|
US ED Vascular Access
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$538.65 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$538.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.20
|
| Rate for Payer: Health EOS Commercial |
$515.97
|
| Rate for Payer: HFN Commercial |
$538.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.56
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$538.65
|
| Rate for Payer: Quartz Beloit One Network |
$249.48
|
| Rate for Payer: Quartz Commercial |
$323.19
|
| Rate for Payer: The Alliance Commercial |
$283.50
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
US Exam Abdo Back Wall, Comp 7677026
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
3403595
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.77 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$352.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$352.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.60
|
| Rate for Payer: Health EOS Commercial |
$337.61
|
| Rate for Payer: HFN Commercial |
$352.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.77
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.45
|
| Rate for Payer: Quartz Beloit One Network |
$163.24
|
| Rate for Payer: Quartz Commercial |
$211.47
|
| Rate for Payer: The Alliance Commercial |
$185.50
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
US Exam,Chest 7660426
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 76604 26
|
| Hospital Charge Code |
3221485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.19 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna Commercial |
$292.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$292.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.80
|
| Rate for Payer: Health EOS Commercial |
$280.28
|
| Rate for Payer: HFN Commercial |
$292.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.19
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$292.60
|
| Rate for Payer: Quartz Beloit One Network |
$135.52
|
| Rate for Payer: Quartz Commercial |
$175.56
|
| Rate for Payer: The Alliance Commercial |
$154.00
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
US Exam of Head and Neck 7653626
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
CPT 76536 26
|
| Hospital Charge Code |
3206218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.82 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna Commercial |
$417.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$417.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.40
|
| Rate for Payer: Health EOS Commercial |
$399.49
|
| Rate for Payer: HFN Commercial |
$417.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.82
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: Preferred Network Access Commercial |
$417.05
|
| Rate for Payer: Quartz Beloit One Network |
$193.16
|
| Rate for Payer: Quartz Commercial |
$250.23
|
| Rate for Payer: The Alliance Commercial |
$219.50
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
US Exam of Head and Neck 76536PP
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
4512616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.84 |
| Max. Negotiated Rate |
$1,650.15 |
| Rate for Payer: Aetna Commercial |
$1,650.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,493.82
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,650.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$868.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.20
|
| Rate for Payer: Health EOS Commercial |
$1,580.67
|
| Rate for Payer: HFN Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.84
|
| Rate for Payer: Multiplan Commercial |
$1,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.15
|
| Rate for Payer: Quartz Beloit One Network |
$764.28
|
| Rate for Payer: Quartz Commercial |
$990.09
|
| Rate for Payer: The Alliance Commercial |
$868.50
|
| Rate for Payer: WEA Trust Commercial |
$955.35
|
| Rate for Payer: WPS Commercial |
$1,286.60
|
|
|
US Exam Thyroid/Soft 76536
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
3147564
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.24 |
| Max. Negotiated Rate |
$396.84 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.60
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.84
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
US Extremity Non-Vascular Bilateral
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Bilateral
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.52
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Bilateral
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: HFN Commercial |
$853.10
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: HFN Commercial |
$853.10
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$227.23 |
| Max. Negotiated Rate |
$887.30 |
| Rate for Payer: Aetna Commercial |
$887.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$887.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$467.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.40
|
| Rate for Payer: Health EOS Commercial |
$849.94
|
| Rate for Payer: HFN Commercial |
$887.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.23
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$887.30
|
| Rate for Payer: Quartz Beloit One Network |
$410.96
|
| Rate for Payer: Quartz Commercial |
$532.38
|
| Rate for Payer: The Alliance Commercial |
$467.00
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.52
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.52
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$607.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$467.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$448.32
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| 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 |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| 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 |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$607.10
|
| 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 |
$513.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$457.66 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$560.40
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: HFN Commercial |
$853.10
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity, Nonvascular, Realtime Image Complete 76881
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
3545508
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.40
|
| Rate for Payer: Health EOS Commercial |
$276.64
|
| Rate for Payer: HFN Commercial |
$288.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.23
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$288.80
|
| Rate for Payer: Quartz Beloit One Network |
$133.76
|
| Rate for Payer: Quartz Commercial |
$173.28
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: WPS Commercial |
$225.17
|
|
|
US Extremity, Nonvascular, Realtime Image Complete 7688126
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 76881 26
|
| Hospital Charge Code |
3015310
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$106.18 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$288.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.44
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$288.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.40
|
| Rate for Payer: Health EOS Commercial |
$276.64
|
| Rate for Payer: HFN Commercial |
$288.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.18
|
| Rate for Payer: Multiplan Commercial |
$243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$288.80
|
| Rate for Payer: Quartz Beloit One Network |
$133.76
|
| Rate for Payer: Quartz Commercial |
$173.28
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: WEA Trust Commercial |
$167.20
|
| Rate for Payer: WPS Commercial |
$225.17
|
|
|
US Extremity, Nonvascular, Realtime Image Complete 76881PP
|
Professional
|
Both
|
$1,275.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
3096893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$227.23 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Aetna Commercial |
$1,211.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,096.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Cigna Commercial |
$1,211.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$637.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$765.00
|
| Rate for Payer: Health EOS Commercial |
$1,160.25
|
| Rate for Payer: HFN Commercial |
$1,211.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.23
|
| Rate for Payer: Multiplan Commercial |
$1,020.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.25
|
| Rate for Payer: Quartz Beloit One Network |
$561.00
|
| Rate for Payer: Quartz Commercial |
$726.75
|
| Rate for Payer: The Alliance Commercial |
$637.50
|
| Rate for Payer: WEA Trust Commercial |
$701.25
|
| Rate for Payer: WPS Commercial |
$944.39
|
|
|
US Extremity, Nonvascular, Realtime Image Limited 7688226
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 76882 26
|
| Hospital Charge Code |
3121586
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna Commercial |
$233.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$233.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.60
|
| Rate for Payer: Health EOS Commercial |
$223.86
|
| Rate for Payer: HFN Commercial |
$233.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$233.70
|
| Rate for Payer: Quartz Beloit One Network |
$108.24
|
| Rate for Payer: Quartz Commercial |
$140.22
|
| Rate for Payer: The Alliance Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
US Extremity Non-Vascular Right
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631091
|
| Min. Negotiated Rate |
$227.23 |
| Max. Negotiated Rate |
$887.30 |
| Rate for Payer: Aetna Commercial |
$887.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$887.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$467.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.40
|
| Rate for Payer: Health EOS Commercial |
$849.94
|
| Rate for Payer: HFN Commercial |
$887.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.23
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$887.30
|
| Rate for Payer: Quartz Beloit One Network |
$410.96
|
| Rate for Payer: Quartz Commercial |
$532.38
|
| Rate for Payer: The Alliance Commercial |
$467.00
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Right
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544855
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$853.10 |
| Rate for Payer: Aetna Commercial |
$853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$853.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$449.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.80
|
| Rate for Payer: Health EOS Commercial |
$817.18
|
| Rate for Payer: HFN Commercial |
$853.10
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: Preferred Network Access Commercial |
$853.10
|
| Rate for Payer: Quartz Beloit One Network |
$395.12
|
| Rate for Payer: Quartz Commercial |
$511.86
|
| Rate for Payer: The Alliance Commercial |
$449.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Right
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631091
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$607.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$467.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$448.32
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| 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 |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| 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 |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$607.10
|
| 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 |
$513.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
