|
US Guided Intraoperative
|
Facility
|
IP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,015.63 |
| Max. Negotiated Rate |
$1,906.90 |
| Rate for Payer: Aetna Commercial |
$1,865.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,782.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,098.54
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,906.90
|
| Rate for Payer: Health EOS Commercial |
$1,844.72
|
| Rate for Payer: HFN Commercial |
$1,906.90
|
| Rate for Payer: Multiplan Commercial |
$1,658.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,906.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,015.63
|
| Rate for Payer: Quartz Commercial |
$1,243.63
|
| Rate for Payer: WEA Trust Commercial |
$1,140.00
|
| Rate for Payer: WPS Commercial |
$1,535.21
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$490.74 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$600.91
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$811.79 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$994.03
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$280.43
|
| 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 |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.47
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.14
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$600.91
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$650.99
|
| Rate for Payer: Quartz Medicare Advantage |
$600.91
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$463.88 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Aetna Managed Medicare |
$463.88
|
| 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 |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$927.13
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.54
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: NAPHCARE Commercial |
$994.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$1,076.87
|
| Rate for Payer: Quartz Medicare Advantage |
$994.03
|
| Rate for Payer: The Alliance Commercial |
$828.36
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
US Guided Intraoperative Prostate
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$184.92 |
| Max. Negotiated Rate |
$1,573.88 |
| Rate for Payer: Aetna Commercial |
$1,573.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,573.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$828.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.03
|
| Rate for Payer: Health EOS Commercial |
$1,507.62
|
| Rate for Payer: HFN Commercial |
$1,573.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.88
|
| Rate for Payer: Quartz Beloit One Network |
$728.96
|
| Rate for Payer: Quartz Commercial |
$944.33
|
| Rate for Payer: The Alliance Commercial |
$828.36
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
US Guided Marker Placement
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.63 |
| Max. Negotiated Rate |
$595.76 |
| Rate for Payer: Aetna Commercial |
$595.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$69.91
|
| Rate for Payer: Anthem Medicare Advantage |
$69.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.91
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$595.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.91
|
| Rate for Payer: Health EOS Commercial |
$570.68
|
| Rate for Payer: HFN Commercial |
$595.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.91
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$104.86
|
| Rate for Payer: Preferred Network Access Commercial |
$595.76
|
| Rate for Payer: Quartz Beloit One Network |
$275.93
|
| Rate for Payer: Quartz Commercial |
$357.46
|
| Rate for Payer: Quartz Medicare Advantage |
$69.91
|
| Rate for Payer: The Alliance Commercial |
$297.11
|
| Rate for Payer: United Healthcare Medicaid |
$67.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.91
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$314.59
|
|
|
US Guided Marker Placement
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| 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: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$407.63
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
US Guided Marker Placement
|
Facility
|
OP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$168.60 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Aetna Managed Medicare |
$168.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.98
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.62
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: NAPHCARE Commercial |
$361.30
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$391.40
|
| Rate for Payer: Quartz Medicare Advantage |
$361.30
|
| Rate for Payer: The Alliance Commercial |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
US Guided Marker Placement
|
Professional
|
Both
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$264.95 |
| Max. Negotiated Rate |
$572.05 |
| Rate for Payer: Aetna Commercial |
$572.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.30
|
| Rate for Payer: Health EOS Commercial |
$547.97
|
| Rate for Payer: HFN Commercial |
$572.05
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$572.05
|
| Rate for Payer: Quartz Beloit One Network |
$264.95
|
| Rate for Payer: Quartz Commercial |
$343.23
|
| Rate for Payer: The Alliance Commercial |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
US Guided Marker Placement
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$376.27
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
US Guided Marker Placement
|
Facility
|
IP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$361.30
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
US Guided Marker Placement ea add
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$35.12
|
| Rate for Payer: Anthem Medicare Advantage |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.12
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.12
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.12
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$52.68
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$35.12
|
| Rate for Payer: The Alliance Commercial |
$149.26
|
| Rate for Payer: United Healthcare Medicaid |
$33.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.12
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$158.04
|
|
|
US Guided Marker Placement ea add
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| 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 |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$140.48
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
US Guided Marker Placement ea add
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
US Guided Marker Placement ea add
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
US Guided Marker Placement ea add
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| 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 |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$140.48
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
US Guided Marker Placement ea add
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$594.78 |
| Rate for Payer: Aetna Commercial |
$594.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$35.12
|
| Rate for Payer: Anthem Medicare Advantage |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.12
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$594.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.12
|
| Rate for Payer: Health EOS Commercial |
$569.73
|
| Rate for Payer: HFN Commercial |
$594.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.12
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$52.68
|
| Rate for Payer: Preferred Network Access Commercial |
$594.78
|
| Rate for Payer: Quartz Beloit One Network |
$275.48
|
| Rate for Payer: Quartz Commercial |
$356.87
|
| Rate for Payer: Quartz Medicare Advantage |
$35.12
|
| Rate for Payer: The Alliance Commercial |
$149.26
|
| Rate for Payer: United Healthcare Medicaid |
$33.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.12
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$158.04
|
|
|
US Guided Needle Placement
|
Facility
|
IP
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$570.24 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$698.26
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
US Guided Needle Placement
|
Facility
|
OP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Aetna Managed Medicare |
$418.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.75
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,120.08
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$896.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$970.74
|
| Rate for Payer: Quartz Medicare Advantage |
$896.06
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
US Guided Needle Placement
|
Facility
|
OP
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,070.66 |
| Rate for Payer: Aetna Commercial |
$1,047.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$325.85
|
| 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 |
$616.79
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,070.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.26
|
| Rate for Payer: Health EOS Commercial |
$1,035.75
|
| Rate for Payer: HFN Commercial |
$1,070.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.82
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$698.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.66
|
| Rate for Payer: Quartz Beloit One Network |
$570.24
|
| Rate for Payer: Quartz Commercial |
$756.44
|
| Rate for Payer: Quartz Medicare Advantage |
$698.26
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$861.97
|
|
|
US Guided Needle Placement
|
Facility
|
IP
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$731.79 |
| Max. Negotiated Rate |
$1,373.96 |
| Rate for Payer: Aetna Commercial |
$1,344.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.52
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,373.96
|
| Rate for Payer: Health EOS Commercial |
$1,329.16
|
| Rate for Payer: HFN Commercial |
$1,373.96
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.96
|
| Rate for Payer: Quartz Beloit One Network |
$731.79
|
| Rate for Payer: Quartz Commercial |
$896.06
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$1,106.15
|
|
|
US Guided Needle Placement
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587169
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,105.57 |
| Rate for Payer: Aetna Commercial |
$1,105.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.83
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna Commercial |
$1,105.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$581.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,059.02
|
| Rate for Payer: HFN Commercial |
$1,105.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$931.01
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,105.57
|
| Rate for Payer: Quartz Beloit One Network |
$512.05
|
| Rate for Payer: Quartz Commercial |
$663.34
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$640.07
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement
|
Professional
|
Both
|
$1,436.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2552806
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,418.77 |
| Rate for Payer: Aetna Commercial |
$1,418.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.36
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cash Price |
$430.80
|
| Rate for Payer: Cigna Commercial |
$1,418.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$746.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,359.03
|
| Rate for Payer: HFN Commercial |
$1,418.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,194.75
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.77
|
| Rate for Payer: Quartz Beloit One Network |
$657.11
|
| Rate for Payer: Quartz Commercial |
$851.26
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$821.39
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement S&I
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
