|
US ED Aorta/Renal
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587094
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$2,940.00 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Aetna Managed Medicare |
$205.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$676.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.31
|
| Rate for Payer: Health EOS Commercial |
$654.15
|
| Rate for Payer: HFN Commercial |
$676.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.25
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: NAPHCARE Commercial |
$441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$676.20
|
| Rate for Payer: Quartz Beloit One Network |
$360.15
|
| Rate for Payer: Quartz Commercial |
$477.75
|
| Rate for Payer: Quartz Medicare Advantage |
$441.00
|
| Rate for Payer: The Alliance Commercial |
$2,940.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
US ED Aorta/Renal
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587094
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$360.15 |
| Max. Negotiated Rate |
$676.20 |
| Rate for Payer: Aetna Commercial |
$661.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.55
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$676.20
|
| Rate for Payer: Health EOS Commercial |
$654.15
|
| Rate for Payer: HFN Commercial |
$676.20
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: NAPHCARE Commercial |
$441.00
|
| Rate for Payer: Preferred Network Access Commercial |
$676.20
|
| Rate for Payer: Quartz Beloit One Network |
$360.15
|
| Rate for Payer: Quartz Commercial |
$441.00
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
US ED Aorta/Renal
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587095
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
US ED Aorta/Renal
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587094
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$698.25 |
| Rate for Payer: Aetna Commercial |
$698.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.10
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$698.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.00
|
| Rate for Payer: Health EOS Commercial |
$668.85
|
| Rate for Payer: HFN Commercial |
$698.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.48
|
| Rate for Payer: Multiplan Commercial |
$588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$698.25
|
| Rate for Payer: Quartz Beloit One Network |
$323.40
|
| Rate for Payer: Quartz Commercial |
$418.95
|
| Rate for Payer: The Alliance Commercial |
$367.50
|
| Rate for Payer: WEA Trust Commercial |
$404.25
|
| Rate for Payer: WPS Commercial |
$544.41
|
|
|
US ED Aorta/Renal
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587095
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.55 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna Commercial |
$515.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$515.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.80
|
| Rate for Payer: Health EOS Commercial |
$494.13
|
| Rate for Payer: HFN Commercial |
$515.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.55
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$515.85
|
| Rate for Payer: Quartz Beloit One Network |
$238.92
|
| Rate for Payer: Quartz Commercial |
$309.51
|
| Rate for Payer: The Alliance Commercial |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
US ED Cardiac
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3033037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Aetna Managed Medicare |
$132.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.13
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$306.80
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,888.00
|
| Rate for Payer: United Healthcare PPO |
$354.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
US ED Cardiac
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3033037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$434.24 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
US ED Cardiac
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3033037
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$207.68 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$448.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$236.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.20
|
| Rate for Payer: Health EOS Commercial |
$429.52
|
| Rate for Payer: HFN Commercial |
$448.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Preferred Network Access Commercial |
$448.40
|
| Rate for Payer: Quartz Beloit One Network |
$207.68
|
| Rate for Payer: Quartz Commercial |
$269.04
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
US ED Chest
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587097
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$458.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$458.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$439.53
|
| Rate for Payer: HFN Commercial |
$458.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.46
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Preferred Network Access Commercial |
$458.85
|
| Rate for Payer: Quartz Beloit One Network |
$212.52
|
| Rate for Payer: Quartz Commercial |
$275.31
|
| Rate for Payer: The Alliance Commercial |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
US ED Chest
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587097
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$1,932.00 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Aetna Managed Medicare |
$135.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.99
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$444.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.29
|
| Rate for Payer: Health EOS Commercial |
$429.87
|
| Rate for Payer: HFN Commercial |
$444.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: NAPHCARE Commercial |
$289.80
|
| Rate for Payer: Preferred Network Access Commercial |
$444.36
|
| Rate for Payer: Quartz Beloit One Network |
$236.67
|
| Rate for Payer: Quartz Commercial |
$313.95
|
| Rate for Payer: Quartz Medicare Advantage |
$289.80
|
| Rate for Payer: The Alliance Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
US ED Chest
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587097
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.67 |
| Max. Negotiated Rate |
$444.36 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.99
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$444.36
|
| Rate for Payer: Health EOS Commercial |
$429.87
|
| Rate for Payer: HFN Commercial |
$444.36
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: NAPHCARE Commercial |
$289.80
|
| Rate for Payer: Preferred Network Access Commercial |
$444.36
|
| Rate for Payer: Quartz Beloit One Network |
$236.67
|
| Rate for Payer: Quartz Commercial |
$289.80
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
US ED DVT Eval
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
2587100
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.84 |
| Max. Negotiated Rate |
$1,812.00 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Aetna Managed Medicare |
$126.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.50
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.75
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$294.45
|
| Rate for Payer: Quartz Medicare Advantage |
$271.80
|
| Rate for Payer: The Alliance Commercial |
$1,812.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
US ED DVT Eval
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
2587100
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$199.32 |
| Max. Negotiated Rate |
$430.35 |
| Rate for Payer: Aetna Commercial |
$430.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$430.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.80
|
| Rate for Payer: Health EOS Commercial |
$412.23
|
| Rate for Payer: HFN Commercial |
$430.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: Preferred Network Access Commercial |
$430.35
|
| Rate for Payer: Quartz Beloit One Network |
$199.32
|
| Rate for Payer: Quartz Commercial |
$258.21
|
| Rate for Payer: The Alliance Commercial |
