|
MA Breast Ndl Loc Placement Right
|
Facility
|
OP
|
$1,508.00
|
|
| Hospital Charge Code |
3072759
|
| Min. Negotiated Rate |
$422.24 |
| Max. Negotiated Rate |
$6,032.00 |
| Rate for Payer: Aetna Commercial |
$1,357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Aetna Managed Medicare |
$422.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$980.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$754.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$723.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$799.24
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,387.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$843.88
|
| Rate for Payer: Health EOS Commercial |
$1,342.12
|
| Rate for Payer: HFN Commercial |
$1,387.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,131.00
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.36
|
| Rate for Payer: Quartz Beloit One Network |
$738.92
|
| Rate for Payer: Quartz Commercial |
$980.20
|
| Rate for Payer: Quartz Medicare Advantage |
$904.80
|
| Rate for Payer: The Alliance Commercial |
$6,032.00
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.98
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
IP
|
$1,508.00
|
|
| Hospital Charge Code |
3072759
|
| Min. Negotiated Rate |
$738.92 |
| Max. Negotiated Rate |
$1,387.36 |
| Rate for Payer: Aetna Commercial |
$1,357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$799.24
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,387.36
|
| Rate for Payer: Health EOS Commercial |
$1,342.12
|
| Rate for Payer: HFN Commercial |
$1,387.36
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: NAPHCARE Commercial |
$904.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.36
|
| Rate for Payer: Quartz Beloit One Network |
$738.92
|
| Rate for Payer: Quartz Commercial |
$904.80
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.98
|
|
|
MA Breast Ndl Loc Placement Right
|
Professional
|
Both
|
$1,508.00
|
|
| Hospital Charge Code |
3072759
|
| Min. Negotiated Rate |
$663.52 |
| Max. Negotiated Rate |
$1,432.60 |
| Rate for Payer: Aetna Commercial |
$1,432.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,296.88
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,432.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$754.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$904.80
|
| Rate for Payer: Health EOS Commercial |
$1,372.28
|
| Rate for Payer: HFN Commercial |
$1,432.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.52
|
| Rate for Payer: Quartz Commercial |
$859.56
|
| Rate for Payer: The Alliance Commercial |
$754.00
|
| Rate for Payer: WEA Trust Commercial |
$829.40
|
| Rate for Payer: WPS Commercial |
$1,116.98
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$2,253.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,153.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,627.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,252.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,201.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,327.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,303.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$2,228.56
|
| Rate for Payer: HFN Commercial |
$2,303.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.96
|
| Rate for Payer: Quartz Commercial |
$1,627.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,377.20
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$1,854.71
|
|
|
MA Breast Ndl Loc Placement Right
|
Professional
|
Both
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.88 |
| Max. Negotiated Rate |
$2,378.80 |
| Rate for Payer: Aetna Commercial |
$2,378.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,153.44
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,378.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,502.40
|
| Rate for Payer: Health EOS Commercial |
$2,278.64
|
| Rate for Payer: HFN Commercial |
$2,378.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.70
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,427.28
|
| Rate for Payer: The Alliance Commercial |
$1,252.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.88
|
| Rate for Payer: WEA Trust Commercial |
$1,377.20
|
| Rate for Payer: WPS Commercial |
$1,854.71
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$182.88 |
| Max. Negotiated Rate |
$2,181.12 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.88
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$247.65
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$2,181.12 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,044.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,635.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,554.05
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$350.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$228.60
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$228.60
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Breast Tissue Specimen Left
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna Commercial |
$361.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$361.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.60
|
| Rate for Payer: Health EOS Commercial |
$346.71
|
| Rate for Payer: HFN Commercial |
$361.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.54
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.95
|
| Rate for Payer: Quartz Beloit One Network |
$167.64
|
| Rate for Payer: Quartz Commercial |
$217.17
|
| Rate for Payer: The Alliance Commercial |
$190.50
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Breast Tissue Specimen Left
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.40
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.54
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: The Alliance Commercial |
$247.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
MA Breast Tissue Specimen Right
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
1268808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.40
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.54
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: The Alliance Commercial |
$247.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
MA Breast Tissue Specimen Right
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711762
