|
US Biopsy Renal Left
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631306
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,760.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$926.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.07
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.35
|
| Rate for Payer: Quartz Beloit One Network |
$815.32
|
| Rate for Payer: Quartz Commercial |
$1,056.21
|
| Rate for Payer: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Biopsy Renal Left
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$7,708.00 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Left
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631306
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$518.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,204.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$926.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,389.75
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,204.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,111.80
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Renal Right
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$7,708.00 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Right
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980120
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$944.23 |
| Max. Negotiated Rate |
$1,772.84 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,156.20
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Right
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980120
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$7,708.00 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Aetna Managed Medicare |
$539.56
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.25
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,252.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.20
|
| Rate for Payer: The Alliance Commercial |
$7,708.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Right
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$944.23 |
| Max. Negotiated Rate |
$1,772.84 |
| Rate for Payer: Aetna Commercial |
$1,734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.31
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,772.84
|
| Rate for Payer: Health EOS Commercial |
$1,715.03
|
| Rate for Payer: HFN Commercial |
$1,772.84
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.84
|
| Rate for Payer: Quartz Beloit One Network |
$944.23
|
| Rate for Payer: Quartz Commercial |
$1,156.20
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Right
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$847.88 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna Commercial |
$1,830.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,830.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,156.20
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.65
|
| Rate for Payer: Quartz Beloit One Network |
$847.88
|
| Rate for Payer: Quartz Commercial |
$1,098.39
|
| Rate for Payer: The Alliance Commercial |
$963.50
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Right
|
Professional
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631291
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Aetna Commercial |
$1,760.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$56.07
|
| Rate for Payer: Anthem Medicare Advantage |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.07
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,760.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$926.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.07
|
| Rate for Payer: Health EOS Commercial |
$1,686.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$196.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.07
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,760.35
|
| Rate for Payer: Quartz Beloit One Network |
$815.32
|
| Rate for Payer: Quartz Commercial |
$1,056.21
|
| Rate for Payer: Quartz Medicare Advantage |
$56.07
|
| Rate for Payer: The Alliance Commercial |
$213.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.07
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$280.35
|
|
|
US Biopsy Renal Right
|
Facility
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631291
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,593.58
|
| Rate for Payer: Aetna Managed Medicare |
$518.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,204.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$926.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,389.75
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,204.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,111.80
|
| Rate for Payer: The Alliance Commercial |
$3.68
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Biopsy Renal Right
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980120
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$847.88 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna Commercial |
$1,830.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,830.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,156.20
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.65
|
| Rate for Payer: Quartz Beloit One Network |
$847.88
|
| Rate for Payer: Quartz Commercial |
$1,098.39
|
| Rate for Payer: The Alliance Commercial |
$963.50
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
US Biopsy Renal Right
|
Facility
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631291
|
| Min. Negotiated Rate |
$907.97 |
| Max. Negotiated Rate |
$1,704.76 |
| Rate for Payer: Aetna Commercial |
$1,667.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.09
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,704.76
|
| Rate for Payer: Health EOS Commercial |
$1,649.17
|
| Rate for Payer: HFN Commercial |
$1,704.76
|
| Rate for Payer: Multiplan Commercial |
$1,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,111.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,704.76
|
| Rate for Payer: Quartz Beloit One Network |
$907.97
|
| Rate for Payer: Quartz Commercial |
$1,111.80
|
| Rate for Payer: WEA Trust Commercial |
$1,019.15
|
| Rate for Payer: WPS Commercial |
$1,372.52
|
|
|
US Birth Center Fetal BPP w/o NST
|
Facility
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US Birth Center Fetal BPP w/o NST
|
Professional
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$46.14 |
| 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: Aetna Managed Medicare |
$46.14
|
| Rate for Payer: Anthem Medicare Advantage |
$46.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.14
|
| 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 |
$46.14
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| 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: Independent Care Health Plan Medicare |
$46.14
|
| 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: Quartz Medicare Advantage |
$46.14
|
| Rate for Payer: The Alliance Commercial |
$175.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.14
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$230.70
|
|
|
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 |
$473.76 |
| Max. Negotiated Rate |
$6,768.00 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$473.76
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| 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: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| 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 |
$1,015.20
|
| Rate for Payer: The Alliance Commercial |
$6,768.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
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: 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 1st Trimester
|
Facility
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$7,384.00 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| 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: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| 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 |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$7,384.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Birth Center Pregnancy 1st Trimester
|
Professional
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$68.68 |
| 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: Aetna Managed Medicare |
$68.68
|
| Rate for Payer: Anthem Medicare Advantage |
$68.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.68
|
| 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 |
$68.68
|
| Rate for Payer: Health EOS Commercial |
$1,679.86
|
| 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: Independent Care Health Plan Medicare |
$68.68
|
| 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: Quartz Medicare Advantage |
$68.68
|
| Rate for Payer: The Alliance Commercial |
$260.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.68
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$343.40
|
|
|
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 |
$516.88 |
| Max. Negotiated Rate |
$7,384.00 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| 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: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| 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 |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$7,384.00
|
| 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
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$85.52 |
| 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: Aetna Managed Medicare |
$85.52
|
| Rate for Payer: Anthem Medicare Advantage |
$85.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.52
|
| 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 |
$85.52
|
| Rate for Payer: Health EOS Commercial |
$1,679.86
|
| 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: Independent Care Health Plan Medicare |
$85.52
|
| 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: Quartz Medicare Advantage |
$85.52
|
| Rate for Payer: The Alliance Commercial |
$324.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.52
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$427.60
|
|
|
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: 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 Follow Up
|
Professional
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6210795
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$67.07 |
| 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: Aetna Managed Medicare |
$67.07
|
| Rate for Payer: Anthem Medicare Advantage |
$67.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.07
|
| 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 |
$67.07
|
| Rate for Payer: Health EOS Commercial |
$1,203.02
|
| 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: Independent Care Health Plan Medicare |
$67.07
|
| 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: Quartz Medicare Advantage |
$67.07
|
| Rate for Payer: The Alliance Commercial |
$254.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.07
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$335.35
|
|
|
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: 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 |
$370.16 |
| Max. Negotiated Rate |
$5,288.00 |
| Rate for Payer: Aetna Commercial |
$1,189.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Aetna Managed Medicare |
$370.16
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.66
|
| 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: Health EOS Commercial |
$1,176.58
|
| Rate for Payer: HFN Commercial |
$1,216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.50
|
| 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 |
$859.30
|
| Rate for Payer: Quartz Medicare Advantage |
$793.20
|
| Rate for Payer: The Alliance Commercial |
$5,288.00
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
US Birth Center Pregnancy Limited
|
Professional
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6210798
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$48.72 |
| Max. Negotiated Rate |
$972.80 |
| Rate for Payer: Aetna Commercial |
$972.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.64
|
| Rate for Payer: Aetna Managed Medicare |
$48.72
|
| Rate for Payer: Anthem Medicare Advantage |
$48.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.72
|
| 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 |
$48.72
|
| Rate for Payer: Health EOS Commercial |
$931.84
|
| 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: Independent Care Health Plan Medicare |
$48.72
|
| 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: Quartz Medicare Advantage |
$48.72
|
| Rate for Payer: The Alliance Commercial |
$185.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.72
|
| Rate for Payer: WEA Trust Commercial |
$563.20
|
| Rate for Payer: WPS Commercial |
$243.60
|
|
