|
US Extremity Non-Vascular Right
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631091
|
| Min. Negotiated Rate |
$53.74 |
| Max. Negotiated Rate |
$922.79 |
| Rate for Payer: Aetna Commercial |
$922.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.37
|
| Rate for Payer: Aetna Managed Medicare |
$53.74
|
| Rate for Payer: Anthem Medicare Advantage |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.74
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$922.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$485.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.74
|
| Rate for Payer: Health EOS Commercial |
$883.94
|
| Rate for Payer: HFN Commercial |
$922.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.74
|
| Rate for Payer: Multiplan Commercial |
$777.09
|
| Rate for Payer: NAPHCARE Commercial |
$80.61
|
| Rate for Payer: Preferred Network Access Commercial |
$922.79
|
| Rate for Payer: Quartz Beloit One Network |
$427.40
|
| Rate for Payer: Quartz Commercial |
$553.68
|
| Rate for Payer: Quartz Medicare Advantage |
$53.74
|
| Rate for Payer: The Alliance Commercial |
$204.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.74
|
| Rate for Payer: WEA Trust Commercial |
$534.25
|
| Rate for Payer: WPS Commercial |
$268.68
|
|
|
US Extremity Non-Vascular Right
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544856
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$494.82 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$605.90
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
US Extremity Non-Vascular Right
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544856
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$282.76 |
| Max. Negotiated Rate |
$929.05 |
| Rate for Payer: Aetna Commercial |
$908.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Aetna Managed Medicare |
$282.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.22
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$929.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.12
|
| Rate for Payer: Health EOS Commercial |
$898.76
|
| Rate for Payer: HFN Commercial |
$929.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.38
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: NAPHCARE Commercial |
$605.90
|
| Rate for Payer: Preferred Network Access Commercial |
$929.05
|
| Rate for Payer: Quartz Beloit One Network |
$494.82
|
| Rate for Payer: Quartz Commercial |
$656.40
|
| Rate for Payer: Quartz Medicare Advantage |
$605.90
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
US Extremity Non-Vascular Right
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544856
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$236.32 |
| Max. Negotiated Rate |
$959.35 |
| Rate for Payer: Aetna Commercial |
$959.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$868.46
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$959.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$504.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.90
|
| Rate for Payer: Health EOS Commercial |
$918.95
|
| Rate for Payer: HFN Commercial |
$959.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.32
|
| Rate for Payer: Multiplan Commercial |
$807.87
|
| Rate for Payer: Preferred Network Access Commercial |
$959.35
|
| Rate for Payer: Quartz Beloit One Network |
$444.33
|
| Rate for Payer: Quartz Commercial |
$575.61
|
| Rate for Payer: The Alliance Commercial |
$504.92
|
| Rate for Payer: WEA Trust Commercial |
$555.41
|
| Rate for Payer: WPS Commercial |
$747.96
|
|
|
US Fetal Biophysical Profile w/ Non-St
|
Facility
|
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
631102
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,499.31 |
| Rate for Payer: Aetna Commercial |
$1,466.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.52
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.25
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cigna Commercial |
$1,499.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,450.42
|
| Rate for Payer: HFN Commercial |
$1,499.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,303.74
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.31
|
| Rate for Payer: Quartz Beloit One Network |
$798.54
|
| Rate for Payer: Quartz Commercial |
$1,059.29
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$896.32
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,207.06
|
|
|
US Fetal Biophysical Profile w/ Non-St
|
Professional
|
Both
|
$1,567.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
631102
|
| Min. Negotiated Rate |
$121.37 |
| Max. Negotiated Rate |
$1,548.20 |
| Rate for Payer: Aetna Commercial |
$1,548.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.52
|
| Rate for Payer: Aetna Managed Medicare |
$121.37
|
| Rate for Payer: Anthem Medicare Advantage |
$121.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.37
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cigna Commercial |
$1,548.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$814.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.37
|
| Rate for Payer: Health EOS Commercial |
$1,483.01
|
| Rate for Payer: HFN Commercial |
$1,548.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$415.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.37
|
| Rate for Payer: Multiplan Commercial |
$1,303.74
|
| Rate for Payer: NAPHCARE Commercial |
$182.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,548.20
|
| Rate for Payer: Quartz Beloit One Network |
$717.06
|
| Rate for Payer: Quartz Commercial |
$928.92
|
| Rate for Payer: Quartz Medicare Advantage |
$121.37
|
| Rate for Payer: The Alliance Commercial |
$461.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.37
|
| Rate for Payer: WEA Trust Commercial |
$896.32
|
| Rate for Payer: WPS Commercial |
$606.84
|
|
|
US Fetal Biophysical Profile w/ Non-St
|
Facility
|
IP
|
$1,567.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
631102
|
| Min. Negotiated Rate |
$798.54 |
| Max. Negotiated Rate |
$1,499.31 |
| Rate for Payer: Aetna Commercial |
$1,466.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.73
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cigna Commercial |
$1,499.31
|
| Rate for Payer: Health EOS Commercial |
$1,450.42
|
| Rate for Payer: HFN Commercial |
$1,499.31
|
| Rate for Payer: Multiplan Commercial |
$1,303.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.31
|
| Rate for Payer: Quartz Beloit One Network |
$798.54
|
| Rate for Payer: Quartz Commercial |
$977.81
|
| Rate for Payer: WEA Trust Commercial |
$896.32
|
| Rate for Payer: WPS Commercial |
$1,207.06
|
|
|
US Fetal Biophysical Profile w/ Non-Str
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
2544857
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.38 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| 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 |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$284.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal Biophysical Profile w/ Non-Str
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
2544857
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal Biophysical Profile w/ Non-Str
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
2544857
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.09 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$71.09
|
| Rate for Payer: Anthem Medicare Advantage |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.09
|
| 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 |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.09
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.09
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$106.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$71.09
|
| Rate for Payer: The Alliance Commercial |
$270.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.09
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$355.47
|
|
|
US Fetal Biophysical Profile w/o NST
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6196438
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal Biophysical Profile w/o NST
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6196438
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.38 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| 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 |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$284.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal Biophysical Profile w/o NST
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6196438
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.09 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$71.09
|
| Rate for Payer: Anthem Medicare Advantage |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.09
|
| 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 |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.09
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.09
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$106.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$71.09
|
| Rate for Payer: The Alliance Commercial |
$270.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.09
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$355.47
|
|
|
US Fetal Biophysical Profile w/o N-Str
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
2544859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.84 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| 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 |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$201.84
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal Biophysical Profile w/o N-Str
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
2544859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$50.46
|
| Rate for Payer: Anthem Medicare Advantage |
$50.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.46
|
| 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 |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.46
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.46
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$75.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$50.46
|
| Rate for Payer: The Alliance Commercial |
$191.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.46
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$252.30
|
|
|
US Fetal Biophysical Profile w/o N-Str
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
2544859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
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 |
$284.38 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| 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 |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$284.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal BPP ea add gestation
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6219448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.09 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$71.09
|
| Rate for Payer: Anthem Medicare Advantage |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.09
|
| 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 |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.09
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.09
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$106.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$71.09
|
| Rate for Payer: The Alliance Commercial |
$270.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.09
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$355.47
|
|
|
US Fetal BPP ea add gestation
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6219448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Gallbladder
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Gallbladder
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| 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 |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Gallbladder
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| 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 |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Gallbladder
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Gallbladder
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Gallbladder
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
