|
US Birth Center Fetal BPP w/o NST
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US Birth Center Fetal BPP w/o NST
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$846.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.13
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US Birth Center Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$249.82 |
| Max. Negotiated Rate |
$1,753.70 |
| Rate for Payer: Aetna Commercial |
$1,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,753.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,107.60
|
| Rate for Payer: Health EOS Commercial |
$1,679.86
|
| Rate for Payer: HFN Commercial |
$1,753.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.82
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,753.70
|
| Rate for Payer: Quartz Beloit One Network |
$812.24
|
| Rate for Payer: Quartz Commercial |
$1,052.22
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy After 1st Tri
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy After 1st Tri
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy After 1st Tri
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$312.48 |
| Max. Negotiated Rate |
$1,753.70 |
| Rate for Payer: Aetna Commercial |
$1,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,753.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,107.60
|
| Rate for Payer: Health EOS Commercial |
$1,679.86
|
| Rate for Payer: HFN Commercial |
$1,753.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.48
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,753.70
|
| Rate for Payer: Quartz Beloit One Network |
$812.24
|
| Rate for Payer: Quartz Commercial |
$1,052.22
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy Follow Up
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6210795
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$245.19 |
| Max. Negotiated Rate |
$1,255.90 |
| Rate for Payer: Aetna Commercial |
$1,255.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,255.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$661.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$793.20
|
| Rate for Payer: Health EOS Commercial |
$1,203.02
|
| Rate for Payer: HFN Commercial |
$1,255.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.19
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,255.90
|
| Rate for Payer: Quartz Beloit One Network |
$581.68
|
| Rate for Payer: Quartz Commercial |
$753.54
|
| Rate for Payer: The Alliance Commercial |
$661.00
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
US Birth Center Pregnancy Follow Up
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6210795
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$647.78 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$793.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$793.20
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
US Birth Center Pregnancy Follow Up
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6210795
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,216.24 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$859.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$661.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.56
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,216.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$739.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.24
|
| Rate for Payer: Quartz Beloit One Network |
$647.78
|
| Rate for Payer: Quartz Commercial |
$859.30
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
US Birth Center Pregnancy Limited
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6210798
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$942.08 |
| Rate for Payer: Aetna Commercial |
$921.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.64
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$665.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$491.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$942.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$911.36
|
| Rate for Payer: HFN Commercial |
$942.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$942.08
|
| Rate for Payer: Quartz Beloit One Network |
$501.76
|
| Rate for Payer: Quartz Commercial |
$665.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$563.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$758.48
|
|
|
US Birth Center Pregnancy Limited
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6210798
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$501.76 |
| Max. Negotiated Rate |
$942.08 |
| Rate for Payer: Aetna Commercial |
$921.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.72
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$942.08
|
| Rate for Payer: Health EOS Commercial |
$911.36
|
| Rate for Payer: HFN Commercial |
$942.08
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: NAPHCARE Commercial |
$614.40
|
| Rate for Payer: Preferred Network Access Commercial |
$942.08
|
| Rate for Payer: Quartz Beloit One Network |
$501.76
|
| Rate for Payer: Quartz Commercial |
$614.40
|
| Rate for Payer: WEA Trust Commercial |
$563.20
|
| Rate for Payer: WPS Commercial |
$758.48
|
|
|
US Birth Center Pregnancy Limited
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6210798
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$177.91 |
| Max. Negotiated Rate |
$972.80 |
| Rate for Payer: Aetna Commercial |
$972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.64
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$972.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$614.40
|
| Rate for Payer: Health EOS Commercial |
$931.84
|
| Rate for Payer: HFN Commercial |
$972.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.91
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: Preferred Network Access Commercial |
$972.80
|
| Rate for Payer: Quartz Beloit One Network |
$450.56
|
| Rate for Payer: Quartz Commercial |
$583.68
|
| Rate for Payer: The Alliance Commercial |
$512.00
|
| Rate for Payer: WEA Trust Commercial |
$563.20
|
| Rate for Payer: WPS Commercial |
$758.48
|
|
|
US Bladder
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
3072736
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Aetna Commercial |
$1,013.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$917.62
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cigna Commercial |
$1,013.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$533.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Health EOS Commercial |
$970.97
|
| Rate for Payer: HFN Commercial |
$1,013.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.58
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,013.65
|
| Rate for Payer: Quartz Beloit One Network |
$469.48
|
| Rate for Payer: Quartz Commercial |
$608.19
|
