|
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
|
|
|
US ED Ocular
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
2587112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: HFN Commercial |
$528.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.88
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
US ED Ocular
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
2587112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| 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 |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
US ED Ocular
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
2587112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
US ED Pel, TV Non OB
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2587115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$119.28 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Aetna Managed Medicare |
$119.28
|
| 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 |
$225.78
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.39
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.50
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$255.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$276.90
|
| Rate for Payer: Quartz Medicare Advantage |
$255.60
|
| Rate for Payer: The Alliance Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
US ED Pel, TV Non OB
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2587115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$391.92 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$255.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$255.60
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
US ED Pel, TV Non OB
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2587115
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$404.70 |
| Rate for Payer: Aetna Commercial |
$404.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$404.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.60
|
| Rate for Payer: Health EOS Commercial |
$387.66
|
| Rate for Payer: HFN Commercial |
$404.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.82
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$404.70
|
| Rate for Payer: Quartz Beloit One Network |
$187.44
|
| Rate for Payer: Quartz Commercial |
$242.82
|
| Rate for Payer: The Alliance Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
US ED Pel, TV, Pregnancy
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
2587118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
US ED Pel, TV, Pregnancy
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
2587118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$1,648.00 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Aetna Managed Medicare |
$115.36
|
| 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 |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.56
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.00
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$267.80
|
| Rate for Payer: Quartz Medicare Advantage |
$247.20
|
| Rate for Payer: The Alliance Commercial |
$1,648.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
US ED Pel, TV, Pregnancy
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
2587118
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$391.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.20
|
| Rate for Payer: Health EOS Commercial |
$374.92
|
| Rate for Payer: HFN Commercial |
$391.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$202.23
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.28
|
| Rate for Payer: Quartz Commercial |
$234.84
|
| Rate for Payer: The Alliance Commercial |
$206.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
US ED Soft Tissue Abdominal Wall
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587121
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.55 |
| Max. Negotiated Rate |
$560.50 |
| Rate for Payer: Aetna Commercial |
$560.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.40
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$560.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.00
|
| Rate for Payer: Health EOS Commercial |
$536.90
|
| Rate for Payer: HFN Commercial |
$560.50
|
| 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 |
$472.00
|
| Rate for Payer: Preferred Network Access Commercial |
$560.50
|
| Rate for Payer: Quartz Beloit One Network |
$259.60
|
| Rate for Payer: Quartz Commercial |
$336.30
|
| Rate for Payer: The Alliance Commercial |
$295.00
|
| Rate for Payer: WEA Trust Commercial |
$324.50
|
| Rate for Payer: WPS Commercial |
$437.01
|
|
|
US ED Soft Tissue Abdominal Wall
|
Facility
|
OP
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587121
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$2,360.00 |
| Rate for Payer: Aetna Commercial |
$531.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.40
|
| Rate for Payer: Aetna Managed Medicare |
$165.20
|
| 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 |
$312.70
|
| 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 |
$542.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.16
|
| Rate for Payer: Health EOS Commercial |
$525.10
|
| Rate for Payer: HFN Commercial |
$542.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.50
|
| Rate for Payer: Multiplan Commercial |
$472.00
|
| Rate for Payer: NAPHCARE Commercial |
$354.00
|
| Rate for Payer: Preferred Network Access Commercial |
$542.80
|
| Rate for Payer: Quartz Beloit One Network |
$289.10
|
| Rate for Payer: Quartz Commercial |
$383.50
|
| Rate for Payer: Quartz Medicare Advantage |
$354.00
|
| Rate for Payer: The Alliance Commercial |
$2,360.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$324.50
|
| Rate for Payer: WPS Commercial |
$437.01
|
|
|
US ED Soft Tissue Abdominal Wall
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552824
|
| Min. Negotiated Rate |
$706.09 |
| Max. Negotiated Rate |
$1,325.72 |
| Rate for Payer: Aetna Commercial |
$1,296.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,239.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.73
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cigna Commercial |
$1,325.72
|
| Rate for Payer: Health EOS Commercial |
$1,282.49
|
| Rate for Payer: HFN Commercial |
$1,325.72
|
| Rate for Payer: Multiplan Commercial |
$1,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$864.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.72
|
| Rate for Payer: Quartz Beloit One Network |
