|
US ED Soft Tissue Upper Back
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
CPT 76604 TC
|
| Hospital Charge Code |
2587154
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$381.37 |
| Rate for Payer: Aetna Commercial |
$381.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| 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 |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$381.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$365.31
|
| Rate for Payer: HFN Commercial |
$381.37
|
| 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 |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$381.37
|
| Rate for Payer: Quartz Beloit One Network |
$176.63
|
| Rate for Payer: Quartz Commercial |
$228.82
|
| 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 |
$220.79
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
US ED Soft Tissue Upper Extremity
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
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 Upper Extremity
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
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 Upper Extremity
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| 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 Upper Extremity
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 76882 TC
|
| Hospital Charge Code |
2587157
|
|
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 Upper Extremity
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| 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 Upper Extremity
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
2552819
|
| 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 Vascular Access
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$560.20 |
| Rate for Payer: Aetna Commercial |
$560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$26.40
|
| Rate for Payer: Anthem Medicare Advantage |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.40
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$560.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$294.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$536.61
|
| Rate for Payer: HFN Commercial |
$560.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$39.59
|
| Rate for Payer: Preferred Network Access Commercial |
$560.20
|
| Rate for Payer: Quartz Beloit One Network |
$259.46
|
| Rate for Payer: Quartz Commercial |
$336.12
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$131.98
|
|
|
US ED Vascular Access
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$105.58 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$165.11
|
| 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 |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$353.81
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$353.81
|
| Rate for Payer: The Alliance Commercial |
$105.58
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
US ED Vascular Access
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
2587160
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
US Exam Abdo Back Wall, Comp 7677026
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 76770 26
|
| Hospital Charge Code |
3403595
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$34.09
|
| Rate for Payer: Anthem Medicare Advantage |
$34.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.09
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.09
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.09
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$51.14
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: Quartz Medicare Advantage |
$34.09
|
| Rate for Payer: The Alliance Commercial |
$129.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.09
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$170.46
|
|
|
US Exam,Chest 7660426
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 76604 26
|
| Hospital Charge Code |
3221485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$304.30 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.56
|
| Rate for Payer: Anthem Medicare Advantage |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.56
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.56
|
| Rate for Payer: Health EOS Commercial |
$291.49
|
| Rate for Payer: HFN Commercial |
$304.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.56
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$41.34
|
| Rate for Payer: Preferred Network Access Commercial |
$304.30
|
| Rate for Payer: Quartz Beloit One Network |
$140.94
|
| Rate for Payer: Quartz Commercial |
$182.58
|
| Rate for Payer: Quartz Medicare Advantage |
$27.56
|
| Rate for Payer: The Alliance Commercial |
$104.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$137.80
|
|
|
US Exam of Head and Neck 7653626
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
CPT 76536 26
|
| Hospital Charge Code |
3206218
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.42 |
| Max. Negotiated Rate |
$433.73 |
| Rate for Payer: Aetna Commercial |
$433.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.64
|
| Rate for Payer: Aetna Managed Medicare |
$26.42
|
| Rate for Payer: Anthem Medicare Advantage |
$26.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.42
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$433.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.42
|
| Rate for Payer: Health EOS Commercial |
$415.47
|
| Rate for Payer: HFN Commercial |
$433.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.42
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: NAPHCARE Commercial |
$39.62
|
| Rate for Payer: Preferred Network Access Commercial |
$433.73
|
| Rate for Payer: Quartz Beloit One Network |
