|
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 |
$982.00 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,202.45
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guidance Needle Placement
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| 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 |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
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 |
$129.54 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$561.14
|
| 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 |
$1,062.16
|
| 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 |
$1,843.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,121.51
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.06
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,202.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,302.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,202.45
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guided Amniocentesis
|
Facility
|
OP
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$1,275.41 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.24
|
| Rate for Payer: Aetna Managed Medicare |
$388.17
|
| 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 |
$734.75
|
| 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 |
$1,275.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.81
|
| Rate for Payer: Health EOS Commercial |
$1,233.82
|
| Rate for Payer: HFN Commercial |
$1,275.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,039.74
|
| Rate for Payer: Multiplan Commercial |
$1,109.06
|
| Rate for Payer: NAPHCARE Commercial |
$831.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,275.41
|
| Rate for Payer: Quartz Beloit One Network |
$679.30
|
| Rate for Payer: Quartz Commercial |
$901.11
|
| Rate for Payer: Quartz Medicare Advantage |
$831.79
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$762.48
|
| Rate for Payer: WPS Commercial |
$1,026.81
|
|
|
US Guided Amniocentesis
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna Commercial |
$1,317.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.81
|
| Rate for Payer: Anthem Medicare Advantage |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.81
|
| 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 |
$1,317.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$693.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.81
|
| Rate for Payer: Health EOS Commercial |
$1,261.55
|
| Rate for Payer: HFN Commercial |
$1,317.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$1,109.06
|
| Rate for Payer: NAPHCARE Commercial |
$50.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.00
|
| Rate for Payer: Quartz Beloit One Network |
$609.98
|
| Rate for Payer: Quartz Commercial |
$790.20
|
| Rate for Payer: Quartz Medicare Advantage |
$33.81
|
| Rate for Payer: The Alliance Commercial |
$128.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.81
|
| Rate for Payer: WEA Trust Commercial |
$762.48
|
| Rate for Payer: WPS Commercial |
$169.05
|
|
|
US Guided Amniocentesis
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$1,266.62 |
| Rate for Payer: Aetna Commercial |
$1,266.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$33.81
|
| Rate for Payer: Anthem Medicare Advantage |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.81
|
| 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 |
$1,266.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$666.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.81
|
| Rate for Payer: Health EOS Commercial |
$1,213.28
|
| Rate for Payer: HFN Commercial |
$1,266.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$50.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,266.62
|
| Rate for Payer: Quartz Beloit One Network |
$586.64
|
| Rate for Payer: Quartz Commercial |
$759.97
|
| Rate for Payer: Quartz Medicare Advantage |
$33.81
|
| Rate for Payer: The Alliance Commercial |
$128.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.81
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$169.05
|
|
|
US Guided Amniocentesis
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$653.31 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$799.97
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
US Guided Amniocentesis
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$373.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$866.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.96
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$799.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$866.63
|
| Rate for Payer: Quartz Medicare Advantage |
$799.97
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
US Guided Amniocentesis
|
Facility
|
IP
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$679.30 |
| Max. Negotiated Rate |
$1,275.41 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.75
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,275.41
|
| Rate for Payer: Health EOS Commercial |
$1,233.82
|
| Rate for Payer: HFN Commercial |
$1,275.41
|
| Rate for Payer: Multiplan Commercial |
$1,109.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,275.41
|
| Rate for Payer: Quartz Beloit One Network |
$679.30
|
| Rate for Payer: Quartz Commercial |
$831.79
|
| Rate for Payer: WEA Trust Commercial |
$762.48
|
| Rate for Payer: WPS Commercial |
$1,026.81
