|
US ED Soft Tissue Other
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587145
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$614.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$587.62
|
| Rate for Payer: Aetna Managed Medicare |
$191.32
|
| 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 |
$362.14
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$628.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.37
|
| Rate for Payer: Health EOS Commercial |
$608.12
|
| Rate for Payer: HFN Commercial |
$628.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$512.46
|
| Rate for Payer: Multiplan Commercial |
$546.62
|
| Rate for Payer: NAPHCARE Commercial |
$409.97
|
| Rate for Payer: Preferred Network Access Commercial |
$628.62
|
| Rate for Payer: Quartz Beloit One Network |
$334.81
|
| Rate for Payer: Quartz Commercial |
$444.13
|
| Rate for Payer: Quartz Medicare Advantage |
$409.97
|
| Rate for Payer: The Alliance Commercial |
$326.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$375.80
|
| Rate for Payer: WPS Commercial |
$506.09
|
|
|
US ED Soft Tissue Other
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587145
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$649.12 |
| Rate for Payer: Aetna Commercial |
$649.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$587.62
|
| Rate for Payer: Aetna Managed Medicare |
$81.64
|
| Rate for Payer: Anthem Medicare Advantage |
$81.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.64
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$649.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$341.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.64
|
| Rate for Payer: Health EOS Commercial |
$621.78
|
| Rate for Payer: HFN Commercial |
$649.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.64
|
| Rate for Payer: Multiplan Commercial |
$546.62
|
| Rate for Payer: NAPHCARE Commercial |
$122.46
|
| Rate for Payer: Preferred Network Access Commercial |
$649.12
|
| Rate for Payer: Quartz Beloit One Network |
$300.64
|
| Rate for Payer: Quartz Commercial |
$389.47
|
| Rate for Payer: Quartz Medicare Advantage |
$81.64
|
| Rate for Payer: The Alliance Commercial |
$310.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.64
|
| Rate for Payer: WEA Trust Commercial |
$375.80
|
| Rate for Payer: WPS Commercial |
$408.20
|
|
|
US ED Soft Tissue Other
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2587145
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$334.81 |
| Max. Negotiated Rate |
$628.62 |
| Rate for Payer: Aetna Commercial |
$614.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$587.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.14
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$628.62
|
| Rate for Payer: Health EOS Commercial |
$608.12
|
| Rate for Payer: HFN Commercial |
$628.62
|
| Rate for Payer: Multiplan Commercial |
$546.62
|
| Rate for Payer: Preferred Network Access Commercial |
$628.62
|
| Rate for Payer: Quartz Beloit One Network |
$334.81
|
| Rate for Payer: Quartz Commercial |
$409.97
|
| Rate for Payer: WEA Trust Commercial |
$375.80
|
| Rate for Payer: WPS Commercial |
$506.09
|
|
|
US ED Soft Tissue Pelvic Wall
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587148
|
|
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 Soft Tissue Pelvic Wall
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587148
|
|
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 Soft Tissue Pelvic Wall
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587148
|
|
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 Soft Tissue Perineum
|
Professional
|
Both
|
$471.00
|
|
| Hospital Charge Code |
2587151
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$215.53 |
| Max. Negotiated Rate |
$465.35 |
| Rate for Payer: Aetna Commercial |
$465.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$465.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.90
|
| Rate for Payer: Health EOS Commercial |
$445.75
|
| Rate for Payer: HFN Commercial |
$465.35
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$465.35
|
| Rate for Payer: Quartz Beloit One Network |
$215.53
|
| Rate for Payer: Quartz Commercial |
$279.21
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US ED Soft Tissue Perineum
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
2587151
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| 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 |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US ED Soft Tissue Perineum
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
2587151
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US ED Soft Tissue Upper Back
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$112.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.65
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.08
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$240.86
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$260.94
|
| Rate for Payer: Quartz Medicare Advantage |
$240.86
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
US ED Soft Tissue Upper Back
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$381.37 |
| Rate for Payer: Aetna Commercial |
$381.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| 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 |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$381.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$365.31
|
| Rate for Payer: HFN Commercial |
$381.37
|
| 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 |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$381.37
|
| Rate for Payer: Quartz Beloit One Network |
$176.63
|
| Rate for Payer: Quartz Commercial |
$228.82
|
| 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 |
$220.79
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
US ED Soft Tissue Upper Back
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552822
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
US ED Soft Tissue Upper Back
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552822
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$1,007.76 |
| Rate for Payer: Aetna Commercial |
$1,007.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| 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 |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$1,007.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.61
|
| Rate for Payer: Health EOS Commercial |
$965.33
|
| Rate for Payer: HFN Commercial |
$1,007.76
|
| 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 |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$90.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.75
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| 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 |
$583.44
|
| Rate for Payer: WPS Commercial |
$303.06
|
|
|
US ED Soft Tissue Upper Back
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$240.86
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
US ED Soft Tissue Upper Back
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552822
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| 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 |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| 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 |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| 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 |
$583.44
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$160.74
|
| 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 |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.26
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$344.45
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| 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 |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| 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 |
$551.41
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
US ED Soft Tissue Upper Extremity
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$545.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$31.72
|
| Rate for Payer: Anthem Medicare Advantage |
$31.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.72
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.72
|
| Rate for Payer: Health EOS Commercial |
$522.41
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.72
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$47.58
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$252.60
|
| Rate for Payer: Quartz Commercial |
$327.23
|
| Rate for Payer: Quartz Medicare Advantage |
$31.72
|
| Rate for Payer: The Alliance Commercial |
$120.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$158.60
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
US ED Soft Tissue Upper Extremity
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$952.43 |
| Rate for Payer: Aetna Commercial |
$952.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$63.74
|
| Rate for Payer: Anthem Medicare Advantage |
$63.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.74
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$952.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$501.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.74
|
| Rate for Payer: Health EOS Commercial |
$912.33
|
| Rate for Payer: HFN Commercial |
$952.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.74
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$95.61
|
| Rate for Payer: Preferred Network Access Commercial |
$952.43
|
| Rate for Payer: Quartz Beloit One Network |
$441.13
|
| Rate for Payer: Quartz Commercial |
$571.46
|
| Rate for Payer: Quartz Medicare Advantage |
$63.74
|
| Rate for Payer: The Alliance Commercial |
$242.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.74
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$318.71
|
|
|
US ED Soft Tissue Upper Extremity
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$344.45
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
US ED Vascular Access
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.58 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$165.11
|
| 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 |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$353.81
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$353.81
|
| Rate for Payer: The Alliance Commercial |
$105.58
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
US ED Vascular Access
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
US ED Vascular Access
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna Commercial |
$560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$26.40
|
| Rate for Payer: Anthem Medicare Advantage |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.40
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$560.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$294.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$536.61
|
| Rate for Payer: HFN Commercial |
$560.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$39.59
|
| Rate for Payer: Preferred Network Access Commercial |
$560.20
|
| Rate for Payer: Quartz Beloit One Network |
$259.46
|
| Rate for Payer: Quartz Commercial |
$336.12
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$131.98
|
|
|
US Exam Abdo Back Wall, Comp 7677026
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
3403595
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$34.09
|
| Rate for Payer: Anthem Medicare Advantage |
$34.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.09
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.09
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.09
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$51.14
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: Quartz Medicare Advantage |
$34.09
|
| Rate for Payer: The Alliance Commercial |
$129.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.09
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$170.46
|
|
