|
US Guided Marker Placement
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$595.76 |
| Rate for Payer: Aetna Commercial |
$595.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$69.91
|
| Rate for Payer: Anthem Medicare Advantage |
$69.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.91
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$595.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.91
|
| Rate for Payer: Health EOS Commercial |
$570.68
|
| Rate for Payer: HFN Commercial |
$595.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.91
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$104.86
|
| Rate for Payer: Preferred Network Access Commercial |
$595.76
|
| Rate for Payer: Quartz Beloit One Network |
$275.93
|
| Rate for Payer: Quartz Commercial |
$357.46
|
| Rate for Payer: Quartz Medicare Advantage |
$69.91
|
| Rate for Payer: The Alliance Commercial |
$297.11
|
| Rate for Payer: United Healthcare Medicaid |
$67.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.91
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$314.59
|
|
|
US Guided Marker Placement ea add
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$35.12
|
| Rate for Payer: Anthem Medicare Advantage |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.12
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.12
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.12
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$52.68
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$35.12
|
| Rate for Payer: The Alliance Commercial |
$149.26
|
| Rate for Payer: United Healthcare Medicaid |
$33.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.12
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$158.04
|
|
|
US Guided Marker Placement ea add
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| 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 |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$140.48
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
US Guided Marker Placement ea add
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$594.78 |
| Rate for Payer: Aetna Commercial |
$594.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$35.12
|
| Rate for Payer: Anthem Medicare Advantage |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.12
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$594.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.12
|
| Rate for Payer: Health EOS Commercial |
$569.73
|
| Rate for Payer: HFN Commercial |
$594.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.12
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$52.68
|
| Rate for Payer: Preferred Network Access Commercial |
$594.78
|
| Rate for Payer: Quartz Beloit One Network |
$275.48
|
| Rate for Payer: Quartz Commercial |
$356.87
|
| Rate for Payer: Quartz Medicare Advantage |
$35.12
|
| Rate for Payer: The Alliance Commercial |
$149.26
|
| Rate for Payer: United Healthcare Medicaid |
$33.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.12
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$158.04
|
|
|
US Guided Marker Placement ea add
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
US Guided Marker Placement ea add
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
US Guided Marker Placement ea add
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| 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 |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$140.48
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
US Guided Needle Placement
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$570.24 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$698.26
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
US Guided Needle Placement
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$731.79 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$896.06
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
US Guided Needle Placement
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,105.57 |
| Rate for Payer: Aetna Commercial |
$1,105.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,105.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$581.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,059.02
|
| Rate for Payer: HFN Commercial |
$1,105.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,105.57
|
| Rate for Payer: Quartz Beloit One Network |
$512.05
|
| Rate for Payer: Quartz Commercial |
$663.34
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$325.85
|
| 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 |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.26
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.82
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$698.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$756.44
|
| Rate for Payer: Quartz Medicare Advantage |
$698.26
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
US Guided Needle Placement
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,418.77 |
| Rate for Payer: Aetna Commercial |
$1,418.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,418.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$746.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,359.03
|
| Rate for Payer: HFN Commercial |
$1,418.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.77
|
| Rate for Payer: Quartz Beloit One Network |
$657.11
|
| Rate for Payer: Quartz Commercial |
$851.26
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Aetna Managed Medicare |
$418.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.75
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.08
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$896.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$970.74
|
| Rate for Payer: Quartz Medicare Advantage |
$896.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
US Guided Needle Placement S&I
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement S&I
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Guided Needle Placement S&I
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$561.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,121.51
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.06
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,202.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,302.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,202.45
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guided Needle Placement S&I
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,202.45
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guided Needle Placement S&I
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,830.76 |
| Rate for Payer: Aetna Commercial |
$1,830.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,830.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,753.68
|
| Rate for Payer: HFN Commercial |
$1,830.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.76
|
| Rate for Payer: Quartz Beloit One Network |
$847.93
|
| Rate for Payer: Quartz Commercial |
$1,098.46
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement S&I
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.45
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Guide, Intraop 7699826
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 76998 26
|
| Hospital Charge Code |
4464925
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$46.27
|
| Rate for Payer: Anthem Medicare Advantage |
$46.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.27
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.27
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.27
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$69.40
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: Quartz Medicare Advantage |
$46.27
|
| Rate for Payer: The Alliance Commercial |
$175.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.27
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$231.35
|
|
|
US Guide, Vascular Access 7693726
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 76937 26
|
| Hospital Charge Code |
3493549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$399.15 |
| Rate for Payer: Aetna Commercial |
$399.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$399.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$382.35
|
| Rate for Payer: HFN Commercial |
$399.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$399.15
|
| Rate for Payer: Quartz Beloit One Network |
$184.87
|
| Rate for Payer: Quartz Commercial |
$239.49
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$50.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$66.92
|
|
|
US Head/Neck Soft Tissue
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
631151
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$1,030.48 |
| Rate for Payer: Aetna Commercial |
$1,030.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$108.06
|
| Rate for Payer: Anthem Medicare Advantage |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.06
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$1,030.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$542.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.06
|
| Rate for Payer: Health EOS Commercial |
$987.10
|
| Rate for Payer: HFN Commercial |
$1,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$412.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.06
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$477.28
|
| Rate for Payer: Quartz Commercial |
$618.29
|
| Rate for Payer: Quartz Medicare Advantage |
$108.06
|
| Rate for Payer: The Alliance Commercial |
$410.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.06
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$540.28
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544891
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$653.82 |
| Max. Negotiated Rate |
$1,227.57 |
| Rate for Payer: Aetna Commercial |
$1,200.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$707.19
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cigna Commercial |
$1,227.57
|
| Rate for Payer: Health EOS Commercial |
$1,187.54
|
| Rate for Payer: HFN Commercial |
$1,227.57
|
| Rate for Payer: Multiplan Commercial |
$1,067.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.57
|
| Rate for Payer: Quartz Beloit One Network |
$653.82
|
| Rate for Payer: Quartz Commercial |
$800.59
|
| Rate for Payer: WEA Trust Commercial |
$733.88
|
| Rate for Payer: WPS Commercial |
$988.29
|
|
|
US Head/Neck Soft Tissue
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544891
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$1,267.60 |
| Rate for Payer: Aetna Commercial |
$1,267.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.52
|
| 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 |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cigna Commercial |
$1,267.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$667.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.64
|
| Rate for Payer: Health EOS Commercial |
$1,214.23
|
| Rate for Payer: HFN Commercial |
$1,267.60
|
| 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 |
$1,067.46
|
| Rate for Payer: NAPHCARE Commercial |
$122.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.60
|
| Rate for Payer: Quartz Beloit One Network |
$587.10
|
| Rate for Payer: Quartz Commercial |
$760.56
|
| 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 |
$733.88
|
| Rate for Payer: WPS Commercial |
$408.20
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
631151
|
| Min. Negotiated Rate |
$531.51 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$650.83
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