$226.50
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
US ED DVT Eval
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
2587100
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$221.97 |
| Max. Negotiated Rate |
$416.76 |
| Rate for Payer: Aetna Commercial |
$407.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.09
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$416.76
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$416.76
|
| Rate for Payer: Multiplan Commercial |
$362.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$416.76
|
| Rate for Payer: Quartz Beloit One Network |
$221.97
|
| Rate for Payer: Quartz Commercial |
$271.80
|
| Rate for Payer: WEA Trust Commercial |
$249.15
|
| Rate for Payer: WPS Commercial |
$335.54
|
|
|
US ED Fast Trauma
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.67 |
| Max. Negotiated Rate |
$444.36 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.99
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$444.36
|
| Rate for Payer: Health EOS Commercial |
$429.87
|
| Rate for Payer: HFN Commercial |
$444.36
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: NAPHCARE Commercial |
$289.80
|
| Rate for Payer: Preferred Network Access Commercial |
$444.36
|
| Rate for Payer: Quartz Beloit One Network |
$236.67
|
| Rate for Payer: Quartz Commercial |
$289.80
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
US ED Fast Trauma
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$131.46 |
| Max. Negotiated Rate |
$458.85 |
| Rate for Payer: Aetna Commercial |
$458.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$458.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$439.53
|
| Rate for Payer: HFN Commercial |
$458.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.46
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: Preferred Network Access Commercial |
$458.85
|
| Rate for Payer: Quartz Beloit One Network |
$212.52
|
| Rate for Payer: Quartz Commercial |
$275.31
|
| Rate for Payer: The Alliance Commercial |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
US ED Fast Trauma
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$1,932.00 |
| Rate for Payer: Aetna Commercial |
$434.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.38
|
| Rate for Payer: Aetna Managed Medicare |
$135.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.99
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$444.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.29
|
| Rate for Payer: Health EOS Commercial |
$429.87
|
| Rate for Payer: HFN Commercial |
$444.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$362.25
|
| Rate for Payer: Multiplan Commercial |
$386.40
|
| Rate for Payer: NAPHCARE Commercial |
$289.80
|
| Rate for Payer: Preferred Network Access Commercial |
$444.36
|
| Rate for Payer: Quartz Beloit One Network |
$236.67
|
| Rate for Payer: Quartz Commercial |
$313.95
|
| Rate for Payer: Quartz Medicare Advantage |
$289.80
|
| Rate for Payer: The Alliance Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$265.65
|
| Rate for Payer: WPS Commercial |
$357.76
|
|
|
US ED Fast Trauma 93308
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3100310
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$207.68 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$448.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$236.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.20
|
| Rate for Payer: Health EOS Commercial |
$429.52
|
| Rate for Payer: HFN Commercial |
$448.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Preferred Network Access Commercial |
$448.40
|
| Rate for Payer: Quartz Beloit One Network |
$207.68
|
| Rate for Payer: Quartz Commercial |
$269.04
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
US ED Fast Trauma 93308
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3100310
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$132.16 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Aetna Managed Medicare |
$132.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$306.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$226.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.13
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.00
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$306.80
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,888.00
|
| Rate for Payer: United Healthcare PPO |
$354.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
US ED Fast Trauma 93308
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3100310
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$434.24 |
| Rate for Payer: Aetna Commercial |
$424.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$250.16
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$434.24
|
| Rate for Payer: Health EOS Commercial |
$420.08
|
| Rate for Payer: HFN Commercial |
$434.24
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: NAPHCARE Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$434.24
|
| Rate for Payer: Quartz Beloit One Network |
$231.28
|
| Rate for Payer: Quartz Commercial |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
US ED Genitalia
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
3000463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.28 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Aetna Commercial |
$510.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$510.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.20
|
| Rate for Payer: Health EOS Commercial |
$488.67
|
| Rate for Payer: HFN Commercial |
$510.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.02
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$510.15
|
| Rate for Payer: Quartz Beloit One Network |
$236.28
|
| Rate for Payer: Quartz Commercial |
$306.09
|
| Rate for Payer: The Alliance Commercial |
$268.50
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
US ED Genitalia
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
3000463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$150.36 |
| Max. Negotiated Rate |
$2,148.00 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Aetna Managed Medicare |
$150.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.51
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$349.05
|
| Rate for Payer: Quartz Medicare Advantage |
$322.20
|
| Rate for Payer: The Alliance Commercial |
$2,148.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
US ED Genitalia
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
3000463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$494.04 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$322.20
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
US ED Guidance for Needle Placement
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
2587109
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$426.55 |
| Rate for Payer: Aetna Commercial |
$426.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$426.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.40
|
| Rate for Payer: Health EOS Commercial |
$408.59
|
| Rate for Payer: HFN Commercial |
$426.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.86
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$426.55
|
| Rate for Payer: Quartz Beloit One Network |
$197.56
|
| Rate for Payer: Quartz Commercial |
$255.93
|
| Rate for Payer: The Alliance Commercial |
$224.50
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
US ED Guidance for Needle Placement
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
2587109
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$220.01 |
| Max. Negotiated Rate |
$413.08 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.97
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$413.08
|
| Rate for Payer: Health EOS Commercial |
$399.61
|
| Rate for Payer: HFN Commercial |
$413.08
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: NAPHCARE Commercial |
$269.40
|
| Rate for Payer: Preferred Network Access Commercial |
$413.08
|
| Rate for Payer: Quartz Beloit One Network |
$220.01
|
| Rate for Payer: Quartz Commercial |
$269.40
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
