|
US Unlisted Procedure
|
Facility
|
IP
|
$1,839.00
|
|
|
Service Code
|
CPT 76999 TC
|
| Hospital Charge Code |
2544985
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$901.11 |
| Max. Negotiated Rate |
$1,691.88 |
| Rate for Payer: Aetna Commercial |
$1,655.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,581.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$974.67
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,691.88
|
| Rate for Payer: Health EOS Commercial |
$1,636.71
|
| Rate for Payer: HFN Commercial |
$1,691.88
|
| Rate for Payer: Multiplan Commercial |
$1,471.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,103.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,691.88
|
| Rate for Payer: Quartz Beloit One Network |
$901.11
|
| Rate for Payer: Quartz Commercial |
$1,103.40
|
| Rate for Payer: WEA Trust Commercial |
$1,011.45
|
| Rate for Payer: WPS Commercial |
$1,362.15
|
|
|
US Upper Extremity Non-Vascular Bilat
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544987
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| 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 |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.24
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Bilat
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544987
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$1,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,047.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.80
|
| Rate for Payer: Health EOS Commercial |
$1,003.73
|
| Rate for Payer: HFN Commercial |
$1,047.85
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.85
|
| Rate for Payer: Quartz Beloit One Network |
$485.32
|
| Rate for Payer: Quartz Commercial |
$628.71
|
| Rate for Payer: The Alliance Commercial |
$551.50
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Bilat
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544987
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Left
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4406577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$427.24 |
| Max. Negotiated Rate |
$922.45 |
| Rate for Payer: Aetna Commercial |
$922.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$922.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$485.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.60
|
| Rate for Payer: Health EOS Commercial |
$883.61
|
| Rate for Payer: HFN Commercial |
$922.45
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.45
|
| Rate for Payer: Quartz Beloit One Network |
$427.24
|
| Rate for Payer: Quartz Commercial |
$553.47
|
| Rate for Payer: The Alliance Commercial |
$485.50
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4406577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$271.88 |
| Max. Negotiated Rate |
$3,884.00 |
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Aetna Managed Medicare |
$271.88
|
| 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 |
$514.63
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$893.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.37
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.25
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$631.15
|
| Rate for Payer: Quartz Medicare Advantage |
$582.60
|
| Rate for Payer: The Alliance Commercial |
$3,884.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,LT
|
| Hospital Charge Code |
2544990
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 76881 TC,LT
|
| Hospital Charge Code |
4406577
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.79 |
| Max. Negotiated Rate |
$893.32 |
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.63
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$893.32
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$582.60
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
US Upper Extremity Non-Vascular Left
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,LT
|
| Hospital Charge Code |
2544990
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| 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 |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.24
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Left
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,LT
|
| Hospital Charge Code |
2544990
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$1,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,047.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.80
|
| Rate for Payer: Health EOS Commercial |
$1,003.73
|
| Rate for Payer: HFN Commercial |
$1,047.85
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.85
|
| Rate for Payer: Quartz Beloit One Network |
$485.32
|
| Rate for Payer: Quartz Commercial |
$628.71
|
| Rate for Payer: The Alliance Commercial |
$551.50
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544993
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Right
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544993
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$1,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,047.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.80
|
| Rate for Payer: Health EOS Commercial |
$1,003.73
|
| Rate for Payer: HFN Commercial |
$1,047.85
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.85
|
| Rate for Payer: Quartz Beloit One Network |
$485.32
|
| Rate for Payer: Quartz Commercial |
$628.71
|
| Rate for Payer: The Alliance Commercial |
$551.50
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Right
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
4330578
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$1,047.85 |
| Rate for Payer: Aetna Commercial |
$1,047.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,047.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.80
|
| Rate for Payer: Health EOS Commercial |
$1,003.73
|
| Rate for Payer: HFN Commercial |
$1,047.85
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.85
|
| Rate for Payer: Quartz Beloit One Network |
$485.32
|
| Rate for Payer: Quartz Commercial |
$628.71
|
| Rate for Payer: The Alliance Commercial |
$551.50
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544993
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| 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 |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.24
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
4330578
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$540.47 |
| Max. Negotiated Rate |
$1,014.76 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$661.80
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
US Upper Extremity Non-Vascular Right
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
4330578
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$308.84 |
| Max. Negotiated Rate |
$4,412.00 |
| Rate for Payer: Aetna Commercial |
$992.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.58
|
| Rate for Payer: Aetna Managed Medicare |
$308.84
|
| 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 |
$584.59
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,014.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.24
|
| Rate for Payer: Health EOS Commercial |
$981.67
|
| Rate for Payer: HFN Commercial |
$1,014.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.25
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: NAPHCARE Commercial |
$661.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.76
|
| Rate for Payer: Quartz Beloit One Network |
$540.47
|
| Rate for Payer: Quartz Commercial |
$716.95
|
| Rate for Payer: Quartz Medicare Advantage |
$661.80
|
| Rate for Payer: The Alliance Commercial |
$4,412.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$606.65
|
| Rate for Payer: WPS Commercial |
$816.99
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$47,694.00
|
|
|
Service Code
|
MSDRG 742
|
| Min. Negotiated Rate |
$17,156.10 |
| Max. Negotiated Rate |
$47,694.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,156.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,344.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,624.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,194.84
|
| Rate for Payer: Anthem Medicare Advantage |
$17,156.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,156.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,156.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,188.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,747.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,156.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,156.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,156.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,156.10
|
| Rate for Payer: NAPHCARE Commercial |
$25,734.15
|
| Rate for Payer: Quartz Medicare Advantage |
$17,156.10
|
| Rate for Payer: The Alliance Commercial |
$47,694.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,156.10
|
| Rate for Payer: United Healthcare PPO |
$27,051.02
|
| Rate for Payer: Wellcare Medicare |
$17,156.10
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$31,213.00
|
|
|
Service Code
|
MSDRG 743
|
| Min. Negotiated Rate |
$11,227.80 |
| Max. Negotiated Rate |
