|
US Fetal BPP ea add gestation
|
Facility
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6219448
|
|
Hospital Revenue Code
|
402
|
| 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 |
$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 |
$896.76
|
| 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 |
$1,556.64
|
| 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: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US Gallbladder
|
Facility
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$493.64 |
| Max. Negotiated Rate |
$7,052.00 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Aetna Managed Medicare |
$493.64
|
| 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 |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.25
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,145.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.80
|
| Rate for Payer: The Alliance Commercial |
$7,052.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Gallbladder
|
Facility
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$1,379.08 |
| Rate for Payer: Aetna Commercial |
$1,349.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$974.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$749.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$719.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.47
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,379.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,334.11
|
| Rate for Payer: HFN Commercial |
$1,379.08
|
| 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 |
$1,199.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.08
|
| Rate for Payer: Quartz Beloit One Network |
$734.51
|
| Rate for Payer: Quartz Commercial |
$974.35
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$13.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Gallbladder
|
Professional
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$85.23 |
| Max. Negotiated Rate |
$1,424.05 |
| Rate for Payer: Aetna Commercial |
$1,424.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,289.14
|
| Rate for Payer: Aetna Managed Medicare |
$85.23
|
| Rate for Payer: Anthem Medicare Advantage |
$85.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.23
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,424.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$749.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.23
|
| Rate for Payer: Health EOS Commercial |
$1,364.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.23
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,424.05
|
| Rate for Payer: Quartz Beloit One Network |
$659.56
|
| Rate for Payer: Quartz Commercial |
$854.43
|
| Rate for Payer: Quartz Medicare Advantage |
$85.23
|
| Rate for Payer: The Alliance Commercial |
$323.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.23
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$426.15
|
|
|
US Gallbladder
|
Professional
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$1,674.85 |
| Rate for Payer: Aetna Commercial |
$1,674.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.18
|
| Rate for Payer: Aetna Managed Medicare |
$58.05
|
| Rate for Payer: Anthem Medicare Advantage |
$58.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.05
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,674.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$881.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.05
|
| Rate for Payer: Health EOS Commercial |
$1,604.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.05
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,674.85
|
| Rate for Payer: Quartz Beloit One Network |
$775.72
|
| Rate for Payer: Quartz Commercial |
$1,004.91
|
| Rate for Payer: Quartz Medicare Advantage |
$58.05
|
| Rate for Payer: The Alliance Commercial |
$220.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.05
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$290.25
|
|
|
US Gallbladder
|
Facility
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$863.87 |
| Max. Negotiated Rate |
$1,621.96 |
| Rate for Payer: Aetna Commercial |
$1,586.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.39
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,621.96
|
| Rate for Payer: Health EOS Commercial |
$1,569.07
|
| Rate for Payer: HFN Commercial |
$1,621.96
|
| Rate for Payer: Multiplan Commercial |
$1,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.96
|
| Rate for Payer: Quartz Beloit One Network |
$863.87
|
| Rate for Payer: Quartz Commercial |
$1,057.80
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Gallbladder
|
Facility
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$734.51 |
| Max. Negotiated Rate |
$1,379.08 |
| Rate for Payer: Aetna Commercial |
$1,349.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$794.47
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,379.08
|
| Rate for Payer: Health EOS Commercial |
$1,334.11
|
| Rate for Payer: HFN Commercial |
$1,379.08
|
| Rate for Payer: Multiplan Commercial |
$1,199.20
|
| Rate for Payer: NAPHCARE Commercial |
$899.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,379.08
|
| Rate for Payer: Quartz Beloit One Network |
$734.51
|
| Rate for Payer: Quartz Commercial |
$899.40
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
|
US Guidance Needle Placement
|
Facility
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
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 Guidance Needle Placement
|
Professional
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$26.83 |
| 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: Aetna Managed Medicare |
$26.83
|
| Rate for Payer: Anthem Medicare Advantage |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.83
|
| 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 |
$26.83
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.83
|
| 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: Quartz Medicare Advantage |
$26.83
|
| Rate for Payer: The Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$134.15
|
|
|
US Guidance Needle Placement
|
Facility
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
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 Guided Amniocentesis
|
Professional
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$31.76 |
| 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: Aetna Managed Medicare |
$31.76
|
| Rate for Payer: Anthem Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.76
|
| 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 |
$31.76
|
| Rate for Payer: Health EOS Commercial |
$1,166.62
|
| 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: Independent Care Health Plan Medicare |
$31.76
|
| 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: Quartz Medicare Advantage |
$31.76
|
| Rate for Payer: The Alliance Commercial |
$120.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.76
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$158.80
|
|
|
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 |
$2,191.20 |
| 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: 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 |
$2,191.20
|
| 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
|
Facility
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$2,191.20 |
| 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: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| 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 |
$2,191.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
US Guided Amniocentesis
|
Facility
IP
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$653.17 |
| Max. Negotiated Rate |
$1,226.36 |
| Rate for Payer: Aetna Commercial |
$1,199.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.49
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,226.36
|
| Rate for Payer: Health EOS Commercial |
$1,186.37
|
| Rate for Payer: HFN Commercial |
$1,226.36
|
| 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 |
$799.80
|
| Rate for Payer: WEA Trust Commercial |
$733.15
|
| Rate for Payer: WPS Commercial |
$987.35
|
|
|
US Guided Amniocentesis
|
Facility
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$1,179.44 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| 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: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| 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 |
$769.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
US Guided Amniocentesis
|
Professional
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.76 |
| 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: Aetna Managed Medicare |
$31.76
|
| Rate for Payer: Anthem Medicare Advantage |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.76
|
| 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 |
$31.76
|
| Rate for Payer: Health EOS Commercial |
$1,213.03
|
| 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: Independent Care Health Plan Medicare |
$31.76
|
| 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: Quartz Medicare Advantage |
$31.76
|
| Rate for Payer: The Alliance Commercial |
$120.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.76
|
| Rate for Payer: WEA Trust Commercial |
$733.15
|
| Rate for Payer: WPS Commercial |
$158.80
|
|
|
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: 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
|
Professional
|
$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: 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: 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
|
Professional
|
$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: 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: 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
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$428.96 |
| 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: 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: 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: 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 |
$763.60
|
| 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 |
$1,833.56 |
| 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: 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 |
$763.60
|
| 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: 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 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: 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
OP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$885.96 |
| 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: 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 |
$3.68
|
| 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
|
Professional
|
$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: 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: 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
|
|
