|
US Guided Needle Placement S&I
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| 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 |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| 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 |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| 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 |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement S&I
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2544883
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$561.14
|
| 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 |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,121.51
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.06
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,202.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,302.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,202.45
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guided Needle Placement S&I
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,830.76 |
| Rate for Payer: Aetna Commercial |
$1,830.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| 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 |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,830.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,753.68
|
| Rate for Payer: HFN Commercial |
$1,830.76
|
| 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 |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.76
|
| Rate for Payer: Quartz Beloit One Network |
$847.93
|
| Rate for Payer: Quartz Commercial |
$1,098.46
|
| 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 |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Guided Needle Placement S&I
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631201
|
| Min. Negotiated Rate |
$255.76 |
| 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: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| 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: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.45
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
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
|
|
|
US Guide, Intraop 7699826
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 76998 26
|
| Hospital Charge Code |
4464925
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.27 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$46.27
|
| Rate for Payer: Anthem Medicare Advantage |
$46.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.27
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.27
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.27
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$69.40
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: Quartz Medicare Advantage |
$46.27
|
| Rate for Payer: The Alliance Commercial |
$175.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.27
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$231.35
|
|
|
US Guide, Vascular Access 7693726
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
CPT 76937 26
|
| Hospital Charge Code |
3493549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$399.15 |
| Rate for Payer: Aetna Commercial |
$399.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$399.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$382.35
|
| Rate for Payer: HFN Commercial |
$399.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$399.15
|
| Rate for Payer: Quartz Beloit One Network |
$184.87
|
| Rate for Payer: Quartz Commercial |
$239.49
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$50.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$66.92
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
631151
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.67
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| 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 |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| 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 |
$596.60
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
631151
|
| Min. Negotiated Rate |
$531.51 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$650.83
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544891
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$326.56 |
| Max. Negotiated Rate |
$1,227.57 |
| Rate for Payer: Aetna Commercial |
$1,200.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.52
|
| Rate for Payer: Aetna Managed Medicare |
$373.61
|
| 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 |
$707.19
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cigna Commercial |
$1,227.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.71
|
| Rate for Payer: Health EOS Commercial |
$1,187.54
|
| Rate for Payer: HFN Commercial |
$1,227.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.74
|
| Rate for Payer: Multiplan Commercial |
$1,067.46
|
| Rate for Payer: NAPHCARE Commercial |
$800.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.57
|
| Rate for Payer: Quartz Beloit One Network |
$653.82
|
| Rate for Payer: Quartz Commercial |
$867.31
|
| Rate for Payer: Quartz Medicare Advantage |
$800.59
|
| Rate for Payer: The Alliance Commercial |
$326.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$733.88
|
| Rate for Payer: WPS Commercial |
$988.29
|
|
|
US Head/Neck Soft Tissue
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
631151
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$1,030.48 |
| Rate for Payer: Aetna Commercial |
$1,030.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| 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 |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$1,030.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$542.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.06
|
| Rate for Payer: Health EOS Commercial |
$987.10
|
| Rate for Payer: HFN Commercial |
$1,030.48
|
| 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 |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$477.28
|
| Rate for Payer: Quartz Commercial |
$618.29
|
| 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 |
$596.60
|
| Rate for Payer: WPS Commercial |
$540.28
|
|
|
US Head/Neck Soft Tissue
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544891
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$1,267.60 |
| Rate for Payer: Aetna Commercial |
$1,267.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.52
|
| Rate for Payer: Aetna Managed Medicare |
