|
US ED Soft Tissue Axilla
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$126.88 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$160.74
|
| 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 |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.26
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$344.45
|
| Rate for Payer: The Alliance Commercial |
$126.88
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$344.45
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
US ED Soft Tissue Axilla
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587124
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.72 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$545.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$31.72
|
| Rate for Payer: Anthem Medicare Advantage |
$31.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.72
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.72
|
| Rate for Payer: Health EOS Commercial |
$522.41
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.72
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$47.58
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$252.60
|
| Rate for Payer: Quartz Commercial |
$327.23
|
| Rate for Payer: Quartz Medicare Advantage |
$31.72
|
| Rate for Payer: The Alliance Commercial |
$120.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$158.60
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552820
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
US ED Soft Tissue Axilla
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552820
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| 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 |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| 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 |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| 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 |
$551.41
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
US ED Soft Tissue Axilla
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552820
|
| Min. Negotiated Rate |
$63.74 |
| Max. Negotiated Rate |
$952.43 |
| Rate for Payer: Aetna Commercial |
$952.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$63.74
|
| Rate for Payer: Anthem Medicare Advantage |
$63.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.74
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$952.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$501.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.74
|
| Rate for Payer: Health EOS Commercial |
$912.33
|
| Rate for Payer: HFN Commercial |
$952.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.74
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$95.61
|
| Rate for Payer: Preferred Network Access Commercial |
$952.43
|
| Rate for Payer: Quartz Beloit One Network |
$441.13
|
| Rate for Payer: Quartz Commercial |
$571.46
|
| Rate for Payer: Quartz Medicare Advantage |
$63.74
|
| Rate for Payer: The Alliance Commercial |
$242.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.74
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$318.71
|
|
|
US ED Soft Tissue Breast
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
3000469
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
US ED Soft Tissue Breast
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
3000469
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.48
|
| 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 |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.62
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$298.90
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$298.90
|
| Rate for Payer: The Alliance Commercial |
$263.99
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
US ED Soft Tissue Breast
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
3000469
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$66.00
|
| Rate for Payer: Anthem Medicare Advantage |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.00
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: Quartz Medicare Advantage |
$66.00
|
| Rate for Payer: The Alliance Commercial |
$250.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$329.99
|
|
|
US ED Soft Tissue Buttock
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587127
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$382.36 |
| Rate for Payer: Aetna Commercial |
$382.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$27.06
|
| Rate for Payer: Anthem Medicare Advantage |
$27.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.06
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$382.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.06
|
| Rate for Payer: Health EOS Commercial |
$366.26
|
| Rate for Payer: HFN Commercial |
$382.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$40.59
|
| Rate for Payer: Preferred Network Access Commercial |
$382.36
|
| Rate for Payer: Quartz Beloit One Network |
$177.09
|
| Rate for Payer: Quartz Commercial |
$229.41
|
| Rate for Payer: Quartz Medicare Advantage |
$27.06
|
| Rate for Payer: The Alliance Commercial |
$102.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.06
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$135.30
|
|
|
US ED Soft Tissue Buttock
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587127
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$197.22 |
| Max. Negotiated Rate |
$370.28 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$241.49
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
US ED Soft Tissue Buttock
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587127
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$362.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$112.69
|
| 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 |
$213.31
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$370.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.23
|
| Rate for Payer: Health EOS Commercial |
$358.21
|
| Rate for Payer: HFN Commercial |
$370.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.86
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$241.49
|
| Rate for Payer: Preferred Network Access Commercial |
$370.28
|
| Rate for Payer: Quartz Beloit One Network |
$197.22
|
| Rate for Payer: Quartz Commercial |
$261.61
|
| Rate for Payer: Quartz Medicare Advantage |
$241.49
|
| Rate for Payer: The Alliance Commercial |
$108.24
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$298.11
|
|
|
US ED Soft Tissue Chest Wall
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587130
|
|
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 Soft Tissue Chest Wall
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587130
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$452.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Aetna Managed Medicare |
$140.65
|
| 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 |
$266.23
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$462.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.11
|
| Rate for Payer: Health EOS Commercial |
$447.06
|
| Rate for Payer: HFN Commercial |
$462.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.74
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: NAPHCARE Commercial |
$301.39
|
| Rate for Payer: Preferred Network Access Commercial |
$462.13
|
| Rate for Payer: Quartz Beloit One Network |
$246.14
|
| Rate for Payer: Quartz Commercial |
$326.51
|
| Rate for Payer: Quartz Medicare Advantage |
$301.39
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$372.05
|
|
|
US ED Soft Tissue Chest Wall
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587130
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$477.20 |
| Rate for Payer: Aetna Commercial |
$477.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.00
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna Commercial |
$477.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$457.11
|
| Rate for Payer: HFN Commercial |
$477.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$401.86
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$477.20
|
| Rate for Payer: Quartz Beloit One Network |
$221.02
|
| Rate for Payer: Quartz Commercial |
$286.32
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$276.28
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
US ED Soft Tissue Chest Wall
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552821
|
| Min. Negotiated Rate |
$60.61 |
| Max. Negotiated Rate |
$1,007.76 |
| Rate for Payer: Aetna Commercial |
$1,007.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$60.61
|
| Rate for Payer: Anthem Medicare Advantage |
$60.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.61
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$1,007.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.61
|
| Rate for Payer: Health EOS Commercial |
$965.33
|
| Rate for Payer: HFN Commercial |
$1,007.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.61
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$90.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.75
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| Rate for Payer: Quartz Medicare Advantage |
$60.61
|
| Rate for Payer: The Alliance Commercial |
$230.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.61
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$303.06
|
|
|
US ED Soft Tissue Chest Wall
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552821
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
US ED Soft Tissue Chest Wall
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 76604
|
| Hospital Charge Code |
2552821
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| 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 |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| 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 |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| 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 |
$583.44
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
US ED Soft Tissue Groin
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
2587133
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| 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 |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US ED Soft Tissue Groin
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
2587133
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US ED Soft Tissue Groin
|
Professional
|
Both
|
$471.00
|
|
| Hospital Charge Code |
2587133
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$215.53 |
| Max. Negotiated Rate |
$465.35 |
| Rate for Payer: Aetna Commercial |
$465.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$465.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.90
|
| Rate for Payer: Health EOS Commercial |
$445.75
|
| Rate for Payer: HFN Commercial |
$465.35
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$465.35
|
| Rate for Payer: Quartz Beloit One Network |
$215.53
|
| Rate for Payer: Quartz Commercial |
$279.21
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US ED Soft Tissue Lower Back
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552823
|
| 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 Lower Back
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552823
|
| 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 Lower Back
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552823
|
| 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 Lower Back
|
Facility
|
IP
|
$590.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587136
|
|
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
|
|
