|
US ED Fast Trauma
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587103
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$246.14 |
| Max. Negotiated Rate |
$462.13 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$301.39
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
US ED Fast Trauma 93308
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3100310
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$466.34 |
| Rate for Payer: Aetna Commercial |
$466.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.75
|
| Rate for Payer: Anthem Medicare Advantage |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.75
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$466.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.75
|
| Rate for Payer: Health EOS Commercial |
$446.70
|
| Rate for Payer: HFN Commercial |
$466.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: NAPHCARE Commercial |
$113.63
|
| Rate for Payer: Preferred Network Access Commercial |
$466.34
|
| Rate for Payer: Quartz Beloit One Network |
$215.99
|
| Rate for Payer: Quartz Commercial |
$279.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.75
|
| Rate for Payer: The Alliance Commercial |
$287.86
|
| Rate for Payer: United Healthcare Medicaid |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$303.01
|
|
|
US ED Fast Trauma 93308
|
Facility
|
IP
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3100310
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$294.53
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
US ED Fast Trauma 93308
|
Facility
|
OP
|
$472.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
3100310
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$137.45 |
| Max. Negotiated Rate |
$451.61 |
| Rate for Payer: Aetna Commercial |
$441.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Aetna Managed Medicare |
$137.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$319.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$245.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$260.17
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$451.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.70
|
| Rate for Payer: Health EOS Commercial |
$436.88
|
| Rate for Payer: HFN Commercial |
$451.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.16
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: NAPHCARE Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$451.61
|
| Rate for Payer: Quartz Beloit One Network |
$240.53
|
| Rate for Payer: Quartz Commercial |
$319.07
|
| Rate for Payer: Quartz Medicare Advantage |
$294.53
|
| Rate for Payer: The Alliance Commercial |
$303.01
|
| Rate for Payer: United Healthcare PPO |
$368.16
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$363.58
|
|
|
US ED Genitalia
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
3000463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$530.56 |
| Rate for Payer: Aetna Commercial |
$530.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.33
|
| Rate for Payer: Anthem Medicare Advantage |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.33
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$530.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.33
|
| Rate for Payer: Health EOS Commercial |
$508.22
|
| Rate for Payer: HFN Commercial |
$530.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.33
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: NAPHCARE Commercial |
$102.49
|
| Rate for Payer: Preferred Network Access Commercial |
$530.56
|
| Rate for Payer: Quartz Beloit One Network |
$245.73
|
| Rate for Payer: Quartz Commercial |
$318.33
|
| Rate for Payer: Quartz Medicare Advantage |
$68.33
|
| Rate for Payer: The Alliance Commercial |
$259.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.33
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$341.64
|
|
|
US ED Genitalia
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
3000463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$156.37 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$502.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Aetna Managed Medicare |
$156.37
|
| 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 |
$295.99
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$513.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.53
|
| Rate for Payer: Health EOS Commercial |
$497.05
|
| Rate for Payer: HFN Commercial |
$513.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.86
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: NAPHCARE Commercial |
$335.09
|
| Rate for Payer: Preferred Network Access Commercial |
$513.80
|
| Rate for Payer: Quartz Beloit One Network |
$273.66
|
| Rate for Payer: Quartz Commercial |
$363.01
|
| Rate for Payer: Quartz Medicare Advantage |
$335.09
|
| Rate for Payer: The Alliance Commercial |
$273.31
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
|
US ED Genitalia
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
3000463
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.66 |
| Max. Negotiated Rate |
$513.80 |
| Rate for Payer: Aetna Commercial |
$502.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.99
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$513.80
|
| Rate for Payer: Health EOS Commercial |
$497.05
|
| Rate for Payer: HFN Commercial |
$513.80
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: Preferred Network Access Commercial |
$513.80
|
| Rate for Payer: Quartz Beloit One Network |
$273.66
|
| Rate for Payer: Quartz Commercial |
$335.09
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
|
US ED Guidance for Needle Placement
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
2587109
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$443.61 |
| Rate for Payer: Aetna Commercial |
$443.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$443.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$233.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$424.93
|
| Rate for Payer: HFN Commercial |
$443.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$443.61
|
| Rate for Payer: Quartz Beloit One Network |
$205.46
|
| Rate for Payer: Quartz Commercial |
$266.17
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
US ED Guidance for Needle Placement
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
2587109
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$130.75
|
| 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 |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.32
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.22
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$280.18
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$303.52
|
| Rate for Payer: Quartz Medicare Advantage |
$280.18
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
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 |
$228.81 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$280.18
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
US ED Ocular
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
2587112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.30 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| 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 |
$306.47
|
| 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 |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$72.30
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
US ED Ocular
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
2587112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
US ED Ocular
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 76512 TC
|
| Hospital Charge Code |
2587112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$549.33 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$18.08
|
| Rate for Payer: Anthem Medicare Advantage |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.08
|
| 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 |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.08
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$27.11
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.08
|
| Rate for Payer: The Alliance Commercial |
$68.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.08
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$90.38
|
|
|
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 |
$217.09 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$265.82
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
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 |
$124.05 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$124.05
|