$81.64
|
| Rate for Payer: Anthem Medicare Advantage |
$81.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.64
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cigna Commercial |
$1,267.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$667.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.64
|
| Rate for Payer: Health EOS Commercial |
$1,214.23
|
| Rate for Payer: HFN Commercial |
$1,267.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.64
|
| Rate for Payer: Multiplan Commercial |
$1,067.46
|
| Rate for Payer: NAPHCARE Commercial |
$122.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,267.60
|
| Rate for Payer: Quartz Beloit One Network |
$587.10
|
| Rate for Payer: Quartz Commercial |
$760.56
|
| Rate for Payer: Quartz Medicare Advantage |
$81.64
|
| Rate for Payer: The Alliance Commercial |
$310.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.64
|
| Rate for Payer: WEA Trust Commercial |
$733.88
|
| Rate for Payer: WPS Commercial |
$408.20
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
IP
|
$1,283.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544891
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$653.82 |
| Max. Negotiated Rate |
$1,227.57 |
| Rate for Payer: Aetna Commercial |
$1,200.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$707.19
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cigna Commercial |
$1,227.57
|
| Rate for Payer: Health EOS Commercial |
$1,187.54
|
| Rate for Payer: HFN Commercial |
$1,227.57
|
| Rate for Payer: Multiplan Commercial |
$1,067.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.57
|
| Rate for Payer: Quartz Beloit One Network |
$653.82
|
| Rate for Payer: Quartz Commercial |
$800.59
|
| Rate for Payer: WEA Trust Commercial |
$733.88
|
| Rate for Payer: WPS Commercial |
$988.29
|
|
|
US Hips Infant Dynamic
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
631145
|
| Min. Negotiated Rate |
$636.49 |
| Max. Negotiated Rate |
$1,195.04 |
| Rate for Payer: Aetna Commercial |
$1,169.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.45
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,195.04
|
| Rate for Payer: Health EOS Commercial |
$1,156.07
|
| Rate for Payer: HFN Commercial |
$1,195.04
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.04
|
| Rate for Payer: Quartz Beloit One Network |
$636.49
|
| Rate for Payer: Quartz Commercial |
$779.38
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: WPS Commercial |
$962.10
|
|
|
US Hips Infant Dynamic
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 76885 TC
|
| Hospital Charge Code |
2544893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$687.96 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
US Hips Infant Dynamic
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
CPT 76885 TC
|
| Hospital Charge Code |
2544893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$96.72
|
| Rate for Payer: Anthem Medicare Advantage |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.72
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,333.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$702.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.72
|
| Rate for Payer: Health EOS Commercial |
$1,277.64
|
| Rate for Payer: HFN Commercial |
$1,333.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$145.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,333.80
|
| Rate for Payer: Quartz Beloit One Network |
$617.76
|
| Rate for Payer: Quartz Commercial |
$800.28
|
| Rate for Payer: Quartz Medicare Advantage |
$96.72
|
| Rate for Payer: The Alliance Commercial |
$367.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$483.60
|
|
|
US Hips Infant Dynamic
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 76885 TC
|
| Hospital Charge Code |
2544893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$386.88 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$393.12
|
| 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 |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.70
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,053.00
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$912.60
|
| Rate for Payer: Quartz Medicare Advantage |
$842.40
|
| Rate for Payer: The Alliance Commercial |
$386.88
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
US Hips Infant Dynamic
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
631145
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,195.04 |
| Rate for Payer: Aetna Commercial |
$1,169.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$844.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.50
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,156.07
|
| Rate for Payer: HFN Commercial |
$1,195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.04
|
| Rate for Payer: Quartz Beloit One Network |
$636.49
|
| Rate for Payer: Quartz Commercial |
$844.32
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$962.10
|
|
|
US Hips Infant Dynamic
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
631145
|
| Min. Negotiated Rate |
$130.81 |
| Max. Negotiated Rate |
$1,234.01 |
| Rate for Payer: Aetna Commercial |
$1,234.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Aetna Managed Medicare |
$130.81
|
| Rate for Payer: Anthem Medicare Advantage |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.81
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,234.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$649.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.81
|
| Rate for Payer: Health EOS Commercial |
$1,182.05
|
| Rate for Payer: HFN Commercial |
$1,234.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.81
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: NAPHCARE Commercial |
$196.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.01
|
| Rate for Payer: Quartz Beloit One Network |
$571.54
|
| Rate for Payer: Quartz Commercial |
$740.41
|
| Rate for Payer: Quartz Medicare Advantage |
$130.81
|
| Rate for Payer: The Alliance Commercial |
$497.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.81
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: WPS Commercial |
$654.06
|
|
|
US Hips Infant Static Limited
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 76886 TC
|
| Hospital Charge Code |
2544895
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.79 |
| Max. Negotiated Rate |
$860.16 |
| Rate for Payer: Aetna Commercial |
