|
US Guided Amniocentesis
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.34 |
| Max. Negotiated Rate |
$1,266.35 |
| Rate for Payer: Aetna Commercial |
$1,266.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.38
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,266.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$666.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.80
|
| Rate for Payer: Health EOS Commercial |
$1,213.03
|
| Rate for Payer: HFN Commercial |
$1,266.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.34
|
| Rate for Payer: Multiplan Commercial |
$1,066.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,266.35
|
| Rate for Payer: Quartz Beloit One Network |
$586.52
|
| Rate for Payer: Quartz Commercial |
$759.81
|
| Rate for Payer: The Alliance Commercial |
$666.50
|
| Rate for Payer: WEA Trust Commercial |
$733.15
|
| Rate for Payer: WPS Commercial |
$987.35
|
|
|
US Guided Amniocentesis
|
Facility
|
OP
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$373.24 |
| Max. Negotiated Rate |
$5,332.00 |
| Rate for Payer: Aetna Commercial |
$1,199.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.38
|
| Rate for Payer: Aetna Managed Medicare |
$373.24
|
| 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 |
$706.49
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,226.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$745.95
|
| Rate for Payer: Health EOS Commercial |
$1,186.37
|
| Rate for Payer: HFN Commercial |
$1,226.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.75
|
| Rate for Payer: Multiplan Commercial |
$1,066.40
|
| Rate for Payer: NAPHCARE Commercial |
$799.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.36
|
| Rate for Payer: Quartz Beloit One Network |
$653.17
|
| Rate for Payer: Quartz Commercial |
$866.45
|
| Rate for Payer: Quartz Medicare Advantage |
$799.80
|
| Rate for Payer: The Alliance Commercial |
$5,332.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$733.15
|
| Rate for Payer: WPS Commercial |
$987.35
|
|
|
US Guided Amniocentesis
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$111.34 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Aetna Commercial |
$1,217.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,217.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$641.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.20
|
| Rate for Payer: Health EOS Commercial |
$1,166.62
|
| Rate for Payer: HFN Commercial |
$1,217.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.34
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,217.90
|
| Rate for Payer: Quartz Beloit One Network |
$564.08
|
| Rate for Payer: Quartz Commercial |
$730.74
|
| Rate for Payer: The Alliance Commercial |
$641.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
US Guided Amniocentesis
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,128.00 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Aetna Managed Medicare |
$358.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.41
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.50
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$833.30
|
| Rate for Payer: Quartz Medicare Advantage |
$769.20
|
| Rate for Payer: The Alliance Commercial |
$5,128.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
US Guided Intraoperative
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$428.96 |
| Max. Negotiated Rate |
$6,128.00 |
| Rate for Payer: Aetna Commercial |
$1,378.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,317.52
|
| Rate for Payer: Aetna Managed Medicare |
$428.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$766.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$735.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.96
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,409.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$857.31
|
| Rate for Payer: Health EOS Commercial |
$1,363.48
|
| Rate for Payer: HFN Commercial |
$1,409.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,149.00
|
| Rate for Payer: Multiplan Commercial |
$1,225.60
|
| Rate for Payer: NAPHCARE Commercial |
$919.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,409.44
|
| Rate for Payer: Quartz Beloit One Network |
$750.68
|
| Rate for Payer: Quartz Commercial |
$995.80
|
| Rate for Payer: Quartz Medicare Advantage |
$919.20
|
| Rate for Payer: The Alliance Commercial |
$6,128.00
|
| Rate for Payer: WEA Trust Commercial |
$842.60
|
| Rate for Payer: WPS Commercial |
$1,134.75
|
|
|
US Guided Intraoperative
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$379.69 |
| Max. Negotiated Rate |
$1,893.35 |
| Rate for Payer: Aetna Commercial |
$1,893.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,713.98
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,893.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$996.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,195.80
|
| Rate for Payer: Health EOS Commercial |
$1,813.63
|
| Rate for Payer: HFN Commercial |
$1,893.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.69
|
| Rate for Payer: Multiplan Commercial |
$1,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,893.35
|
| Rate for Payer: Quartz Beloit One Network |
$876.92
|
| Rate for Payer: Quartz Commercial |
$1,136.01