| 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 |
$234.81
|
| 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 |
$407.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.93
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.28
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$265.82
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$287.98
|
| Rate for Payer: Quartz Medicare Advantage |
$265.82
|
| Rate for Payer: The Alliance Commercial |
$337.63
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
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 |
$84.41 |
| Max. Negotiated Rate |
$422.03 |
| Rate for Payer: Aetna Commercial |
$420.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$84.41
|
| Rate for Payer: Anthem Medicare Advantage |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.41
|
| 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 |
$420.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.41
|
| Rate for Payer: Health EOS Commercial |
$403.17
|
| Rate for Payer: HFN Commercial |
$420.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.41
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$126.61
|
| Rate for Payer: Preferred Network Access Commercial |
$420.89
|
| Rate for Payer: Quartz Beloit One Network |
$194.94
|
| Rate for Payer: Quartz Commercial |
$252.53
|
| Rate for Payer: Quartz Medicare Advantage |
$84.41
|
| Rate for Payer: The Alliance Commercial |
$320.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.41
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$422.03
|
|
|
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 |
$209.96 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$257.09
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
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 |
$57.01 |
| Max. Negotiated Rate |
$407.06 |
| Rate for Payer: Aetna Commercial |
$407.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$57.01
|
| Rate for Payer: Anthem Medicare Advantage |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.01
|
| 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 |
$407.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.01
|
| Rate for Payer: Health EOS Commercial |
$389.92
|
| Rate for Payer: HFN Commercial |
$407.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.01
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$85.52
|
| Rate for Payer: Preferred Network Access Commercial |
$407.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.53
|
| Rate for Payer: Quartz Commercial |
$244.23
|
| Rate for Payer: Quartz Medicare Advantage |
$57.01
|
| Rate for Payer: The Alliance Commercial |
$216.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.01
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$285.06
|
|
|
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 |
$119.97 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$119.97
|
| 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 |
$227.09
|
| 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 |
$394.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.78
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.36
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$257.09
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$278.51
|
| Rate for Payer: Quartz Medicare Advantage |
$257.09
|
| Rate for Payer: The Alliance Commercial |
$228.05
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
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 |
$300.66 |
| Max. Negotiated Rate |
$564.51 |
| Rate for Payer: Aetna Commercial |
$552.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$527.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.21
|
| Rate for Payer: Cash Price |
$177.00
|
| Rate for Payer: Cigna Commercial |
$564.51
|
| Rate for Payer: Health EOS Commercial |
$546.10
|
| Rate for Payer: HFN Commercial |
$564.51
|
| Rate for Payer: Multiplan Commercial |
$490.88
|
| Rate for Payer: Preferred Network Access Commercial |
$564.51
|
| Rate for Payer: Quartz Beloit One Network |
$300.66
|
| Rate for Payer: Quartz Commercial |
$368.16
|
| Rate for Payer: WEA Trust Commercial |
$337.48
|
| Rate for Payer: WPS Commercial |
$454.48
|
|
|
US ED Soft Tissue Abdominal Wall
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552824
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,423.71 |
| Rate for Payer: Aetna Commercial |
$1,423.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.83
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cigna Commercial |
$1,423.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$749.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,363.76
|
| Rate for Payer: HFN Commercial |
$1,423.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,198.91
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,423.71
|
| Rate for Payer: Quartz Beloit One Network |
$659.40
|
| Rate for Payer: Quartz Commercial |
$854.22
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$824.25
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US ED Soft Tissue Abdominal Wall
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552824
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,378.75 |
| Rate for Payer: Aetna Commercial |
$1,348.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.83
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$974.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.35
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cigna Commercial |
$1,378.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,333.79
|
| Rate for Payer: HFN Commercial |
$1,378.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,198.91
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.75
|
| Rate for Payer: Quartz Beloit One Network |
$734.33
|
| Rate for Payer: Quartz Commercial |
$974.12
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$824.25
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,110.00
|
|
|
US ED Soft Tissue Abdominal Wall
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552824
|
| Min. Negotiated Rate |
$734.33 |
| Max. Negotiated Rate |
$1,378.75 |
| Rate for Payer: Aetna Commercial |
$1,348.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,288.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.28
|
| Rate for Payer: Cash Price |
$432.30
|
| Rate for Payer: Cigna Commercial |
$1,378.75
|
| Rate for Payer: Health EOS Commercial |
$1,333.79
|
| Rate for Payer: HFN Commercial |
$1,378.75
|
| Rate for Payer: Multiplan Commercial |
$1,198.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,378.75
|
| Rate for Payer: Quartz Beloit One Network |
$734.33
|
| Rate for Payer: Quartz Commercial |
$899.18
|
| Rate for Payer: WEA Trust Commercial |
$824.25
|
| Rate for Payer: WPS Commercial |
$1,110.00
|
|
|
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 |
$58.34 |
| Max. Negotiated Rate |
$582.92 |
| Rate for Payer: Aetna Commercial |
$582.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$527.70
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| 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 |
$582.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$306.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$558.38
|
| Rate for Payer: HFN Commercial |
$582.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$490.88
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$582.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.98
|
| Rate for Payer: Quartz Commercial |
$349.75
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$337.48
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
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 |
$171.81 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$552.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$527.70
|
| Rate for Payer: Aetna Managed Medicare |
$171.81
|
| 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 |
$325.21
|
| 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 |
$564.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.38
|
| Rate for Payer: Health EOS Commercial |
$546.10
|
| Rate for Payer: HFN Commercial |
$564.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.20
|
| Rate for Payer: Multiplan Commercial |
$490.88
|
| Rate for Payer: NAPHCARE Commercial |
$368.16
|
| Rate for Payer: Preferred Network Access Commercial |
$564.51
|
| Rate for Payer: Quartz Beloit One Network |
$300.66
|
| Rate for Payer: Quartz Commercial |
$398.84
|
| Rate for Payer: Quartz Medicare Advantage |
$368.16
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$337.48
|
| Rate for Payer: WPS Commercial |
$454.48
|
|