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$361.95 |
| Rate for Payer: Aetna Commercial |
$361.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$361.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.60
|
| Rate for Payer: Health EOS Commercial |
$346.71
|
| Rate for Payer: HFN Commercial |
$361.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.54
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: Preferred Network Access Commercial |
$361.95
|
| Rate for Payer: Quartz Beloit One Network |
$167.64
|
| Rate for Payer: Quartz Commercial |
$217.17
|
| Rate for Payer: The Alliance Commercial |
$190.50
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711762
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$350.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$228.60
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$228.60
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711762
|
| Min. Negotiated Rate |
$182.88 |
| Max. Negotiated Rate |
$2,181.12 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$247.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$182.88
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$247.65
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
1268808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
MA Breast Tissue Specimen Right
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 76098 RT
|
| Hospital Charge Code |
1268808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$2,181.12 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,044.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,635.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,554.05
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
MACI HAND-SCORING STARTER KIT
|
Facility
|
IP
|
$4,699.00
|
|
| Hospital Charge Code |
2973532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,302.51 |
| Max. Negotiated Rate |
$4,323.08 |
| Rate for Payer: Aetna Commercial |
$4,229.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,041.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,490.47
|
| Rate for Payer: Cash Price |
$1,409.70
|
| Rate for Payer: Cigna Commercial |
$4,323.08
|
| Rate for Payer: Health EOS Commercial |
$4,182.11
|
| Rate for Payer: HFN Commercial |
$4,323.08
|
| Rate for Payer: Multiplan Commercial |
$3,759.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,819.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,323.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,302.51
|
| Rate for Payer: Quartz Commercial |
$2,819.40
|
| Rate for Payer: WEA Trust Commercial |
$2,584.45
|
| Rate for Payer: WPS Commercial |
$3,480.55
|
|
|
MACI HAND-SCORING STARTER KIT
|
Facility
|
OP
|
$4,699.00
|
|
| Hospital Charge Code |
2973532
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,315.72 |
| Max. Negotiated Rate |
$18,796.00 |
| Rate for Payer: Aetna Commercial |
$4,229.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,041.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,315.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,054.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,349.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,255.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,490.47
|
| Rate for Payer: Cash Price |
$1,409.70
|
| Rate for Payer: Cigna Commercial |
$4,323.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,629.56
|
| Rate for Payer: Health EOS Commercial |
$4,182.11
|
| Rate for Payer: HFN Commercial |
$4,323.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,524.25
|
| Rate for Payer: Multiplan Commercial |
$3,759.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,819.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,323.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,302.51
|
| Rate for Payer: Quartz Commercial |
$3,054.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,819.40
|
| Rate for Payer: The Alliance Commercial |
$18,796.00
|
| Rate for Payer: WEA Trust Commercial |
$2,584.45
|
| Rate for Payer: WPS Commercial |
$3,480.55
|
|
|
MAC/IV SEDATION IN GI - SET-UP CHARGE
|
Facility
|
IP
|
$98.00
|
|
| Hospital Charge Code |
4519586
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
MAC/IV SEDATION IN GI - SET-UP CHARGE
|
Facility
|
OP
|
$98.00
|
|
| Hospital Charge Code |
4519586
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
MAC/IV SEDATION IN OR - SET-UP CHARGE
|
Facility
|
OP
|
$1,303.00
|
|
| Hospital Charge Code |
4519585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$364.84 |
| Max. Negotiated Rate |
$5,212.00 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Aetna Managed Medicare |
$364.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$625.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$729.16
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.25
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$846.95
|
| Rate for Payer: Quartz Medicare Advantage |
$781.80
|
| Rate for Payer: The Alliance Commercial |
$5,212.00
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
MAC/IV SEDATION IN OR - SET-UP CHARGE
|
Facility
|
IP
|
$1,303.00
|
|
| Hospital Charge Code |
4519585
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$638.47 |
| Max. Negotiated Rate |
$1,198.76 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$781.80
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
MA Dig Diag Bilateral
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5478930
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$245.08 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: HFN Commercial |
$529.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$387.91
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
MA Dig Diag Bilateral
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 77066 TC
|
| Hospital Charge Code |
5478930
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Aetna Managed Medicare |
$155.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.70
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.75
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$362.05
|
| Rate for Payer: Quartz Medicare Advantage |
$334.20
|
| Rate for Payer: The Alliance Commercial |
$2,228.00
|
| Rate for Payer: United Healthcare PPO |
$417.75
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
