.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.16
|
| Rate for Payer: Quartz Beloit One Network |
$540.69
|
| Rate for Payer: Quartz Commercial |
$717.24
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$606.89
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$817.29
|
|
|
US Chest
|
Facility
|
IP
|
$1,061.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
629714
|
| Min. Negotiated Rate |
$540.69 |
| Max. Negotiated Rate |
$1,015.16 |
| Rate for Payer: Aetna Commercial |
$993.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.82
|
| Rate for Payer: Cash Price |
$318.30
|
| Rate for Payer: Cigna Commercial |
$1,015.16
|
| Rate for Payer: Health EOS Commercial |
$982.06
|
| Rate for Payer: HFN Commercial |
$1,015.16
|
| Rate for Payer: Multiplan Commercial |
$882.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.16
|
| Rate for Payer: Quartz Beloit One Network |
$540.69
|
| Rate for Payer: Quartz Commercial |
$662.06
|
| Rate for Payer: WEA Trust Commercial |
$606.89
|
| Rate for Payer: WPS Commercial |
$817.29
|
|
|
US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL 7693626
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 76936 26
|
| Hospital Charge Code |
5416647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.60 |
| Max. Negotiated Rate |
$941.56 |
| Rate for Payer: Aetna Commercial |
$941.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Aetna Managed Medicare |
$90.60
|
| Rate for Payer: Anthem Medicare Advantage |
$90.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.60
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$941.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$495.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$901.92
|
| Rate for Payer: HFN Commercial |
$941.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$331.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.60
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: NAPHCARE Commercial |
$135.91
|
| Rate for Payer: Preferred Network Access Commercial |
$941.56
|
| Rate for Payer: Quartz Beloit One Network |
$436.09
|
| Rate for Payer: Quartz Commercial |
$564.94
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$344.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$453.02
|
|
|
US Doppler
|
Professional
|
Both
|
$881.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
6187358
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$142.41 |
| Max. Negotiated Rate |
$870.43 |
| Rate for Payer: Aetna Commercial |
$870.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.97
|
| Rate for Payer: Aetna Managed Medicare |
$204.42
|
| Rate for Payer: Anthem Medicare Advantage |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.42
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$870.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.42
|
| Rate for Payer: Health EOS Commercial |
$833.78
|
| Rate for Payer: HFN Commercial |
$870.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.42
|
| Rate for Payer: Multiplan Commercial |
$732.99
|
| Rate for Payer: NAPHCARE Commercial |
$306.63
|
| Rate for Payer: Preferred Network Access Commercial |
$870.43
|
| Rate for Payer: Quartz Beloit One Network |
$403.15
|
| Rate for Payer: Quartz Commercial |
$522.26
|
| Rate for Payer: Quartz Medicare Advantage |
$204.42
|
| Rate for Payer: The Alliance Commercial |
$511.06
|
| Rate for Payer: United Healthcare Medicaid |
$142.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.42
|
| Rate for Payer: WEA Trust Commercial |
$503.93
|
| Rate for Payer: WPS Commercial |
$817.69
|
|
|
US Doppler
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
6187358
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$448.96 |
| Max. Negotiated Rate |
$842.94 |
| Rate for Payer: Aetna Commercial |
$824.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.61
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$842.94
|
| Rate for Payer: Health EOS Commercial |
$815.45
|
| Rate for Payer: HFN Commercial |
$842.94
|
| Rate for Payer: Multiplan Commercial |
$732.99
|
| Rate for Payer: Preferred Network Access Commercial |
$842.94
|
| Rate for Payer: Quartz Beloit One Network |
$448.96
|
| Rate for Payer: Quartz Commercial |
$549.74
|
| Rate for Payer: WEA Trust Commercial |
$503.93
|
| Rate for Payer: WPS Commercial |
$678.63
|
|
|
US Doppler
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
6187358
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$256.55 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$824.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.97
|
| Rate for Payer: Aetna Managed Medicare |
$256.55
|
| 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 |
$485.61
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cash Price |
$264.30
|
| Rate for Payer: Cigna Commercial |
$842.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.74
|
| Rate for Payer: Health EOS Commercial |
$815.45
|
| Rate for Payer: HFN Commercial |
$842.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.18
|
| Rate for Payer: Multiplan Commercial |
$732.99
|
| Rate for Payer: NAPHCARE Commercial |
$549.74
|
| Rate for Payer: Preferred Network Access Commercial |
$842.94
|
| Rate for Payer: Quartz Beloit One Network |
$448.96
|
| Rate for Payer: Quartz Commercial |
$595.56
|
| Rate for Payer: Quartz Medicare Advantage |
$549.74
|
| Rate for Payer: The Alliance Commercial |
$817.69
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$503.93
|
| Rate for Payer: WPS Commercial |
$678.63
|
|
|
US Doppler Limited
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
6187360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
US Doppler Limited
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
6187360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$118.02 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$118.02
|
| Rate for Payer: Anthem Medicare Advantage |
$118.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.02
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.02
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.02
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$177.03
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$118.02
|
| Rate for Payer: The Alliance Commercial |
$295.05
|
| Rate for Payer: United Healthcare Medicaid |
$121.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.02
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$472.08
|
|
|
US Doppler Limited
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
6187360
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$182.29 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| 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 |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$472.08
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
US Drainage Abscess or Cyst
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,426.67 |
| Rate for Payer: Aetna Commercial |
$1,426.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,426.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$750.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,366.60
|
| Rate for Payer: HFN Commercial |
$1,426.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,426.67
|
| Rate for Payer: Quartz Beloit One Network |
$660.77
|
| Rate for Payer: Quartz Commercial |
$856.00
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Drainage Abscess or Cyst
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$735.86 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$901.06
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Drainage Abscess or Cyst
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544829
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,381.62 |
| Rate for Payer: Aetna Commercial |
$1,351.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,291.51
|
| Rate for Payer: Aetna Managed Medicare |
$420.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$795.93
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cash Price |
$433.20
|
| Rate for Payer: Cigna Commercial |
$1,381.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$840.41
|
| Rate for Payer: Health EOS Commercial |
$1,336.57
|
| Rate for Payer: HFN Commercial |
$1,381.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,126.32
|
| Rate for Payer: Multiplan Commercial |
$1,201.41
|
| Rate for Payer: NAPHCARE Commercial |
$901.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,381.62
|
| Rate for Payer: Quartz Beloit One Network |
$735.86
|
| Rate for Payer: Quartz Commercial |
$976.14
|
| Rate for Payer: Quartz Medicare Advantage |
$901.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$825.97
|
| Rate for Payer: WPS Commercial |
$1,112.31
|
|
|
US Drainage Gallbladder
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
5963643
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$230.71 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$655.20
|
| 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 |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.50
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,521.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.00
|
| Rate for Payer: The Alliance Commercial |
$230.71
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
