|
CT Biopsy
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627622
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627622
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Aetna Commercial |
$2,797.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,797.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,797.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.80
|
| Rate for Payer: Quartz Commercial |
$1,678.65
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240896
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,683.15 |
| Max. Negotiated Rate |
$3,160.20 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,061.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240896
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$961.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,232.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,061.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$956.69
|
|
|
CT Biopsy Abdomen
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240898
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$3,263.25 |
| Rate for Payer: Aetna Commercial |
$3,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,263.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,717.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,511.40
|
| Rate for Payer: Quartz Commercial |
$1,957.95
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy Abdomen
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
625590
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy Abdomen
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240898
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,683.15 |
| Max. Negotiated Rate |
$3,160.20 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,061.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Abdomen
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
625590
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$824.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,914.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,208.75
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy Abdomen
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
625590
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Aetna Commercial |
$2,797.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,797.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,797.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.80
|
| Rate for Payer: Quartz Commercial |
$1,678.65
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy Abdomen
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240898
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$961.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,232.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,061.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$956.69
|
|
|
CT Biopsy Bone
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240900
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,683.15 |
| Max. Negotiated Rate |
$3,160.20 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,061.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Bone
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627630
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$824.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,914.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,208.75
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy Bone
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240900
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$3,263.25 |
| Rate for Payer: Aetna Commercial |
$3,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,263.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,717.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,511.40
|
| Rate for Payer: Quartz Commercial |
$1,957.95
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy Bone
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627630
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Aetna Commercial |
$2,797.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,797.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,797.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.80
|
| Rate for Payer: Quartz Commercial |
$1,678.65
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy Bone
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240900
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$961.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,232.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,061.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$956.69
|
|
|
CT Biopsy Bone
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627630
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy Bone Marrow
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 TC
|
| Hospital Charge Code |
6230674
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,683.15 |
| Max. Negotiated Rate |
$3,160.20 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,061.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Bone Marrow
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 TC
|
| Hospital Charge Code |
6230674
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$69.32 |
| Max. Negotiated Rate |
$3,263.25 |
| Rate for Payer: Aetna Commercial |
$3,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$69.32
|
| Rate for Payer: Anthem Medicare Advantage |
$69.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.32
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,263.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,717.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.32
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$260.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.32
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,511.40
|
| Rate for Payer: Quartz Commercial |
$1,957.95
|
| Rate for Payer: Quartz Medicare Advantage |
$69.32
|
| Rate for Payer: The Alliance Commercial |
$263.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.32
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$346.60
|
|
|
CT Biopsy Bone Marrow
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 TC
|
| Hospital Charge Code |
6230674
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$485.24 |
| Max. Negotiated Rate |
$13,740.00 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$961.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,232.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,061.00
|
| Rate for Payer: The Alliance Commercial |
$13,740.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$485.24
|
|
|
CT Biopsy Liver
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240902
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$3,263.25 |
| Rate for Payer: Aetna Commercial |
$3,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,263.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,717.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,263.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,511.40
|
| Rate for Payer: Quartz Commercial |
$1,957.95
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy Liver
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629782
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy Liver
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629782
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Aetna Commercial |
$2,797.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,797.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,797.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.80
|
| Rate for Payer: Quartz Commercial |
$1,678.65
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Biopsy Liver
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629782
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$824.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,914.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,208.75
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Biopsy Liver
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240902
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,683.15 |
| Max. Negotiated Rate |
$3,160.20 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,061.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Liver
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240902
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$961.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,232.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,061.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$956.69
|
|
