|
US Pregnancy, Transvaginal
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2587190
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Prostate Transrectal
|
Professional
|
Both
|
$1,455.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
630899
|
| Min. Negotiated Rate |
$640.20 |
| Max. Negotiated Rate |
$1,382.25 |
| Rate for Payer: Aetna Commercial |
$1,382.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,382.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$727.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$873.00
|
| Rate for Payer: Health EOS Commercial |
$1,324.05
|
| Rate for Payer: HFN Commercial |
$1,382.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.86
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,382.25
|
| Rate for Payer: Quartz Beloit One Network |
$640.20
|
| Rate for Payer: Quartz Commercial |
$829.35
|
| Rate for Payer: The Alliance Commercial |
$727.50
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
US Prostate Transrectal
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
630899
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.40
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| 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 |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$945.75
|
| 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 |
$800.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
US Prostate Transrectal
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
2544961
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$741.37 |
| Max. Negotiated Rate |
$1,391.96 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$801.89
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,391.96
|
| Rate for Payer: Health EOS Commercial |
$1,346.57
|
| Rate for Payer: HFN Commercial |
$1,391.96
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$907.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.96
|
| Rate for Payer: Quartz Beloit One Network |
$741.37
|
| Rate for Payer: Quartz Commercial |
$907.80
|
| Rate for Payer: WEA Trust Commercial |
$832.15
|
| Rate for Payer: WPS Commercial |
$1,120.68
|
|
|
US Prostate Transrectal
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
630899
|
| Min. Negotiated Rate |
$712.95 |
| Max. Negotiated Rate |
$1,338.60 |
| Rate for Payer: Aetna Commercial |
$1,309.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.15
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,338.60
|
| Rate for Payer: Health EOS Commercial |
$1,294.95
|
| Rate for Payer: HFN Commercial |
$1,338.60
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$873.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.60
|
| Rate for Payer: Quartz Beloit One Network |
$712.95
|
| Rate for Payer: Quartz Commercial |
$873.00
|
| Rate for Payer: WEA Trust Commercial |
$800.25
|
| Rate for Payer: WPS Commercial |
$1,077.72
|
|
|
US Prostate Transrectal
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
3072735
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$478.72 |
| Max. Negotiated Rate |
$1,033.60 |
| Rate for Payer: Aetna Commercial |
$1,033.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.68
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$1,033.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$544.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.80
|
| Rate for Payer: Health EOS Commercial |
$990.08
|
| Rate for Payer: HFN Commercial |
$1,033.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$528.30
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,033.60
|
| Rate for Payer: Quartz Beloit One Network |
$478.72
|
| Rate for Payer: Quartz Commercial |
$620.16
|
| Rate for Payer: The Alliance Commercial |
$544.00
|
| Rate for Payer: WEA Trust Commercial |
$598.40
|
| Rate for Payer: WPS Commercial |
$805.88
|
|
|
US Prostate Transrectal
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
2544961
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$528.30 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Aetna Commercial |
$1,437.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.18
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,437.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$756.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.80
|
| Rate for Payer: Health EOS Commercial |
$1,376.83
|
| Rate for Payer: HFN Commercial |
$1,437.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$528.30
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,437.35
|
| Rate for Payer: Quartz Beloit One Network |
$665.72
|
| Rate for Payer: Quartz Commercial |
$862.41
|
| Rate for Payer: The Alliance Commercial |
$756.50
|
| Rate for Payer: WEA Trust Commercial |
$832.15
|
| Rate for Payer: WPS Commercial |
$1,120.68
|
|
|
US Prostate Transrectal
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
2544961
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$423.64 |
| Max. Negotiated Rate |
$6,052.00 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.18
|
| Rate for Payer: Aetna Managed Medicare |
$423.64
|
| 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 |
$801.89
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,391.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.67
|
| Rate for Payer: Health EOS Commercial |
$1,346.57
|
| Rate for Payer: HFN Commercial |
$1,391.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.75
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$907.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,391.96
|
| Rate for Payer: Quartz Beloit One Network |
$741.37
|
| Rate for Payer: Quartz Commercial |
$983.45
|
| Rate for Payer: Quartz Medicare Advantage |
$907.80
|
| Rate for Payer: The Alliance Commercial |
$6,052.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$832.15
|
| Rate for Payer: WPS Commercial |
$1,120.68
|
|
|
