|
US Right Upper Quadrant
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711782
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.82
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| 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 |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$995.07
|
| 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 |
$841.98
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
US Screening AAA
|
Facility
|
OP
|
$471.00
|
|
|
Service Code
|
CPT 76706 TC
|
| Hospital Charge Code |
5238867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| 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 |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$318.57
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US Screening AAA
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
CPT 76706 TC
|
| Hospital Charge Code |
5238867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$465.35 |
| Rate for Payer: Aetna Commercial |
$465.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$79.64
|
| Rate for Payer: Anthem Medicare Advantage |
$79.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.64
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$465.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.64
|
| Rate for Payer: Health EOS Commercial |
$445.75
|
| Rate for Payer: HFN Commercial |
$465.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.64
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$119.46
|
| Rate for Payer: Preferred Network Access Commercial |
$465.35
|
| Rate for Payer: Quartz Beloit One Network |
$215.53
|
| Rate for Payer: Quartz Commercial |
$279.21
|
| Rate for Payer: Quartz Medicare Advantage |
$79.64
|
| Rate for Payer: The Alliance Commercial |
$302.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.64
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$398.22
|
|
|
US Screening AAA
|
Facility
|
IP
|
$471.00
|
|
|
Service Code
|
CPT 76706 TC
|
| Hospital Charge Code |
5238867
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
US Scrotum (Contents)
|
Facility
|
IP
|
$1,442.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
2544975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$734.84 |
| Max. Negotiated Rate |
$1,379.71 |
| Rate for Payer: Aetna Commercial |
$1,349.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.83
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$1,379.71
|
| Rate for Payer: Health EOS Commercial |
$1,334.72
|
| Rate for Payer: HFN Commercial |
$1,379.71
|
| Rate for Payer: Multiplan Commercial |
$1,199.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.71
|
| Rate for Payer: Quartz Beloit One Network |
$734.84
|
| Rate for Payer: Quartz Commercial |
$899.81
|
| Rate for Payer: WEA Trust Commercial |
$824.82
|
| Rate for Payer: WPS Commercial |
$1,110.77
|
|
|
US Scrotum (Contents)
|
Facility
|
OP
|
$1,442.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
2544975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$273.31 |
| Max. Negotiated Rate |
$1,379.71 |
| Rate for Payer: Aetna Commercial |
$1,349.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.72
|
| Rate for Payer: Aetna Managed Medicare |
$419.91
|
| 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 |
$794.83
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$1,379.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$839.24
|
| Rate for Payer: Health EOS Commercial |
$1,334.72
|
| Rate for Payer: HFN Commercial |
$1,379.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,124.76
|
| Rate for Payer: Multiplan Commercial |
$1,199.74
|
| Rate for Payer: NAPHCARE Commercial |
$899.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.71
|
| Rate for Payer: Quartz Beloit One Network |
$734.84
|
| Rate for Payer: Quartz Commercial |
$974.79
|
| Rate for Payer: Quartz Medicare Advantage |
$899.81
|
| Rate for Payer: The Alliance Commercial |
$273.31
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$824.82
|
| Rate for Payer: WPS Commercial |
$1,110.77
|
|
|
US Scrotum (Contents)
|
Facility
|
IP
|
$1,285.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
630851
|
| Min. Negotiated Rate |
$654.84 |
| Max. Negotiated Rate |
$1,229.49 |
| Rate for Payer: Aetna Commercial |
$1,202.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.29
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,229.49
|
| Rate for Payer: Health EOS Commercial |
$1,189.40
|
| Rate for Payer: HFN Commercial |
$1,229.49
|
| Rate for Payer: Multiplan Commercial |
$1,069.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,229.49
|
| Rate for Payer: Quartz Beloit One Network |
$654.84
|
| Rate for Payer: Quartz Commercial |
$801.84
|
| Rate for Payer: WEA Trust Commercial |
$735.02
|
| Rate for Payer: WPS Commercial |
$989.84
|
|
|
US Scrotum (Contents)
|
Professional
|
Both
|
$1,442.00
|
|
|
Service Code
|
CPT 76870 TC
|
| Hospital Charge Code |
2544975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$1,424.70 |
| Rate for Payer: Aetna Commercial |
$1,424.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.72
|
| Rate for Payer: Aetna Managed Medicare |
$68.33
|
| Rate for Payer: Anthem Medicare Advantage |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.33
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cash Price |
