|
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 |
$2,023.11 |
| Max. Negotiated Rate |
$3,798.50 |
| Rate for Payer: Aetna Commercial |
$3,715.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,550.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,188.26
|
| Rate for Payer: Cash Price |
$1,191.00
|
| Rate for Payer: Cigna Commercial |
$3,798.50
|
| Rate for Payer: Health EOS Commercial |
$3,674.63
|
| Rate for Payer: HFN Commercial |
$3,798.50
|
| Rate for Payer: Multiplan Commercial |
$3,303.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,023.11
|
| Rate for Payer: Quartz Commercial |
$2,477.28
|
| Rate for Payer: WEA Trust Commercial |
$2,270.84
|
| Rate for Payer: WPS Commercial |
$3,058.09
|
|
|
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 |
$1,156.06 |
| Max. Negotiated Rate |
$3,798.50 |
| Rate for Payer: Aetna Commercial |
$3,715.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,550.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,156.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,188.26
|
| 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 |
$3,798.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,310.54
|
| Rate for Payer: Health EOS Commercial |
$3,674.63
|
| Rate for Payer: HFN Commercial |
$3,798.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,096.60
|
| Rate for Payer: Multiplan Commercial |
$3,303.04
|
| Rate for Payer: NAPHCARE Commercial |
$2,477.28
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,023.11
|
| Rate for Payer: Quartz Commercial |
$2,683.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,477.28
|
| Rate for Payer: The Alliance Commercial |
$2,064.40
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,270.84
|
| Rate for Payer: WPS Commercial |
$3,058.09
|
|
|
CT Biopsy
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240896
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| 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 |
$3,286.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,999.17
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,679.30
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,143.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,322.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,143.44
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$856.35
|
|
|
CT Biopsy
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627622
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627622
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$2,909.66 |
| Rate for Payer: Aetna Commercial |
$2,909.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$2,909.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,531.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$2,787.15
|
| Rate for Payer: HFN Commercial |
$2,909.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,909.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.63
|
| Rate for Payer: Quartz Commercial |
$1,745.80
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Biopsy
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240896
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$3,393.78 |
| Rate for Payer: Aetna Commercial |
$3,393.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$3,393.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$3,250.88
|
| Rate for Payer: HFN Commercial |
$3,393.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.86
|
| Rate for Payer: Quartz Commercial |
$2,036.27
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Biopsy
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240896
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$3,286.61 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,286.61
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,143.44
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$2,645.98
|
|
|
CT Biopsy
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627622
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy Abdomen
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240898
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| 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 |
$3,286.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,999.17
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,679.30
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,143.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,322.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,143.44
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$856.35
|
|
|
CT Biopsy Abdomen
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240898
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$3,286.61 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,286.61
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,143.44
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$2,645.98
|
|
|
CT Biopsy Abdomen
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
625590
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy Abdomen
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
625590
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy Abdomen
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
625590
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$2,909.66 |
| Rate for Payer: Aetna Commercial |
$2,909.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$2,909.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,531.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$2,787.15
|
| Rate for Payer: HFN Commercial |
$2,909.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,909.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.63
|
| Rate for Payer: Quartz Commercial |
$1,745.80
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Biopsy Abdomen
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240898
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$3,393.78 |
| Rate for Payer: Aetna Commercial |
$3,393.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$3,393.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$3,250.88
|
| Rate for Payer: HFN Commercial |
$3,393.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.86
|
| Rate for Payer: Quartz Commercial |
$2,036.27
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Biopsy Bone
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627630
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$2,909.66 |
| Rate for Payer: Aetna Commercial |
$2,909.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$2,909.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,531.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$2,787.15
|
| Rate for Payer: HFN Commercial |
$2,909.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,909.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.63
|
| Rate for Payer: Quartz Commercial |
$1,745.80
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Biopsy Bone
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627630
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy Bone
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240900
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$3,393.78 |
| Rate for Payer: Aetna Commercial |
$3,393.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$3,393.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$3,250.88
|
| Rate for Payer: HFN Commercial |
$3,393.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.86
|
| Rate for Payer: Quartz Commercial |
$2,036.27
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Biopsy Bone
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240900
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| 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 |
$3,286.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,999.17
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,679.30
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,143.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,322.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,143.44
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$856.35
|
|
|
CT Biopsy Bone
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1240900
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$3,286.61 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,286.61
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,143.44
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$2,645.98
|
|
|
CT Biopsy Bone
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
627630
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy Bone Marrow
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 TC
|
| Hospital Charge Code |
6230674
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$3,393.78 |
| Rate for Payer: Aetna Commercial |
$3,393.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$55.35
|
| Rate for Payer: Anthem Medicare Advantage |
$55.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55.35
|
| 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 |
$3,393.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.35
|
| Rate for Payer: Health EOS Commercial |
$3,250.88
|
| Rate for Payer: HFN Commercial |
$3,393.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$270.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55.35
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$83.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.86
|
| Rate for Payer: Quartz Commercial |
$2,036.27
|
| Rate for Payer: Quartz Medicare Advantage |
$55.35
|
| Rate for Payer: The Alliance Commercial |
$210.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.35
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$276.74
|
|
|
CT Biopsy Bone Marrow
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 TC
|
| Hospital Charge Code |
6230674
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| 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 |
$3,286.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,999.17
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,679.30
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,143.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,322.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,143.44
|
| Rate for Payer: The Alliance Commercial |
$221.40
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$387.44
|
|
|
CT Biopsy Bone Marrow
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012 TC
|
| Hospital Charge Code |
6230674
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$3,286.61 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,286.61
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,143.44
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$2,645.98
|
|
|
CT Biopsy Liver
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629782
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Biopsy Liver
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629782
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$2,909.66 |
| Rate for Payer: Aetna Commercial |
$2,909.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| 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 |
$2,909.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,531.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$2,787.15
|
| Rate for Payer: HFN Commercial |
$2,909.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,909.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.63
|
| Rate for Payer: Quartz Commercial |
$1,745.80
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