|
| Rate for Payer: The Alliance Commercial |
$996.50
|
| Rate for Payer: WEA Trust Commercial |
$1,096.15
|
| Rate for Payer: WPS Commercial |
$1,476.22
|
|
|
US Guided Intraoperative
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$750.68 |
| Max. Negotiated Rate |
$1,409.44 |
| Rate for Payer: Aetna Commercial |
$1,378.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,317.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.96
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,409.44
|
| Rate for Payer: Health EOS Commercial |
$1,363.48
|
| Rate for Payer: HFN Commercial |
$1,409.44
|
| Rate for Payer: Multiplan Commercial |
$1,225.60
|
| Rate for Payer: NAPHCARE Commercial |
$919.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,409.44
|
| Rate for Payer: Quartz Beloit One Network |
$750.68
|
| Rate for Payer: Quartz Commercial |
$919.20
|
| Rate for Payer: WEA Trust Commercial |
$842.60
|
| Rate for Payer: WPS Commercial |
$1,134.75
|
|
|
US Guided Intraoperative
|
Facility
|
OP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$558.04 |
| Max. Negotiated Rate |
$7,972.00 |
| Rate for Payer: Aetna Commercial |
$1,793.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,713.98
|
| Rate for Payer: Aetna Managed Medicare |
$558.04
|
| 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 |
$1,056.29
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,833.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.28
|
| Rate for Payer: Health EOS Commercial |
$1,773.77
|
| Rate for Payer: HFN Commercial |
$1,833.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,494.75
|
| Rate for Payer: Multiplan Commercial |
$1,594.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,195.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,833.56
|
| Rate for Payer: Quartz Beloit One Network |
$976.57
|
| Rate for Payer: Quartz Commercial |
$1,295.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,195.80
|
| Rate for Payer: The Alliance Commercial |
$7,972.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,096.15
|
| Rate for Payer: WPS Commercial |
$1,476.22
|
|
|
US Guided Intraoperative
|
Facility
|
IP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$976.57 |
| Max. Negotiated Rate |
$1,833.56 |
| Rate for Payer: Aetna Commercial |
$1,793.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,713.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.29
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,833.56
|
| Rate for Payer: Health EOS Commercial |
$1,773.77
|
| Rate for Payer: HFN Commercial |
$1,833.56
|
| Rate for Payer: Multiplan Commercial |
$1,594.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,195.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,833.56
|
| Rate for Payer: Quartz Beloit One Network |
$976.57
|
| Rate for Payer: Quartz Commercial |
$1,195.80
|
| Rate for Payer: WEA Trust Commercial |
$1,096.15
|
| Rate for Payer: WPS Commercial |
$1,476.22
|
|
|
US Guided Intraoperative
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$379.69 |
| Max. Negotiated Rate |
$1,455.40 |
| Rate for Payer: Aetna Commercial |
$1,455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,317.52
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,455.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$766.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.20
|
| Rate for Payer: Health EOS Commercial |
$1,394.12
|
| Rate for Payer: HFN Commercial |
$1,455.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.69
|
| Rate for Payer: Multiplan Commercial |
$1,225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,455.40
|
| Rate for Payer: Quartz Beloit One Network |
$674.08
|
| Rate for Payer: Quartz Commercial |
$873.24
|
| Rate for Payer: The Alliance Commercial |
$766.00
|
| Rate for Payer: WEA Trust Commercial |
$842.60
|
| Rate for Payer: WPS Commercial |
$1,134.75
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$269.64 |
| Max. Negotiated Rate |
$3,852.00 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Aetna Managed Medicare |
$269.64
|
| 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 |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.89
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.25
|
| 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 |
$625.95
|
| Rate for Payer: Quartz Medicare Advantage |
$577.80
|
| Rate for Payer: The Alliance Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
OP
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$446.04 |
| Max. Negotiated Rate |
$6,372.00 |
| Rate for Payer: Aetna Commercial |
$1,433.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.98
|
| Rate for Payer: Aetna Managed Medicare |
$446.04
|
| 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 |
$844.29
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,465.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.44
|
| Rate for Payer: Health EOS Commercial |
$1,417.77
|
| Rate for Payer: HFN Commercial |
$1,465.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.75
|
| Rate for Payer: Multiplan Commercial |
$1,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$955.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.56
|
| Rate for Payer: Quartz Beloit One Network |
$780.57
|
| Rate for Payer: Quartz Commercial |