$432.60
|
| Rate for Payer: Cigna Commercial |
$1,424.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$749.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.33
|
| Rate for Payer: Health EOS Commercial |
$1,364.71
|
| Rate for Payer: HFN Commercial |
$1,424.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.33
|
| Rate for Payer: Multiplan Commercial |
$1,199.74
|
| Rate for Payer: NAPHCARE Commercial |
$102.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,424.70
|
| Rate for Payer: Quartz Beloit One Network |
$659.86
|
| Rate for Payer: Quartz Commercial |
$854.82
|
| Rate for Payer: Quartz Medicare Advantage |
$68.33
|
| Rate for Payer: The Alliance Commercial |
$259.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.33
|
| Rate for Payer: WEA Trust Commercial |
$824.82
|
| Rate for Payer: WPS Commercial |
$341.64
|
|
|
US Scrotum (Contents)
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
630851
|
| Min. Negotiated Rate |
$97.95 |
| Max. Negotiated Rate |
$1,269.58 |
| Rate for Payer: Aetna Commercial |
$1,269.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.30
|
| Rate for Payer: Aetna Managed Medicare |
$97.95
|
| Rate for Payer: Anthem Medicare Advantage |
$97.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.95
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,269.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$668.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.95
|
| Rate for Payer: Health EOS Commercial |
$1,216.12
|
| Rate for Payer: HFN Commercial |
$1,269.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$372.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.95
|
| Rate for Payer: Multiplan Commercial |
$1,069.12
|
| Rate for Payer: NAPHCARE Commercial |
$146.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.58
|
| Rate for Payer: Quartz Beloit One Network |
$588.02
|
| Rate for Payer: Quartz Commercial |
$761.75
|
| Rate for Payer: Quartz Medicare Advantage |
$97.95
|
| Rate for Payer: The Alliance Commercial |
$372.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.95
|
| Rate for Payer: WEA Trust Commercial |
$735.02
|
| Rate for Payer: WPS Commercial |
$489.74
|
|
|
US Scrotum (Contents)
|
Facility
|
OP
|
$1,285.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
630851
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,229.49 |
| Rate for Payer: Aetna Commercial |
$1,202.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.30
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$868.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.47
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.29
|
| 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 |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,229.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$747.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,189.40
|
| Rate for Payer: HFN Commercial |
$1,229.49
|
| 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 |
$1,069.12
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,229.49
|
| Rate for Payer: Quartz Beloit One Network |
$654.84
|
| Rate for Payer: Quartz Commercial |
$868.66
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$735.02
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$989.84
|
|
|
US Spinal Canal
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
CPT 76800 TC
|
| Hospital Charge Code |
2544977
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$125.24 |
| Max. Negotiated Rate |
$739.02 |
| Rate for Payer: Aetna Commercial |
$739.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Aetna Managed Medicare |
$125.24
|
| Rate for Payer: Anthem Medicare Advantage |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.24
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$739.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$388.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.24
|
| Rate for Payer: Health EOS Commercial |
$707.91
|
| Rate for Payer: HFN Commercial |
$739.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.24
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: NAPHCARE Commercial |
$187.86
|
| Rate for Payer: Preferred Network Access Commercial |
$739.02
|
| Rate for Payer: Quartz Beloit One Network |
$342.28
|
| Rate for Payer: Quartz Commercial |
$443.41
|
| Rate for Payer: Quartz Medicare Advantage |
$125.24
|
| Rate for Payer: The Alliance Commercial |
$475.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.24
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$626.18
|
|
|
US Spinal Canal
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
630847
|
| Min. Negotiated Rate |
$185.87 |
| Max. Negotiated Rate |
$929.34 |
| Rate for Payer: Aetna Commercial |
$684.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Managed Medicare |
$185.87
|
| Rate for Payer: Anthem Medicare Advantage |
$185.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.87
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$684.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$360.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.87
|
| Rate for Payer: Health EOS Commercial |
$655.86
|
| Rate for Payer: HFN Commercial |
$684.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$501.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.87