US Prostate Transrectal
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
3072735
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.64 |
| Max. Negotiated Rate |
$4,352.00 |
| Rate for Payer: Aetna Commercial |
$979.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.68
|
| Rate for Payer: Aetna Managed Medicare |
$304.64
|
| 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 |
$576.64
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$1,000.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$608.84
|
| Rate for Payer: Health EOS Commercial |
$968.32
|
| Rate for Payer: HFN Commercial |
$1,000.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.00
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: NAPHCARE Commercial |
$652.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,000.96
|
| Rate for Payer: Quartz Beloit One Network |
$533.12
|
| Rate for Payer: Quartz Commercial |
$707.20
|
| Rate for Payer: Quartz Medicare Advantage |
$652.80
|
| Rate for Payer: The Alliance Commercial |
$4,352.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$598.40
|
| Rate for Payer: WPS Commercial |
$805.88
|
|
|
US Prostate Transrectal
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
3072735
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$1,000.96 |
| Rate for Payer: Aetna Commercial |
$979.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$935.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$576.64
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cigna Commercial |
$1,000.96
|
| Rate for Payer: Health EOS Commercial |
$968.32
|
| Rate for Payer: HFN Commercial |
$1,000.96
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: NAPHCARE Commercial |
$652.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,000.96
|
| Rate for Payer: Quartz Beloit One Network |
$533.12
|
| Rate for Payer: Quartz Commercial |
$652.80
|
| Rate for Payer: WEA Trust Commercial |
$598.40
|
| Rate for Payer: WPS Commercial |
$805.88
|
|
|
US Renal
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587193
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$8,176.00 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Aetna Managed Medicare |
$572.32
|
| 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 |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.82
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.00
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,328.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,226.40
|
| Rate for Payer: The Alliance Commercial |
$8,176.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
US Renal
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552814
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| 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 |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| 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 |
$864.05
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
US Renal
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587193
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,941.80 |
| Rate for Payer: Aetna Commercial |
$1,941.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,941.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,022.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.40
|
| Rate for Payer: Health EOS Commercial |
$1,860.04
|
| Rate for Payer: HFN Commercial |
$1,941.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.48
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.80
|
| Rate for Payer: Quartz Beloit One Network |
$899.36
|
| Rate for Payer: Quartz Commercial |
$1,165.08
|
| Rate for Payer: The Alliance Commercial |
$1,022.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
US Renal
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552814
|
| Min. Negotiated Rate |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
US Renal
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587193
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,001.56 |
| Max. Negotiated Rate |
$1,880.48 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,226.40
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
US Retroperitoneal Complete
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2544965
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$808.01 |
| Max. Negotiated Rate |
$1,517.08 |
| Rate for Payer: Aetna Commercial |
$1,484.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,418.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$873.97
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cigna Commercial |
$1,517.08
|
| Rate for Payer: Health EOS Commercial |
$1,467.61
|
| Rate for Payer: HFN Commercial |
$1,517.08
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$989.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,517.08
|
| Rate for Payer: Quartz Beloit One Network |
$808.01
|
| Rate for Payer: Quartz Commercial |
$989.40
|
| Rate for Payer: WEA Trust Commercial |
$906.95
|
| Rate for Payer: WPS Commercial |
$1,221.41
|
|
|
US Retroperitoneal Complete
|
Professional
|
Both
|
$1,649.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2544965
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.43 |
| Max. Negotiated Rate |
$1,566.55 |
| Rate for Payer: Aetna Commercial |
$1,566.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,418.14
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cigna Commercial |
$1,566.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$824.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$989.40
|
| Rate for Payer: Health EOS Commercial |
$1,500.59
|
| Rate for Payer: HFN Commercial |
$1,566.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,566.55
|
| Rate for Payer: Quartz Beloit One Network |
$725.56
|
| Rate for Payer: Quartz Commercial |
$939.93
|
| Rate for Payer: The Alliance Commercial |