|
|
|
US Guided Intraoperative
|
Facility
|
OP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$580.36 |
| Max. Negotiated Rate |
$1,906.90 |
| Rate for Payer: Aetna Commercial |
$1,865.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,782.54
|
| Rate for Payer: Aetna Managed Medicare |
$580.36
|
| 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 |
$1,098.54
|
| 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 |
$1,906.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,159.93
|
| Rate for Payer: Health EOS Commercial |
$1,844.72
|
| Rate for Payer: HFN Commercial |
$1,906.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,554.54
|
| Rate for Payer: Multiplan Commercial |
$1,658.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,243.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,906.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,015.63
|
| Rate for Payer: Quartz Commercial |
$1,347.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,243.63
|
| Rate for Payer: The Alliance Commercial |
$1,036.36
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,140.00
|
| Rate for Payer: WPS Commercial |
$1,535.21
|
|
|
US Guided Intraoperative
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$780.71 |
| Max. Negotiated Rate |
$1,465.82 |
| Rate for Payer: Aetna Commercial |
$1,433.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,370.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.44
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,465.82
|
| Rate for Payer: Health EOS Commercial |
$1,418.02
|
| Rate for Payer: HFN Commercial |
$1,465.82
|
| Rate for Payer: Multiplan Commercial |
$1,274.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.82
|
| Rate for Payer: Quartz Beloit One Network |
$780.71
|
| Rate for Payer: Quartz Commercial |
$955.97
|
| Rate for Payer: WEA Trust Commercial |
$876.30
|
| Rate for Payer: WPS Commercial |
$1,180.10
|
|
|
US Guided Intraoperative
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$394.88 |
| Max. Negotiated Rate |
$1,513.62 |
| Rate for Payer: Aetna Commercial |
$1,513.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,370.22
|
| 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 |
$1,513.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$796.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.97
|
| Rate for Payer: Health EOS Commercial |
$1,449.88
|
| Rate for Payer: HFN Commercial |
$1,513.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.88
|
| Rate for Payer: Multiplan Commercial |
$1,274.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,513.62
|
| Rate for Payer: Quartz Beloit One Network |
$701.04
|
| Rate for Payer: Quartz Commercial |
$908.17
|
| Rate for Payer: The Alliance Commercial |
$796.64
|
| Rate for Payer: WEA Trust Commercial |
$876.30
|
| Rate for Payer: WPS Commercial |
$1,180.10
|
|
|
US Guided Intraoperative
|
Facility
|
IP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,015.63 |
| Max. Negotiated Rate |
$1,906.90 |
| Rate for Payer: Aetna Commercial |
$1,865.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,782.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,098.54
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,906.90
|
| Rate for Payer: Health EOS Commercial |
$1,844.72
|
| Rate for Payer: HFN Commercial |
$1,906.90
|
| Rate for Payer: Multiplan Commercial |
$1,658.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,906.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,015.63
|
| Rate for Payer: Quartz Commercial |
$1,243.63
|
| Rate for Payer: WEA Trust Commercial |
$1,140.00
|
| Rate for Payer: WPS Commercial |
$1,535.21
|
|
|
US Guided Intraoperative
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$394.88 |
| Max. Negotiated Rate |
$1,969.08 |
| Rate for Payer: Aetna Commercial |
$1,969.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,782.54
|
| 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 |
$1,969.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,036.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,243.63
|
| Rate for Payer: Health EOS Commercial |
$1,886.18
|
| Rate for Payer: HFN Commercial |
$1,969.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.88
|
| Rate for Payer: Multiplan Commercial |
$1,658.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,969.08
|
| Rate for Payer: Quartz Beloit One Network |
$912.00
|
| Rate for Payer: Quartz Commercial |
$1,181.45
|
| Rate for Payer: The Alliance Commercial |
$1,036.36
|
| Rate for Payer: WEA Trust Commercial |
$1,140.00
|
| Rate for Payer: WPS Commercial |
$1,535.21
|
|
|
US Guided Intraoperative
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$446.12 |
| Max. Negotiated Rate |
$1,465.82 |
| Rate for Payer: Aetna Commercial |
$1,433.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,370.22
|
| Rate for Payer: Aetna Managed Medicare |
$446.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,035.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.44
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,465.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.62
|
| Rate for Payer: Health EOS Commercial |
$1,418.02
|
| Rate for Payer: HFN Commercial |
$1,465.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.96
|
| Rate for Payer: Multiplan Commercial |
$1,274.62
|
| Rate for Payer: NAPHCARE Commercial |
