|
US Inferior Vena Cava Duplex Limited
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
2544905
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Aetna Managed Medicare |
$223.06
|
| 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 |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.81
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.48
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: NAPHCARE Commercial |
$477.98
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$517.82
|
| Rate for Payer: Quartz Medicare Advantage |
$477.98
|
| Rate for Payer: The Alliance Commercial |
$370.91
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
US Inferior Vena Cava Duplex Limited
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
2544905
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$92.73 |
| Max. Negotiated Rate |
$756.81 |
| Rate for Payer: Aetna Commercial |
$756.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Aetna Managed Medicare |
$92.73
|
| Rate for Payer: Anthem Medicare Advantage |
$92.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.73
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$756.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.73
|
| Rate for Payer: Health EOS Commercial |
$724.94
|
| Rate for Payer: HFN Commercial |
$756.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$345.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.73
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: NAPHCARE Commercial |
$139.09
|
| Rate for Payer: Preferred Network Access Commercial |
$756.81
|
| Rate for Payer: Quartz Beloit One Network |
$350.52
|
| Rate for Payer: Quartz Commercial |
$454.08
|
| Rate for Payer: Quartz Medicare Advantage |
$92.73
|
| Rate for Payer: The Alliance Commercial |
$231.82
|
| Rate for Payer: United Healthcare Medicaid |
$99.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.73
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$370.91
|
|
|
US Inferior Vena Cava Duplex Limited
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
2544905
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.35 |
| Max. Negotiated Rate |
$732.91 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$477.98
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
US Kidney Transplant Left
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$1,274.46 |
| Rate for Payer: Aetna Commercial |
$1,246.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.20
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$1,274.46
|
| Rate for Payer: Health EOS Commercial |
$1,232.90
|
| Rate for Payer: HFN Commercial |
$1,274.46
|
| Rate for Payer: Multiplan Commercial |
$1,108.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.46
|
| Rate for Payer: Quartz Beloit One Network |
$678.79
|
| Rate for Payer: Quartz Commercial |
$831.17
|
| Rate for Payer: WEA Trust Commercial |
$761.90
|
| Rate for Payer: WPS Commercial |
$1,026.04
|
|
|
US Kidney Transplant Left
|
Professional
|
Both
|
$1,332.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$1,316.02 |
| Rate for Payer: Aetna Commercial |
$1,316.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.34
|
| Rate for Payer: Aetna Managed Medicare |
$107.70
|
| Rate for Payer: Anthem Medicare Advantage |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.70
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$1,316.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$692.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.70
|
| Rate for Payer: Health EOS Commercial |
$1,260.60
|
| Rate for Payer: HFN Commercial |
$1,316.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$419.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$419.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.70
|
| Rate for Payer: Multiplan Commercial |
$1,108.22
|
| Rate for Payer: NAPHCARE Commercial |
$161.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.02
|
| Rate for Payer: Quartz Beloit One Network |
$609.52
|
| Rate for Payer: Quartz Commercial |
$789.61
|
| Rate for Payer: Quartz Medicare Advantage |
$107.70
|
| Rate for Payer: The Alliance Commercial |
$409.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.70
|
| Rate for Payer: WEA Trust Commercial |
$761.90
|
| Rate for Payer: WPS Commercial |
$538.51
|
|
|
US Kidney Transplant Left
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$387.88 |
| Max. Negotiated Rate |
$1,274.46 |
| Rate for Payer: Aetna Commercial |
$1,246.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.34
|
| Rate for Payer: Aetna Managed Medicare |
$387.88
|
| 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 |
$734.20
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$1,274.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.22
|
| Rate for Payer: Health EOS Commercial |
$1,232.90
|
| Rate for Payer: HFN Commercial |
$1,274.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.96
|
| Rate for Payer: Multiplan Commercial |
$1,108.22
|
| Rate for Payer: NAPHCARE Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.46
|
| Rate for Payer: Quartz Beloit One Network |
$678.79
|
| Rate for Payer: Quartz Commercial |
$900.43
|
| Rate for Payer: Quartz Medicare Advantage |
$831.17
|
| Rate for Payer: The Alliance Commercial |
$430.81
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$761.90
|
| Rate for Payer: WPS Commercial |
$1,026.04
|
|
|
US Kidney Transplant Right
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544913
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.73
|
| 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 |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.91
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.74
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$862.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$934.91
|
| Rate for Payer: Quartz Medicare Advantage |
$862.99
|
| Rate for Payer: The Alliance Commercial |
$430.81
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
US Kidney Transplant Right
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544913
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$862.99
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
US Kidney Transplant Right
|
Professional
|
Both
|
$1,383.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544913
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$1,366.40 |
| Rate for Payer: Aetna Commercial |
$1,366.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$107.70
|
| Rate for Payer: Anthem Medicare Advantage |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.70
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,366.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$719.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.70
|
| Rate for Payer: Health EOS Commercial |
$1,308.87
|
| Rate for Payer: HFN Commercial |
$1,366.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$419.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$419.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.70
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$161.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,366.40
|
| Rate for Payer: Quartz Beloit One Network |
$632.86
|
| Rate for Payer: Quartz Commercial |
$819.84
|
| Rate for Payer: Quartz Medicare Advantage |
$107.70
|
| Rate for Payer: The Alliance Commercial |
$409.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.70
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$538.51
|
|
|
US Left Lower Quadrant
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$794.47 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$972.82
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Lower Quadrant
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$453.98
|
| 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 |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.34
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.02
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$972.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$1,053.88
|
| Rate for Payer: Quartz Medicare Advantage |
$972.82
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Lower Quadrant
|
Professional
|
Both
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,540.29 |
| Rate for Payer: Aetna Commercial |
$1,540.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,540.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$810.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,475.44
|
| Rate for Payer: HFN Commercial |
$1,540.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,540.29
|
| Rate for Payer: Quartz Beloit One Network |
$713.40
|
| Rate for Payer: Quartz Commercial |
$924.18
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Left Lower Quadrant
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711775
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Lower Quadrant
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711775
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| 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 |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Lower Quadrant
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711775
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Left Upper Quadrant
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$794.47 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$972.82
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Upper Quadrant
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711776
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| 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 |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Upper Quadrant
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711776
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Left Upper Quadrant
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711776
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Upper Quadrant
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$453.98
|
| 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 |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.34
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.02
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$972.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$1,053.88
|
| Rate for Payer: Quartz Medicare Advantage |
$972.82
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Upper Quadrant
|
Professional
|
Both
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,540.29 |
| Rate for Payer: Aetna Commercial |
$1,540.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,540.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$810.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,475.44
|
| Rate for Payer: HFN Commercial |
$1,540.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,540.29
|
| Rate for Payer: Quartz Beloit One Network |
$713.40
|
| Rate for Payer: Quartz Commercial |
$924.18
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Liver
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587172
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Liver
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552807
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| 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 |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Liver
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587172
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| 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 |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Liver
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587172
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