$824.50
|
| Rate for Payer: WEA Trust Commercial |
$906.95
|
| Rate for Payer: WPS Commercial |
$1,221.41
|
|
|
US Retroperitoneal Complete
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
630892
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,167.48 |
| Rate for Payer: Aetna Commercial |
$1,142.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.34
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$824.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$609.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.57
|
| 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 |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,167.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,129.41
|
| Rate for Payer: HFN Commercial |
$1,167.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.48
|
| Rate for Payer: Quartz Beloit One Network |
$621.81
|
| Rate for Payer: Quartz Commercial |
$824.85
|
| 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 |
$697.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$939.95
|
|
|
US Retroperitoneal Complete
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
630892
|
| Min. Negotiated Rate |
$384.21 |
| Max. Negotiated Rate |
$1,205.55 |
| Rate for Payer: Aetna Commercial |
$1,205.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.34
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,205.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$634.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.40
|
| Rate for Payer: Health EOS Commercial |
$1,154.79
|
| Rate for Payer: HFN Commercial |
$1,205.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$384.21
|
| Rate for Payer: Multiplan Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,205.55
|
| Rate for Payer: Quartz Beloit One Network |
$558.36
|
| Rate for Payer: Quartz Commercial |
$723.33
|
| Rate for Payer: The Alliance Commercial |
$634.50
|
| Rate for Payer: WEA Trust Commercial |
$697.95
|
| Rate for Payer: WPS Commercial |
$939.95
|
|
|
US Retroperitoneal Complete
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
630892
|
| Min. Negotiated Rate |
$621.81 |
| Max. Negotiated Rate |
$1,167.48 |
| Rate for Payer: Aetna Commercial |
$1,142.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$672.57
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,167.48
|
| Rate for Payer: Health EOS Commercial |
$1,129.41
|
| Rate for Payer: HFN Commercial |
$1,167.48
|
| Rate for Payer: Multiplan Commercial |
$1,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$761.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,167.48
|
| Rate for Payer: Quartz Beloit One Network |
$621.81
|
| Rate for Payer: Quartz Commercial |
$761.40
|
| Rate for Payer: WEA Trust Commercial |
$697.95
|
| Rate for Payer: WPS Commercial |
$939.95
|
|
|
US Retroperitoneal Complete
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2544965
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$461.72 |
| Max. Negotiated Rate |
$6,596.00 |
| Rate for Payer: Aetna Commercial |
$1,484.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,418.14
|
| Rate for Payer: Aetna Managed Medicare |
$461.72
|
| 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 |
$873.97
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cigna Commercial |
$1,517.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$922.78
|
| Rate for Payer: Health EOS Commercial |
$1,467.61
|
| Rate for Payer: HFN Commercial |
$1,517.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,236.75
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$989.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,517.08
|
| Rate for Payer: Quartz Beloit One Network |
$808.01
|
| Rate for Payer: Quartz Commercial |
$1,071.85
|
| Rate for Payer: Quartz Medicare Advantage |
$989.40
|
| Rate for Payer: The Alliance Commercial |
$6,596.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$906.95
|
| Rate for Payer: WPS Commercial |
$1,221.41
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
630854
|
| Min. Negotiated Rate |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
US Retroperitoneal Limited
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
630854
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| 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 |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| 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 |
$864.05
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
US Retroperitoneal Limited
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3072700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$572.32 |
| Max. Negotiated Rate |
$8,176.00 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Aetna Managed Medicare |
$572.32
|
| 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 |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.82
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.00
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,328.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,226.40
|
| Rate for Payer: The Alliance Commercial |
$8,176.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2544967
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$800.66 |
| Max. Negotiated Rate |
$1,503.28 |
| Rate for Payer: Aetna Commercial |
$1,470.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$866.02
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,503.28
|
| Rate for Payer: Health EOS Commercial |
$1,454.26
|
| Rate for Payer: HFN Commercial |
$1,503.28
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$980.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.28
|
| Rate for Payer: Quartz Beloit One Network |
$800.66
|
| Rate for Payer: Quartz Commercial |
$980.40
|
| Rate for Payer: WEA Trust Commercial |
$898.70
|
| Rate for Payer: WPS Commercial |
$1,210.30
|
|