| Rate for Payer: The Alliance Commercial |
$533.50
|
| Rate for Payer: WEA Trust Commercial |
$586.85
|
| Rate for Payer: WPS Commercial |
$790.33
|
|
|
US Bladder
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
3072736
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$981.64 |
| Rate for Payer: Aetna Commercial |
$960.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$917.62
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$565.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cigna Commercial |
$981.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$597.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$949.63
|
| Rate for Payer: HFN Commercial |
$981.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$981.64
|
| Rate for Payer: Quartz Beloit One Network |
$522.83
|
| Rate for Payer: Quartz Commercial |
$693.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$586.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$790.33
|
|
|
US Bladder
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$522.83 |
| Max. Negotiated Rate |
$981.64 |
| Rate for Payer: Aetna Commercial |
$960.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$917.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$565.51
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cigna Commercial |
$981.64
|
| Rate for Payer: Health EOS Commercial |
$949.63
|
| Rate for Payer: HFN Commercial |
$981.64
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: NAPHCARE Commercial |
$640.20
|
| Rate for Payer: Preferred Network Access Commercial |
$981.64
|
| Rate for Payer: Quartz Beloit One Network |
$522.83
|
| Rate for Payer: Quartz Commercial |
$640.20
|
| Rate for Payer: WEA Trust Commercial |
$586.85
|
| Rate for Payer: WPS Commercial |
$790.33
|
|
|
US Bladder
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2552805
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.00
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$650.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
US Bladder
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$981.64 |
| Rate for Payer: Aetna Commercial |
$960.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$917.62
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$565.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cigna Commercial |
$981.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$597.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$949.63
|
| Rate for Payer: HFN Commercial |
$981.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$981.64
|
| Rate for Payer: Quartz Beloit One Network |
$522.83
|
| Rate for Payer: Quartz Commercial |
$693.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$586.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$790.33
|
|
|
US Bladder
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2552805
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
US Bladder
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
3072736
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$522.83 |
| Max. Negotiated Rate |
$981.64 |
| Rate for Payer: Aetna Commercial |
$960.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$917.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$565.51
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cigna Commercial |
$981.64
|
| Rate for Payer: Health EOS Commercial |
$949.63
|
| Rate for Payer: HFN Commercial |
$981.64
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: NAPHCARE Commercial |
$640.20
|
| Rate for Payer: Preferred Network Access Commercial |
$981.64
|
| Rate for Payer: Quartz Beloit One Network |
$522.83
|
| Rate for Payer: Quartz Commercial |
$640.20
|
| Rate for Payer: WEA Trust Commercial |
$586.85
|
| Rate for Payer: WPS Commercial |
$790.33
|
|
|
US Bladder
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2587082
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$1,013.65 |
| Rate for Payer: Aetna Commercial |
$1,013.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$917.62
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cash Price |
$320.10
|
| Rate for Payer: Cigna Commercial |
$1,013.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$533.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Health EOS Commercial |
$970.97
|
| Rate for Payer: HFN Commercial |
$1,013.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.58
|
| Rate for Payer: Multiplan Commercial |
$853.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,013.65
|
| Rate for Payer: Quartz Beloit One Network |
$469.48
|
| Rate for Payer: Quartz Commercial |
$608.19
|
| Rate for Payer: The Alliance Commercial |
$533.50
|
| Rate for Payer: WEA Trust Commercial |
$586.85
|
| Rate for Payer: WPS Commercial |
$790.33
|
|
|
US Bladder
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
2552805
|
| Min. Negotiated Rate |
$163.62 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$950.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$950.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.00
|
| Rate for Payer: Health EOS Commercial |
$910.00
|
| Rate for Payer: HFN Commercial |
$950.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$163.62
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$950.00
|
| Rate for Payer: Quartz Beloit One Network |
$440.00
|
| Rate for Payer: Quartz Commercial |
$570.00
|
| Rate for Payer: The Alliance Commercial |
$500.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
US Bone Stimulation 20979
|
Professional
|
Both
|
$1,535.00
|
|
|
Service Code
|
CPT 20979
|
| Hospital Charge Code |
3798690
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.58 |
| Max. Negotiated Rate |
$1,458.25 |
| Rate for Payer: Aetna Commercial |
$1,458.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,320.10
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$1,458.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.00
|
| Rate for Payer: Health EOS Commercial |
$1,396.85
|
| Rate for Payer: HFN Commercial |
$1,458.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.16
|
| Rate for Payer: Multiplan Commercial |
$1,228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.25
|
| Rate for Payer: Quartz Beloit One Network |
$675.40
|
| Rate for Payer: Quartz Commercial |
$874.95
|
| Rate for Payer: The Alliance Commercial |
$767.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.58
|
| Rate for Payer: WEA Trust Commercial |
$844.25
|
| Rate for Payer: WPS Commercial |
$1,136.97
|
|
|
US Breast & Axillary Bilateral
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC
|
| Hospital Charge Code |
6196375
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$471.87 |
| Max. Negotiated Rate |
$885.96 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$577.80
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