$955.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.82
|
| Rate for Payer: Quartz Beloit One Network |
$780.71
|
| Rate for Payer: Quartz Commercial |
$1,035.63
|
| Rate for Payer: Quartz Medicare Advantage |
$955.97
|
| Rate for Payer: The Alliance Commercial |
$796.64
|
| Rate for Payer: WEA Trust Commercial |
$876.30
|
| Rate for Payer: WPS Commercial |
$1,180.10
|
|
|
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 |
$184.92 |
| Max. Negotiated Rate |
$1,573.88 |
| Rate for Payer: Aetna Commercial |
$1,573.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| 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 |
$1,573.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$828.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.03
|
| Rate for Payer: Health EOS Commercial |
$1,507.62
|
| Rate for Payer: HFN Commercial |
$1,573.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.88
|
| Rate for Payer: Quartz Beloit One Network |
$728.96
|
| Rate for Payer: Quartz Commercial |
$944.33
|
| Rate for Payer: The Alliance Commercial |
$828.36
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$490.74 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$600.91
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Guided Intraoperative Prostate
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
2587163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$280.43
|
| 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 |
$530.81
|
| 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 |
$921.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.47
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.14
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$600.91
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$650.99
|
| Rate for Payer: Quartz Medicare Advantage |
$600.91
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
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 |
$811.79 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$994.03
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
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 |
$463.88 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Aetna Managed Medicare |
$463.88
|
| 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 |
$878.06
|
| 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 |
$1,524.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$927.13
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.54
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: NAPHCARE Commercial |
$994.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$1,076.87
|
| Rate for Payer: Quartz Medicare Advantage |
$994.03
|
| Rate for Payer: The Alliance Commercial |
$828.36
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
US Guided Marker Placement
|
Professional
|
Both
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$264.95 |
| Max. Negotiated Rate |
$572.05 |
| Rate for Payer: Aetna Commercial |
$572.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$572.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.30
|
| Rate for Payer: Health EOS Commercial |
$547.97
|
| Rate for Payer: HFN Commercial |
$572.05
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$572.05
|
| Rate for Payer: Quartz Beloit One Network |
$264.95
|
| Rate for Payer: Quartz Commercial |
$343.23
|
| Rate for Payer: The Alliance Commercial |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
US Guided Marker Placement
|
Facility
|
IP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$376.27
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
US Guided Marker Placement
|
Facility
|
OP
|
$603.00
|
|
|
Service Code
|
CPT 19285
|
| Hospital Charge Code |
2587166
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| 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: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| 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 |
$576.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$407.63
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
|
US Guided Marker Placement
|
Facility
|
OP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$168.60 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Aetna Managed Medicare |
$168.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.98
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.62
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: NAPHCARE Commercial |
$361.30
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$391.40
|
| Rate for Payer: Quartz Medicare Advantage |
$361.30
|
| Rate for Payer: The Alliance Commercial |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
|
US Guided Marker Placement
|
Facility
|
IP
|
$579.00
|
|
| Hospital Charge Code |
2552808
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$553.99 |
| Rate for Payer: Aetna Commercial |
$541.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.14
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$553.99
|
| Rate for Payer: Health EOS Commercial |
$535.92
|
| Rate for Payer: HFN Commercial |
$553.99
|
| Rate for Payer: Multiplan Commercial |
$481.73
|
| Rate for Payer: Preferred Network Access Commercial |
$553.99
|
| Rate for Payer: Quartz Beloit One Network |
$295.06
|
| Rate for Payer: Quartz Commercial |
$361.30
|
| Rate for Payer: WEA Trust Commercial |
$331.19
|
| Rate for Payer: WPS Commercial |
$446.00
|
|