$200.89
|
| Rate for Payer: Quartz Commercial |
$260.24
|
| Rate for Payer: Quartz Medicare Advantage |
$26.42
|
| Rate for Payer: The Alliance Commercial |
$100.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.42
|
| Rate for Payer: WEA Trust Commercial |
$251.11
|
| Rate for Payer: WPS Commercial |
$132.08
|
|
|
US Exam of Head and Neck 76536PP
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
4512616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$1,716.16 |
| Rate for Payer: Aetna Commercial |
$1,716.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.57
|
| Rate for Payer: Aetna Managed Medicare |
$108.06
|
| Rate for Payer: Anthem Medicare Advantage |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.06
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,716.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$903.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.06
|
| Rate for Payer: Health EOS Commercial |
$1,643.90
|
| Rate for Payer: HFN Commercial |
$1,716.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$412.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.06
|
| Rate for Payer: Multiplan Commercial |
$1,445.18
|
| Rate for Payer: NAPHCARE Commercial |
$162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,716.16
|
| Rate for Payer: Quartz Beloit One Network |
$794.85
|
| Rate for Payer: Quartz Commercial |
$1,029.69
|
| Rate for Payer: Quartz Medicare Advantage |
$108.06
|
| Rate for Payer: The Alliance Commercial |
$410.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.06
|
| Rate for Payer: WEA Trust Commercial |
$993.56
|
| Rate for Payer: WPS Commercial |
$540.28
|
|
|
US Exam Thyroid/Soft 76536
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
3147564
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.81 |
| Max. Negotiated Rate |
$540.28 |
| Rate for Payer: Aetna Commercial |
$144.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.06
|
| Rate for Payer: Anthem Medicare Advantage |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.06
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$144.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.06
|
| Rate for Payer: Health EOS Commercial |
$138.17
|
| Rate for Payer: HFN Commercial |
$144.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$412.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.06
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$144.25
|
| Rate for Payer: Quartz Beloit One Network |
$66.81
|
| Rate for Payer: Quartz Commercial |
$86.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.06
|
| Rate for Payer: The Alliance Commercial |
$410.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.06
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$540.28
|
|
|
US Extremity Non-Vascular Bilateral
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.50 |
| Max. Negotiated Rate |
$859.21 |
| Rate for Payer: Aetna Commercial |
$840.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Aetna Managed Medicare |
$261.50
|
| 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 |
$494.98
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$859.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.64
|
| Rate for Payer: Health EOS Commercial |
$831.19
|
| Rate for Payer: HFN Commercial |
$859.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.44
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: NAPHCARE Commercial |
$560.35
|
| Rate for Payer: Preferred Network Access Commercial |
$859.21
|
| Rate for Payer: Quartz Beloit One Network |
$457.62
|
| Rate for Payer: Quartz Commercial |
$607.05
|
| Rate for Payer: Quartz Medicare Advantage |
$560.35
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
US Extremity Non-Vascular Bilateral
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.62 |
| Max. Negotiated Rate |
$859.21 |
| Rate for Payer: Aetna Commercial |
$840.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$494.98
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$859.21
|
| Rate for Payer: Health EOS Commercial |
$831.19
|
| Rate for Payer: HFN Commercial |
$859.21
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: Preferred Network Access Commercial |
$859.21
|
| Rate for Payer: Quartz Beloit One Network |
$457.62
|
| Rate for Payer: Quartz Commercial |
$560.35
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
US Extremity Non-Vascular Bilateral
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544851
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$887.22 |
| Rate for Payer: Aetna Commercial |
$887.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$887.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$466.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.35
|
| Rate for Payer: Health EOS Commercial |
$849.87
|
| Rate for Payer: HFN Commercial |
$887.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: Preferred Network Access Commercial |
$887.22
|
| Rate for Payer: Quartz Beloit One Network |
$410.92
|
| Rate for Payer: Quartz Commercial |
$532.33
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$887.22 |
| Rate for Payer: Aetna Commercial |
$887.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$887.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$466.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.35
|
| Rate for Payer: Health EOS Commercial |
$849.87
|
| Rate for Payer: HFN Commercial |
$887.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: Preferred Network Access Commercial |
$887.22
|
| Rate for Payer: Quartz Beloit One Network |
$410.92
|
| Rate for Payer: Quartz Commercial |
$532.33
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$922.79 |
