|
CT Biopsy Lung Left
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629784
|
| 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 Lung Left
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629784
|
| 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 Lung Left
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
1240904
|
|
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 Lung Left
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629784
|
| 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 Lung Left
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
1240904
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| 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: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| 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 |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| 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 |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Lung Left
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
1240904
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$142.82 |
| 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 |
$142.82
|
| Rate for Payer: Anthem Medicare Advantage |
$142.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.82
|
| 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 |
$142.82
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$517.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.82
|
| 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 |
$142.82
|
| Rate for Payer: The Alliance Commercial |
$606.98
|
| Rate for Payer: United Healthcare Medicaid |
$727.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$642.69
|
|
|
CT Biopsy Lung Right
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
1240906
|
|
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 Lung Right
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
1240906
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$142.82 |
| 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 |
$142.82
|
| Rate for Payer: Anthem Medicare Advantage |
$142.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.82
|
| 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 |
$142.82
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$517.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.82
|
| 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 |
$142.82
|
| Rate for Payer: The Alliance Commercial |
$606.98
|
| Rate for Payer: United Healthcare Medicaid |
$727.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$642.69
|
|
|
CT Biopsy Lung Right
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 32408
|
| Hospital Charge Code |
1240906
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,602.49 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| 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: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| 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: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| 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 |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| 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 |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Lung Right
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629786
|
| 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 Lung Right
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629786
|
| 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 Lung Right
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629786
|
| 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 Pancreas
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629788
|
| 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 Pancreas
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240908
|
|
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 Pancreas
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240908
|
|
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 Pancreas
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629788
|
| 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 Pancreas
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629788
|
| 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 Pancreas
|
Professional
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240908
|
|
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 Pleura Left
|
Facility
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629790
|
| 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 Pleura Left
|
Facility
OP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240910
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,111.60 |
| Max. Negotiated Rate |
$15,880.00 |
| Rate for Payer: Aetna Commercial |
$3,573.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,414.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,111.60
|
| 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 |
$2,104.10
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cigna Commercial |
$3,652.40
|
| Rate for Payer: Health EOS Commercial |
$3,533.30
|
| Rate for Payer: HFN Commercial |
$3,652.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,977.50
|
| Rate for Payer: Multiplan Commercial |
$3,176.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,945.30
|
| Rate for Payer: Quartz Commercial |
$2,580.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,382.00
|
| Rate for Payer: The Alliance Commercial |
$15,880.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,183.50
|
| Rate for Payer: WPS Commercial |
$2,940.58
|
|
|
CT Biopsy Pleura Left
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629790
|
| 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 Pleura Left
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629790
|
| 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 Pleura Left
|
Professional
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240910
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,746.80 |
| Max. Negotiated Rate |
$3,771.50 |
| Rate for Payer: Aetna Commercial |
$3,771.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,414.20
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cigna Commercial |
$3,771.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,985.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,382.00
|
| Rate for Payer: Health EOS Commercial |
$3,612.70
|
| Rate for Payer: Multiplan Commercial |
$3,176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,771.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.80
|
| Rate for Payer: Quartz Commercial |
$2,262.90
|
| Rate for Payer: The Alliance Commercial |
$1,985.00
|
| Rate for Payer: WEA Trust Commercial |
$2,183.50
|
| Rate for Payer: WPS Commercial |
$2,940.58
|
|
|
CT Biopsy Pleura Left
|
Facility
IP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240910
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,945.30 |
| Max. Negotiated Rate |
$3,652.40 |
| Rate for Payer: Aetna Commercial |
$3,573.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,104.10
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cigna Commercial |
$3,652.40
|
| Rate for Payer: Health EOS Commercial |
$3,533.30
|
| Rate for Payer: HFN Commercial |
$3,652.40
|
| Rate for Payer: Multiplan Commercial |
$3,176.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,945.30
|
| Rate for Payer: Quartz Commercial |
$2,382.00
|
| Rate for Payer: WEA Trust Commercial |
$2,183.50
|
| Rate for Payer: WPS Commercial |
$2,940.58
|
|
|
CT Biopsy Pleura Right
|
Facility
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629792
|
| 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
|
|