$1,035.45
|
| Rate for Payer: Quartz Medicare Advantage |
$955.80
|
| Rate for Payer: The Alliance Commercial |
$6,372.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
IP
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$780.57 |
| Max. Negotiated Rate |
$1,465.56 |
| Rate for Payer: Aetna Commercial |
$1,433.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.29
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,465.56
|
| Rate for Payer: Health EOS Commercial |
$1,417.77
|
| Rate for Payer: HFN Commercial |
$1,465.56
|
| Rate for Payer: Multiplan Commercial |
$1,274.40
|
| Rate for Payer: NAPHCARE Commercial |
$955.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.56
|
| Rate for Payer: Quartz Beloit One Network |
$780.57
|
| Rate for Payer: Quartz Commercial |
$955.80
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
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
|
|
|
US Guided Intraoperative Prostate
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
CPT 76998 TC
|
| Hospital Charge Code |
3072699
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.81 |
| Max. Negotiated Rate |
$1,513.35 |
| Rate for Payer: Aetna Commercial |
$1,513.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.98
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,513.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$796.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,449.63
|
| Rate for Payer: HFN Commercial |
$1,513.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.81
|
| Rate for Payer: Multiplan Commercial |
$1,274.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,513.35
|
| Rate for Payer: Quartz Beloit One Network |
$700.92
|
| Rate for Payer: Quartz Commercial |
$908.01
|
| Rate for Payer: The Alliance Commercial |
$796.50
|
| Rate for Payer: WEA Trust Commercial |
$876.15
|
| Rate for Payer: WPS Commercial |
$1,179.94
|
|
|
US Guided Marker Placement
|
Facility
|
IP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
US Guided Marker Placement
|
Professional
|
Both
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$254.76 |
| Max. Negotiated Rate |
$550.05 |
| Rate for Payer: Aetna Commercial |
$550.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$550.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.40
|
| Rate for Payer: Health EOS Commercial |
$526.89
|
| Rate for Payer: HFN Commercial |
$550.05
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$550.05
|
| Rate for Payer: Quartz Beloit One Network |
$254.76
|
| Rate for Payer: Quartz Commercial |
$330.03
|
| Rate for Payer: The Alliance Commercial |
$289.50
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
US Guided Marker Placement
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$65.03 |
| Max. Negotiated Rate |
$572.85 |
| Rate for Payer: Aetna Commercial |
$572.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$572.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.80
|
| Rate for Payer: Health EOS Commercial |
$548.73
|
| Rate for Payer: HFN Commercial |
$572.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.81
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: Preferred Network Access Commercial |
$572.85
|
| Rate for Payer: Quartz Beloit One Network |
$265.32
|
| Rate for Payer: Quartz Commercial |
$343.71
|
| Rate for Payer: The Alliance Commercial |
$301.50
|
| Rate for Payer: United Healthcare Medicaid |
$65.03
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
US Guided Marker Placement
|
Facility
|
OP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
US Guided Marker Placement
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$554.76 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$361.80
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
US Guided Marker Placement
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| 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 |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$391.95
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
US Guided Marker Placement ea add
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.20
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: HFN Commercial |
$571.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.95
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: The Alliance Commercial |
$301.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.89
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
US Guided Marker Placement ea add
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125681
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| 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 |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
US Guided Marker Placement ea add
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$139.16 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.16
|
| 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 |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.75
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$298.20
|
| Rate for Payer: The Alliance Commercial |
$1,988.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
US Guided Marker Placement ea add
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
4125680
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