$31,213.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,227.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,336.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,653.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,722.48
|
| Rate for Payer: Anthem Medicare Advantage |
$11,227.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,227.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,227.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,227.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,673.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,227.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,659.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,227.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,227.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,227.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,227.80
|
| Rate for Payer: NAPHCARE Commercial |
$16,841.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11,227.80
|
| Rate for Payer: The Alliance Commercial |
$31,213.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,227.80
|
| Rate for Payer: United Healthcare PPO |
$17,640.32
|
| Rate for Payer: Wellcare Medicare |
$11,227.80
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$47,830.00
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$17,204.87 |
| Max. Negotiated Rate |
$47,830.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,204.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,554.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,784.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,347.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17,204.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,204.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,204.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,204.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,358.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,204.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,846.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,204.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,204.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,204.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,204.87
|
| Rate for Payer: NAPHCARE Commercial |
$25,807.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17,204.87
|
| Rate for Payer: The Alliance Commercial |
$47,830.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,204.87
|
| Rate for Payer: United Healthcare PPO |
$27,128.45
|
| Rate for Payer: Wellcare Medicare |
$17,204.87
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$96,463.00
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$34,699.01 |
| Max. Negotiated Rate |
$96,463.00 |
| Rate for Payer: Aetna Managed Medicare |
$34,699.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,947.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,213.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,306.36
|
| Rate for Payer: Anthem Medicare Advantage |
$34,699.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,699.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,699.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,699.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,395.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,699.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,517.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,699.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,699.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,699.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,699.01
|
| Rate for Payer: NAPHCARE Commercial |
$52,048.52
|
| Rate for Payer: Quartz Medicare Advantage |
$34,699.01
|
| Rate for Payer: The Alliance Commercial |
$96,463.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,699.01
|
| Rate for Payer: United Healthcare PPO |
$54,899.05
|
| Rate for Payer: Wellcare Medicare |
$34,699.01
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$34,864.00
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$12,540.86 |
| Max. Negotiated Rate |
$34,864.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,540.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,274.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,905.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,861.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12,540.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,540.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,540.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,540.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,047.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,540.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,336.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,540.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,540.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,540.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,540.86
|
| Rate for Payer: NAPHCARE Commercial |
$18,811.29
|
| Rate for Payer: Quartz Medicare Advantage |
$12,540.86
|
| Rate for Payer: The Alliance Commercial |
$34,864.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,540.86
|
| Rate for Payer: United Healthcare PPO |
$19,724.67
|
| Rate for Payer: Wellcare Medicare |
$12,540.86
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$52,796.00
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$18,991.30 |
| Max. Negotiated Rate |
$52,796.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,991.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,330.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,679.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,097.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18,991.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,991.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,991.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,991.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,411.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,991.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,991.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,991.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,991.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,991.30
|
| Rate for Payer: NAPHCARE Commercial |
$28,486.95
|
| Rate for Payer: Quartz Medicare Advantage |
$18,991.30
|
| Rate for Payer: The Alliance Commercial |
$52,796.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,991.30
|
| Rate for Payer: United Healthcare PPO |
$29,964.26
|
| Rate for Payer: Wellcare Medicare |
$18,991.30
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$103,665.00
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$37,289.70 |
| Max. Negotiated Rate |
$103,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,289.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81,612.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,555.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,431.42
|
| Rate for Payer: Anthem Medicare Advantage |
$37,289.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,289.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,289.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,289.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65,974.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,289.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,800.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,289.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,289.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,289.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,289.70
|
| Rate for Payer: NAPHCARE Commercial |
$55,934.55
|
| Rate for Payer: Quartz Medicare Advantage |
$37,289.70
|
| Rate for Payer: The Alliance Commercial |
$103,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,289.70
|
| Rate for Payer: United Healthcare PPO |
$59,011.58
|
| Rate for Payer: Wellcare Medicare |
$37,289.70
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$36,600.00
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$13,165.35 |
| Max. Negotiated Rate |
$36,600.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,165.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,165.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,165.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,165.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,609.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,165.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,165.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,165.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,165.35
|
| Rate for Payer: NAPHCARE Commercial |
$19,748.02
|
| Rate for Payer: Quartz Medicare Advantage |
$13,165.35
|
| Rate for Payer: The Alliance Commercial |
$36,600.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,165.35
|
| Rate for Payer: United Healthcare PPO |
$20,715.99
|
| Rate for Payer: Wellcare Medicare |
$13,165.35
|
|
|
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 59870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