|
| Rate for Payer: Multiplan Commercial |
$576.58
|
| Rate for Payer: NAPHCARE Commercial |
$278.80
|
| Rate for Payer: Preferred Network Access Commercial |
$684.68
|
| Rate for Payer: Quartz Beloit One Network |
$317.12
|
| Rate for Payer: Quartz Commercial |
$410.81
|
| Rate for Payer: Quartz Medicare Advantage |
$185.87
|
| Rate for Payer: The Alliance Commercial |
$706.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.87
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: WPS Commercial |
$929.34
|
|
|
US Spinal Canal
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 76800 TC
|
| Hospital Charge Code |
2544977
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$217.82 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Aetna Managed Medicare |
$217.82
|
| 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 |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.34
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.44
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: NAPHCARE Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$505.65
|
| Rate for Payer: Quartz Medicare Advantage |
$466.75
|
| Rate for Payer: The Alliance Commercial |
$500.95
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
US Spinal Canal
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
630847
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$663.06 |
| Rate for Payer: Aetna Commercial |
$648.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.95
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.98
|
| 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 |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$663.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$641.44
|
| Rate for Payer: HFN Commercial |
$663.06
|
| 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 |
$576.58
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$663.06
|
| Rate for Payer: Quartz Beloit One Network |
$353.15
|
| Rate for Payer: Quartz Commercial |
$468.47
|
| 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 |
$396.40
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$533.82
|
|
|
US Spinal Canal
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT 76800
|
| Hospital Charge Code |
630847
|
| Min. Negotiated Rate |
$353.15 |
| Max. Negotiated Rate |
$663.06 |
| Rate for Payer: Aetna Commercial |
$648.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.98
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$663.06
|
| Rate for Payer: Health EOS Commercial |
$641.44
|
| Rate for Payer: HFN Commercial |
$663.06
|
| Rate for Payer: Multiplan Commercial |
$576.58
|
| Rate for Payer: Preferred Network Access Commercial |
$663.06
|
| Rate for Payer: Quartz Beloit One Network |
$353.15
|
| Rate for Payer: Quartz Commercial |
$432.43
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: WPS Commercial |
$533.82
|
|
|
US Spinal Canal
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 76800 TC
|
| Hospital Charge Code |
2544977
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$715.69 |
| Rate for Payer: Aetna Commercial |
$700.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.30
|
| Rate for Payer: Cash Price |
$224.40
|
| Rate for Payer: Cigna Commercial |
$715.69
|
| Rate for Payer: Health EOS Commercial |
$692.35
|
| Rate for Payer: HFN Commercial |
$715.69
|
| Rate for Payer: Multiplan Commercial |
$622.34
|
| Rate for Payer: Preferred Network Access Commercial |
$715.69
|
| Rate for Payer: Quartz Beloit One Network |
$381.18
|
| Rate for Payer: Quartz Commercial |
$466.75
|
| Rate for Payer: WEA Trust Commercial |
$427.86
|
| Rate for Payer: WPS Commercial |
$576.18
|
|
|
US Spleen
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587202
|
|
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 Spleen
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587202
|
|
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
|
|
|
US Spleen
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552817
|
| 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 Spleen
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552817
|
| 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 Spleen
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552817
|
| 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 Spleen
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587202
|
|
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
|
|
|
Ustekinumab and Anti-Ustekinumab Antibody
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5542685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$121.68
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
|
Ustekinumab and Anti-Ustekinumab Antibody
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5542685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$177.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$170.35
|
| Rate for Payer: HFN Commercial |
$177.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$177.84
|
| Rate for Payer: Quartz Beloit One Network |
$82.37
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Ustekinumab and Anti-Ustekinumab Antibody
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5542685
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