| Rate for Payer: Aetna Commercial |
$922.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.37
|
| Rate for Payer: Aetna Managed Medicare |
$53.74
|
| Rate for Payer: Anthem Medicare Advantage |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.74
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$922.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$485.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.74
|
| Rate for Payer: Health EOS Commercial |
$883.94
|
| Rate for Payer: HFN Commercial |
$922.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.74
|
| Rate for Payer: Multiplan Commercial |
$777.09
|
| Rate for Payer: NAPHCARE Commercial |
$80.61
|
| Rate for Payer: Preferred Network Access Commercial |
$922.79
|
| Rate for Payer: Quartz Beloit One Network |
$427.40
|
| Rate for Payer: Quartz Commercial |
$553.68
|
| Rate for Payer: Quartz Medicare Advantage |
$53.74
|
| Rate for Payer: The Alliance Commercial |
$204.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.74
|
| Rate for Payer: WEA Trust Commercial |
$534.25
|
| Rate for Payer: WPS Commercial |
$268.68
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.50 |
| Max. Negotiated Rate |
$859.21 |
| Rate for Payer: Aetna Commercial |
$840.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Aetna Managed Medicare |
$261.50
|
| 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 |
$494.98
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$859.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.64
|
| Rate for Payer: Health EOS Commercial |
$831.19
|
| Rate for Payer: HFN Commercial |
$859.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.44
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: NAPHCARE Commercial |
$560.35
|
| Rate for Payer: Preferred Network Access Commercial |
$859.21
|
| Rate for Payer: Quartz Beloit One Network |
$457.62
|
| Rate for Payer: Quartz Commercial |
$607.05
|
| Rate for Payer: Quartz Medicare Advantage |
$560.35
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
US Extremity Non-Vascular Left
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
CPT 76881 LT,TC
|
| Hospital Charge Code |
2544853
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$887.22 |
| Rate for Payer: Aetna Commercial |
$887.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$887.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$466.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.35
|
| Rate for Payer: Health EOS Commercial |
$849.87
|
| Rate for Payer: HFN Commercial |
$887.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: Preferred Network Access Commercial |
$887.22
|
| Rate for Payer: Quartz Beloit One Network |
$410.92
|
| Rate for Payer: Quartz Commercial |
$532.33
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
OP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$893.65 |
| Rate for Payer: Aetna Commercial |
$874.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.37
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$631.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$485.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$466.25
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.82
|
| 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 |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$893.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$864.51
|
| Rate for Payer: HFN Commercial |
$893.65
|
| 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 |
$777.09
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$893.65
|
| Rate for Payer: Quartz Beloit One Network |
$475.97
|
| Rate for Payer: Quartz Commercial |
$631.38
|
| 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 |
$534.25
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$719.46
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631085
|
| Min. Negotiated Rate |
$475.97 |
| Max. Negotiated Rate |
$893.65 |
| Rate for Payer: Aetna Commercial |
$874.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.82
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$893.65
|
| Rate for Payer: Health EOS Commercial |
$864.51
|
| Rate for Payer: HFN Commercial |
$893.65
|
| Rate for Payer: Multiplan Commercial |
$777.09
|
| Rate for Payer: Preferred Network Access Commercial |
$893.65
|
| Rate for Payer: Quartz Beloit One Network |
$475.97
|
| Rate for Payer: Quartz Commercial |
$582.82
|
| Rate for Payer: WEA Trust Commercial |
$534.25
|
| Rate for Payer: WPS Commercial |
$719.46
|
|
|
US Extremity Non-Vascular Left
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4054117
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.50 |
| Max. Negotiated Rate |
$859.21 |
| Rate for Payer: Aetna Commercial |
$840.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.17
|
| Rate for Payer: Aetna Managed Medicare |
$261.50
|
| 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 |
$494.98
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$859.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$522.64
|
| Rate for Payer: Health EOS Commercial |
$831.19
|
| Rate for Payer: HFN Commercial |
$859.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.44
|
| Rate for Payer: Multiplan Commercial |
$747.14
|
| Rate for Payer: NAPHCARE Commercial |
$560.35
|
| Rate for Payer: Preferred Network Access Commercial |
$859.21
|
| Rate for Payer: Quartz Beloit One Network |
$457.62
|
| Rate for Payer: Quartz Commercial |
$607.05
|
| Rate for Payer: Quartz Medicare Advantage |
$560.35
|
| Rate for Payer: The Alliance Commercial |
$466.96
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$513.66
|
| Rate for Payer: WPS Commercial |
$691.73
|
|
