|
US Drainage Gallbladder
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
5963643
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,146.60 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| 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 |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
US Drainage Gallbladder
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
5963643
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$57.68
|
| Rate for Payer: Anthem Medicare Advantage |
$57.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.68
|
| 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 |
$2,223.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.68
|
| Rate for Payer: Health EOS Commercial |
$2,129.40
|
| Rate for Payer: HFN Commercial |
$2,223.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.68
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$86.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.60
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: Quartz Medicare Advantage |
$57.68
|
| Rate for Payer: The Alliance Commercial |
$219.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.68
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$288.39
|
|
|
US Drainage Liver
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
2544831
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$57.68
|
| Rate for Payer: Anthem Medicare Advantage |
$57.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.68
|
| 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 |
$2,223.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.68
|
| Rate for Payer: Health EOS Commercial |
$2,129.40
|
| Rate for Payer: HFN Commercial |
$2,223.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.68
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$86.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.60
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: Quartz Medicare Advantage |
$57.68
|
| Rate for Payer: The Alliance Commercial |
$219.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.68
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$288.39
|
|
|
US Drainage Liver
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
2544831
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,146.60 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| 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 |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
US Drainage Liver
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 TC
|
| Hospital Charge Code |
2544831
|
|
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
|
|
|
US Drainage Peritoneal
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
2544841
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$841.53 |
| Max. Negotiated Rate |
$1,816.93 |
| Rate for Payer: Aetna Commercial |
$1,816.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.80
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,816.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$956.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.54
|
| Rate for Payer: Health EOS Commercial |
$1,740.43
|
| Rate for Payer: HFN Commercial |
$1,816.93
|
| Rate for Payer: Multiplan Commercial |
$1,530.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,816.93
|
| Rate for Payer: Quartz Beloit One Network |
$841.53
|
| Rate for Payer: Quartz Commercial |
$1,090.16
|
| Rate for Payer: The Alliance Commercial |
$956.28
|
| Rate for Payer: WEA Trust Commercial |
$1,051.91
|
| Rate for Payer: WPS Commercial |
$1,416.58
|
|
|
US Drainage Peritoneal
|
Facility
|
OP
|
$1,839.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
2544841
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,759.56 |
| Rate for Payer: Aetna Commercial |
$1,721.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.80
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| 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: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,759.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,070.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,702.18
|
| Rate for Payer: HFN Commercial |
$1,759.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$1,530.05
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.56
|
| Rate for Payer: Quartz Beloit One Network |
$937.15
|
| Rate for Payer: Quartz Commercial |
$1,243.16
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,051.91
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$1,416.58
|
|
|
US Drainage Peritoneal
|
Facility
|
IP
|
$1,839.00
|
|
|
Service Code
|
CPT 76999
|
| Hospital Charge Code |
2544841
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$937.15 |
| Max. Negotiated Rate |
$1,759.56 |
| Rate for Payer: Aetna Commercial |
$1,721.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.66
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,759.56
|
| Rate for Payer: Health EOS Commercial |
$1,702.18
|
| Rate for Payer: HFN Commercial |
$1,759.56
|
| Rate for Payer: Multiplan Commercial |
$1,530.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.56
|
| Rate for Payer: Quartz Beloit One Network |
$937.15
|
| Rate for Payer: Quartz Commercial |
$1,147.54
|
| Rate for Payer: WEA Trust Commercial |
$1,051.91
|
| Rate for Payer: WPS Commercial |
$1,416.58
|
|
|
US Drainage Renal Right
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544847
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$561.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,121.51
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.06
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,202.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,302.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,202.45
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Drainage Renal Right
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544847
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Drainage Renal Right
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544847
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,202.45
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US ED Abdomen Limited
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
3100311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$179.09
|
| 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 |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.70
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$383.76
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$383.76
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
US ED Abdomen Limited
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
3100311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
US ED Abdomen Limited
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$582.92 |
| Rate for Payer: Aetna Commercial |
$582.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$527.70
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$582.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$306.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$558.38
|
| Rate for Payer: HFN Commercial |
$582.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$490.88
