|
CT Ankle w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625684
|
| Min. Negotiated Rate |
$718.67 |
| Max. Negotiated Rate |
$3,652.75 |
| Rate for Payer: Aetna Commercial |
$3,652.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,652.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,922.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,307.00
|
| Rate for Payer: Health EOS Commercial |
$3,498.95
|
| Rate for Payer: HFN Commercial |
$3,652.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$718.67
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.80
|
| Rate for Payer: Quartz Commercial |
$2,191.65
|
| Rate for Payer: The Alliance Commercial |
$1,922.50
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Arthrogram Knee w/ Contrast Left
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,LT
|
| Hospital Charge Code |
5724136
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,895.40
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Arthrogram Knee w/ Contrast Left
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,LT
|
| Hospital Charge Code |
5724136
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,428.84 |
| Max. Negotiated Rate |
$2,682.72 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,749.60
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Arthrogram Knee w/ Contrast Left
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,LT
|
| Hospital Charge Code |
5724136
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$2,770.20 |
| Rate for Payer: Aetna Commercial |
$2,770.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,770.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,458.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,749.60
|
| Rate for Payer: Health EOS Commercial |
$2,653.56
|
| Rate for Payer: HFN Commercial |
$2,770.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
| Rate for Payer: Quartz Commercial |
$1,662.12
|
| Rate for Payer: The Alliance Commercial |
$1,458.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Arthrogram Knee w/ Contrast Right
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
5724139
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$2,770.20 |
| Rate for Payer: Aetna Commercial |
$2,770.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,770.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,458.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,749.60
|
| Rate for Payer: Health EOS Commercial |
$2,653.56
|
| Rate for Payer: HFN Commercial |
$2,770.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
| Rate for Payer: Quartz Commercial |
$1,662.12
|
| Rate for Payer: The Alliance Commercial |
$1,458.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Arthrogram Knee w/ Contrast Right
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
5724139
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,428.84 |
| Max. Negotiated Rate |
$2,682.72 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,749.60
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Arthrogram Knee w/ Contrast Right
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
5724139
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,895.40
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Aspiration
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627588
|
| Min. Negotiated Rate |
$1,443.05 |
| 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: 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 Aspiration
|
Facility
|
OP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240881
|
|
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: Cigna Commercial |
$3,652.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,221.61
|
| 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 Aspiration
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627588
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$11,780.00 |
| 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: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| 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 |
$11,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Aspiration
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240881
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$505.18 |
| 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: 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: HFN Commercial |
$3,771.50
|
| 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: 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 Aspiration
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627588
|
| Min. Negotiated Rate |
$505.18 |
| 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: Cash Price |
$883.50
|
| 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 |
$1,767.00
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: HFN Commercial |
$2,797.75
|
| 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: 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: The Alliance Commercial |
$1,472.50
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Aspiration
|
Facility
|
IP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240881
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,414.20
|
| 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 Aspiration Renal Left
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629780
|
| Min. Negotiated Rate |
$505.18 |
| 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: Cash Price |
$883.50
|
| 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 |
$1,767.00
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: HFN Commercial |
$2,797.75
|
| 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: 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: The Alliance Commercial |
$1,472.50
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Aspiration Renal Left
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629780
|
| Min. Negotiated Rate |
$1,443.05 |
| 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: 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 Aspiration Renal Left
|
Facility
|
IP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240883
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,414.20
|
| 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 Aspiration Renal Left
|
Facility
|
OP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240883
|
|
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: Cigna Commercial |
$3,652.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,221.61
|
| 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 Aspiration Renal Left
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629780
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$11,780.00 |
| 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: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| 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 |
$11,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Aspiration Renal Left
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240883
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$505.18 |
| 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: 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: HFN Commercial |
$3,771.50
|
| 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: 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 Aspiration Renal Right
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$505.18 |
| 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: 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: HFN Commercial |
$3,771.50
|
| 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: 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 Aspiration Renal Right
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627590
|
| Min. Negotiated Rate |
$824.60 |
| Max. Negotiated Rate |
$11,780.00 |
| 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: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| 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 |
$11,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Aspiration Renal Right
|
Facility
|
OP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240885
|
|
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: Cigna Commercial |
$3,652.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,221.61
|
| 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 Aspiration Renal Right
|
Facility
|
IP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240885
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,414.20
|
| 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 Aspiration Renal Right
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627590
|
| Min. Negotiated Rate |
$1,443.05 |
| 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: 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 Aspiration Renal Right
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627590
|
| Min. Negotiated Rate |
$505.18 |
| 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: Cash Price |
$883.50
|
| 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 |
$1,767.00
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: HFN Commercial |
$2,797.75
|
| 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: 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: The Alliance Commercial |
$1,472.50
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
