|
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: 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 Biopsy Pleura Right
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240912
|
|
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: HFN Commercial |
$3,771.50
|
| 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 Right
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629792
|
| 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 Biopsy Pleura Right
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629792
|
| 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: 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 Biopsy Pleura Right
|
Facility
|
OP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240912
|
|
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 Biopsy Pleura Right
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629792
|
| 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 Biopsy Pleura Right
|
Facility
|
IP
|
$3,970.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240912
|
|
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 Biopsy Renal Left
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629794
|
| 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 Biopsy Renal Left
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629794
|
| 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: 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 Biopsy Renal Left
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629794
|
| 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 Biopsy Renal Left
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240914
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| 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 Renal Left
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240914
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$961.80 |
| 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: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,922.23
|
| 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 |
$2,544.30
|
|
|
CT Biopsy Renal Left
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 LT
|
| Hospital Charge Code |
1240914
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,511.40 |
| 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: 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 |
$2,061.00
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: HFN Commercial |
$3,263.25
|
| 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: The Alliance Commercial |
$1,717.50
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Renal Right
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629796
|
| 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: 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 Biopsy Renal Right
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240916
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,511.40 |
| 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: 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 |
$2,061.00
|
| Rate for Payer: Health EOS Commercial |
$3,125.85
|
| Rate for Payer: HFN Commercial |
$3,263.25
|
| 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: The Alliance Commercial |
$1,717.50
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Biopsy Renal Right
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240916
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$961.80 |
| 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: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,922.23
|
| 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 |
$2,544.30
|
|
|
CT Biopsy Renal Right
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 RT
|
| Hospital Charge Code |
1240916
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| 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 Renal Right
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629796
|
| 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 Biopsy Renal Right
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629796
|
| 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 Brain STROKE w/o Contrast
|
Professional
|
Both
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
6101637
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$246.36 |
| Max. Negotiated Rate |
$2,572.60 |
| Rate for Payer: Aetna Commercial |
$2,572.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.88
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,572.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,354.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,624.80
|
| Rate for Payer: Health EOS Commercial |
$2,464.28
|
| Rate for Payer: HFN Commercial |
$2,572.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.36
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,572.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.52
|
| Rate for Payer: Quartz Commercial |
$1,543.56
|
| Rate for Payer: The Alliance Commercial |
$1,354.00
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$2,005.82
|
|
|
CT Brain STROKE w/o Contrast
|
Facility
|
IP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
6101637
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,326.92 |
| Max. Negotiated Rate |
$2,491.36 |
| Rate for Payer: Aetna Commercial |
$2,437.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,435.24
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,491.36
|
| Rate for Payer: Health EOS Commercial |
$2,410.12
|
| Rate for Payer: HFN Commercial |
$2,491.36
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.92
|
| Rate for Payer: Quartz Commercial |
$1,624.80
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$2,005.82
|
|
|
CT Brain STROKE w/o Contrast
|
Facility
|
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
6101637
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$758.24 |
| Max. Negotiated Rate |
$10,832.00 |
| Rate for Payer: Aetna Commercial |
$2,437.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.88
|
| Rate for Payer: Aetna Managed Medicare |
$758.24
|
| 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 |
$1,435.24
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,515.40
|
| Rate for Payer: Health EOS Commercial |
$2,410.12
|
| Rate for Payer: HFN Commercial |
$2,491.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,031.00
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.92
|
| Rate for Payer: Quartz Commercial |
$1,760.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.80
|
| Rate for Payer: The Alliance Commercial |
$10,832.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$2,005.82
|
|
|
CT Brain w/ Contrast
|
Professional
|
Both
|
$3,117.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
1240938
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$357.73 |
| Max. Negotiated Rate |
$2,961.15 |
| Rate for Payer: Aetna Commercial |
$2,961.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,680.62
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$2,961.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,558.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,870.20
|
| Rate for Payer: Health EOS Commercial |
$2,836.47
|
| Rate for Payer: HFN Commercial |
$2,961.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.73
|
| Rate for Payer: Multiplan Commercial |
$2,493.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,961.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,371.48
|
| Rate for Payer: Quartz Commercial |
$1,776.69
|
| Rate for Payer: The Alliance Commercial |
$1,558.50
|
| Rate for Payer: WEA Trust Commercial |
$1,714.35
|
| Rate for Payer: WPS Commercial |
$2,308.76
|
|
|
CT Brain w/ Contrast
|
Facility
|
IP
|
$3,117.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
1240938
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,527.33 |
| Max. Negotiated Rate |
$2,867.64 |
| Rate for Payer: Aetna Commercial |
$2,805.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,680.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,652.01
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$2,867.64
|
| Rate for Payer: Health EOS Commercial |
$2,774.13
|
| Rate for Payer: HFN Commercial |
$2,867.64
|
| Rate for Payer: Multiplan Commercial |
$2,493.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,870.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,867.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.33
|
| Rate for Payer: Quartz Commercial |
$1,870.20
|
| Rate for Payer: WEA Trust Commercial |
$1,714.35
|
| Rate for Payer: WPS Commercial |
$2,308.76
|
|
|
CT Brain w/ Contrast
|
Facility
|
OP
|
$3,117.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
1240938
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$872.76 |
| Max. Negotiated Rate |
$12,468.00 |
| Rate for Payer: Aetna Commercial |
$2,805.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,680.62
|
| Rate for Payer: Aetna Managed Medicare |
$872.76
|
| 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 |
$1,652.01
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$2,867.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,744.27
|
| Rate for Payer: Health EOS Commercial |
$2,774.13
|
| Rate for Payer: HFN Commercial |
$2,867.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,337.75
|
| Rate for Payer: Multiplan Commercial |
$2,493.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,870.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,867.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.33
|
| Rate for Payer: Quartz Commercial |
$2,026.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,870.20
|
| Rate for Payer: The Alliance Commercial |
$12,468.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,714.35
|
| Rate for Payer: WPS Commercial |
$2,308.76
|
|