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$582.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.98
|
| Rate for Payer: Quartz Commercial |
$349.75
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$337.48
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US ED Abdomen Limited
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
3100311
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$607.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$582.04
|
| Rate for Payer: HFN Commercial |
$607.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$607.62
|
| Rate for Payer: Quartz Beloit One Network |
$281.42
|
| Rate for Payer: Quartz Commercial |
$364.57
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US ED Abdomen Limited
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$300.66 |
| Max. Negotiated Rate |
$564.51 |
| Rate for Payer: Aetna Commercial |
$552.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$527.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.21
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$564.51
|
| Rate for Payer: Health EOS Commercial |
$546.10
|
| Rate for Payer: HFN Commercial |
$564.51
|
| Rate for Payer: Multiplan Commercial |
$490.88
|
| Rate for Payer: Preferred Network Access Commercial |
$564.51
|
| Rate for Payer: Quartz Beloit One Network |
$300.66
|
| Rate for Payer: Quartz Commercial |
$368.16
|
| Rate for Payer: WEA Trust Commercial |
$337.48
|
| Rate for Payer: WPS Commercial |
$454.48
|
|
|
US ED Abdomen Limited
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587091
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$171.81 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$552.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$527.70
|
| Rate for Payer: Aetna Managed Medicare |
$171.81
|
| 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 |
$325.21
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$564.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.38
|
| Rate for Payer: Health EOS Commercial |
$546.10
|
| Rate for Payer: HFN Commercial |
$564.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.20
|
| Rate for Payer: Multiplan Commercial |
$490.88
|
| Rate for Payer: NAPHCARE Commercial |
$368.16
|
| Rate for Payer: Preferred Network Access Commercial |
$564.51
|
| Rate for Payer: Quartz Beloit One Network |
$300.66
|
| Rate for Payer: Quartz Commercial |
$398.84
|
| Rate for Payer: Quartz Medicare Advantage |
$368.16
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$337.48
|
| Rate for Payer: WPS Commercial |
$454.48
|
|
|
US ED Abd, Pel, Non OB eval
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$382.36 |
| Rate for Payer: Aetna Commercial |
$382.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$27.06
|
| Rate for Payer: Anthem Medicare Advantage |
$27.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.06
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$382.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.06
|
| Rate for Payer: Health EOS Commercial |
$366.26
|
| Rate for Payer: HFN Commercial |
$382.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$40.59
|
| Rate for Payer: Preferred Network Access Commercial |
$382.36
|
| Rate for Payer: Quartz Beloit One Network |
$177.09
|
| Rate for Payer: Quartz Commercial |
$229.41
|
| Rate for Payer: Quartz Medicare Advantage |
$27.06
|
| Rate for Payer: The Alliance Commercial |
$102.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.06
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$135.30
|
|
|
US ED Abd, Pel, Non OB eval
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$112.69
|
| 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 |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.23
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.86
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$241.49
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$261.61
|
| Rate for Payer: Quartz Medicare Advantage |
$241.49
|
| Rate for Payer: The Alliance Commercial |
$108.24
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
US ED Abd, Pel, Non OB eval
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587085
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$197.22 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$241.49
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
US ED Abd, Pel, Pregnancy
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$419.08 |
| Rate for Payer: Aetna Commercial |
$409.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.43
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$419.08
|
| Rate for Payer: Health EOS Commercial |
$405.41
|
| Rate for Payer: HFN Commercial |
$419.08
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: Preferred Network Access Commercial |
$419.08
|
| Rate for Payer: Quartz Beloit One Network |
$223.20
|
| Rate for Payer: Quartz Commercial |
$273.31
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$337.39
|
|
|
US ED Abd, Pel, Pregnancy
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587088
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$409.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$127.55
|
| 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 |
$241.43
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$419.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.92
|
| Rate for Payer: Health EOS Commercial |
$405.41
|
| Rate for Payer: HFN Commercial |
$419.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$341.64
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$273.31
|
| Rate for Payer: Preferred Network Access Commercial |
$419.08
|
| Rate for Payer: Quartz Beloit One Network |
$223.20
|
| Rate for Payer: Quartz Commercial |
$296.09
|
| Rate for Payer: Quartz Medicare Advantage |
$273.31
|
| Rate for Payer: The Alliance Commercial |
$201.43
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$337.39
|
|
|
US ED Aorta/Renal
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587095
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.12
|
| 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 |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$338.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$338.83
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
US ED Aorta/Renal
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587095
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
US ED Aorta/Renal
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587094
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$726.18 |
| Rate for Payer: Aetna Commercial |
$726.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| 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 |
$726.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$382.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$695.60
|
| Rate for Payer: HFN Commercial |
$726.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$726.18
|
| Rate for Payer: Quartz Beloit One Network |
$336.34
|
| Rate for Payer: Quartz Commercial |
$435.71
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