$841.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.07
|
| Rate for Payer: Aetna Managed Medicare |
$261.79
|
| 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 |
$495.53
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cigna Commercial |
$860.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.22
|
| Rate for Payer: Health EOS Commercial |
$832.11
|
| Rate for Payer: HFN Commercial |
$860.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.22
|
| Rate for Payer: Multiplan Commercial |
$747.97
|
| Rate for Payer: NAPHCARE Commercial |
$560.98
|
| Rate for Payer: Preferred Network Access Commercial |
$860.16
|
| Rate for Payer: Quartz Beloit One Network |
$458.13
|
| Rate for Payer: Quartz Commercial |
$607.72
|
| Rate for Payer: Quartz Medicare Advantage |
$560.98
|
| Rate for Payer: The Alliance Commercial |
$271.98
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$514.23
|
| Rate for Payer: WPS Commercial |
$692.50
|
|
|
US Hips Infant Static Limited
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
CPT 76886 TC
|
| Hospital Charge Code |
2544895
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$888.21 |
| Rate for Payer: Aetna Commercial |
$888.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.07
|
| Rate for Payer: Aetna Managed Medicare |
$68.00
|
| Rate for Payer: Anthem Medicare Advantage |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.00
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cigna Commercial |
$888.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$467.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.00
|
| Rate for Payer: Health EOS Commercial |
$850.81
|
| Rate for Payer: HFN Commercial |
$888.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$263.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$263.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$747.97
|
| Rate for Payer: NAPHCARE Commercial |
$101.99
|
| Rate for Payer: Preferred Network Access Commercial |
$888.21
|
| Rate for Payer: Quartz Beloit One Network |
$411.38
|
| Rate for Payer: Quartz Commercial |
$532.93
|
| Rate for Payer: Quartz Medicare Advantage |
$68.00
|
| Rate for Payer: The Alliance Commercial |
$258.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$514.23
|
| Rate for Payer: WPS Commercial |
$339.98
|
|
|
US Hips Infant Static Limited
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 76886 TC
|
| Hospital Charge Code |
2544895
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$458.13 |
| Max. Negotiated Rate |
$860.16 |
| Rate for Payer: Aetna Commercial |
$841.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.53
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cigna Commercial |
$860.16
|
| Rate for Payer: Health EOS Commercial |
$832.11
|
| Rate for Payer: HFN Commercial |
$860.16
|
| Rate for Payer: Multiplan Commercial |
$747.97
|
| Rate for Payer: Preferred Network Access Commercial |
$860.16
|
| Rate for Payer: Quartz Beloit One Network |
$458.13
|
| Rate for Payer: Quartz Commercial |
$560.98
|
| Rate for Payer: WEA Trust Commercial |
$514.23
|
| Rate for Payer: WPS Commercial |
$692.50
|
|
|
US Inferior Vena Cava Duplex Complete
|
Facility
|
IP
|
$1,288.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544903
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$656.36 |
| Max. Negotiated Rate |
$1,232.36 |
| Rate for Payer: Aetna Commercial |
$1,205.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,151.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$709.95
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$1,232.36
|
| Rate for Payer: Health EOS Commercial |
$1,192.17
|
| Rate for Payer: HFN Commercial |
$1,232.36
|
| Rate for Payer: Multiplan Commercial |
$1,071.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.36
|
| Rate for Payer: Quartz Beloit One Network |
$656.36
|
| Rate for Payer: Quartz Commercial |
$803.71
|
| Rate for Payer: WEA Trust Commercial |
$736.74
|
| Rate for Payer: WPS Commercial |
$992.15
|
|
|
US Inferior Vena Cava Duplex Complete
|
Facility
|
OP
|
$1,288.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544903
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$375.07 |
| Max. Negotiated Rate |
$1,232.36 |
| Rate for Payer: Aetna Commercial |
$1,205.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,151.99
|
| Rate for Payer: Aetna Managed Medicare |
$375.07
|
| 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 |
$709.95
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$1,232.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$749.62
|
| Rate for Payer: Health EOS Commercial |
$1,192.17
|
| Rate for Payer: HFN Commercial |
$1,232.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,004.64
|
| Rate for Payer: Multiplan Commercial |
$1,071.62
|
| Rate for Payer: NAPHCARE Commercial |
$803.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.36
|
| Rate for Payer: Quartz Beloit One Network |
$656.36
|
| Rate for Payer: Quartz Commercial |
$870.69
|
| Rate for Payer: Quartz Medicare Advantage |
$803.71
|
| Rate for Payer: The Alliance Commercial |
$567.01
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$736.74
|
| Rate for Payer: WPS Commercial |
$992.15
|
|
|
US Inferior Vena Cava Duplex Complete
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544903
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.98 |
| Max. Negotiated Rate |
$1,272.54 |
| Rate for Payer: Aetna Commercial |
$1,272.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,151.99
|
| Rate for Payer: Aetna Managed Medicare |
$141.75
|
| Rate for Payer: Anthem Medicare Advantage |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.75
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$1,272.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.75
|
| Rate for Payer: Health EOS Commercial |
$1,218.96
|
| Rate for Payer: HFN Commercial |
$1,272.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$1,071.62
|
| Rate for Payer: NAPHCARE Commercial |
$212.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.54
|
| Rate for Payer: Quartz Beloit One Network |
$589.39
|
| Rate for Payer: Quartz Commercial |
$763.53
|
| Rate for Payer: Quartz Medicare Advantage |
$141.75
|
| Rate for Payer: The Alliance Commercial |
$354.38
|
| Rate for Payer: United Healthcare Medicaid |
$134.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$736.74
|
| Rate for Payer: WPS Commercial |
$567.01
|
|