$706.09
|
| Rate for Payer: Quartz Commercial |
$864.60
|
| Rate for Payer: WEA Trust Commercial |
$792.55
|
| Rate for Payer: WPS Commercial |
$1,067.35
|
|
|
US ED Soft Tissue Abdominal Wall
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587121
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.10 |
| Max. Negotiated Rate |
$542.80 |
| Rate for Payer: Aetna Commercial |
$531.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.70
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$542.80
|
| Rate for Payer: Health EOS Commercial |
$525.10
|
| Rate for Payer: HFN Commercial |
$542.80
|
| Rate for Payer: Multiplan Commercial |
$472.00
|
| Rate for Payer: NAPHCARE Commercial |
$354.00
|
| Rate for Payer: Preferred Network Access Commercial |
$542.80
|
| Rate for Payer: Quartz Beloit One Network |
$289.10
|
| Rate for Payer: Quartz Commercial |
$354.00
|
| Rate for Payer: WEA Trust Commercial |
$324.50
|
| Rate for Payer: WPS Commercial |
$437.01
|
|
|
US ED Soft Tissue Abdominal Wall
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552824
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,325.72 |
| Rate for Payer: Aetna Commercial |
$1,296.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,239.26
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$936.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$720.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.68
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cigna Commercial |
$1,325.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$806.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,282.49
|
| Rate for Payer: HFN Commercial |
$1,325.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,152.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.72
|
| Rate for Payer: Quartz Beloit One Network |
$706.09
|
| Rate for Payer: Quartz Commercial |
$936.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$792.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,067.35
|
|
|
US ED Soft Tissue Abdominal Wall
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552824
|
| Min. Negotiated Rate |
$310.04 |
| Max. Negotiated Rate |
$1,368.95 |
| Rate for Payer: Aetna Commercial |
$1,368.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,239.26
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cigna Commercial |
$1,368.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$720.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$864.60
|
| Rate for Payer: Health EOS Commercial |
$1,311.31
|
| Rate for Payer: HFN Commercial |
$1,368.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$1,152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,368.95
|
| Rate for Payer: Quartz Beloit One Network |
$634.04
|
| Rate for Payer: Quartz Commercial |
$821.37
|
| Rate for Payer: The Alliance Commercial |
$720.50
|
| Rate for Payer: WEA Trust Commercial |
$792.55
|
| Rate for Payer: WPS Commercial |
$1,067.35
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$331.20
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
US ED Soft Tissue Axilla
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$502.32
|
| Rate for Payer: HFN Commercial |
$524.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.76
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$242.88
|
| Rate for Payer: Quartz Commercial |
$314.64
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
US ED Soft Tissue Axilla
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552820
|
| Min. Negotiated Rate |
$192.56 |
| Max. Negotiated Rate |
$915.80 |
| Rate for Payer: Aetna Commercial |
$915.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$915.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$482.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$578.40
|
| Rate for Payer: Health EOS Commercial |
$877.24
|
| Rate for Payer: HFN Commercial |
$915.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.56
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$915.80
|
| Rate for Payer: Quartz Beloit One Network |
$424.16
|
| Rate for Payer: Quartz Commercial |
$549.48
|
| Rate for Payer: The Alliance Commercial |
$482.00
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552820
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$886.88 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$626.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$482.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.72
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$626.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552820
|
| Min. Negotiated Rate |
$472.36 |
| Max. Negotiated Rate |
$886.88 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$578.40
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$2,208.00 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$154.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| 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 |
$507.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.90
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$331.20
|
| Rate for Payer: The Alliance Commercial |
$2,208.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
US ED Soft Tissue Breast
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
3000469
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$1,916.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.05
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.25
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$287.40
|
| Rate for Payer: The Alliance Commercial |
$1,916.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
US ED Soft Tissue Breast
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
3000469
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$210.76 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna Commercial |
$455.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$455.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.40
|
| Rate for Payer: Health EOS Commercial |
$435.89
|
| Rate for Payer: HFN Commercial |
$455.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.70
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$455.05
|
| Rate for Payer: Quartz Beloit One Network |
$210.76
|
| Rate for Payer: Quartz Commercial |
$273.03
|
| Rate for Payer: The Alliance Commercial |
$239.50
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
US ED Soft Tissue Breast
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
3000469
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
