|
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 |
$475.79 |
| Max. Negotiated Rate |
$893.32 |
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$514.63
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$893.32
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$582.60
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
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 |
$271.88 |
| Max. Negotiated Rate |
$3,884.00 |
| Rate for Payer: Aetna Commercial |
$873.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Aetna Managed Medicare |
$271.88
|
| 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 |
$514.63
|
| 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 |
$893.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$543.37
|
| Rate for Payer: Health EOS Commercial |
$864.19
|
| Rate for Payer: HFN Commercial |
$893.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.25
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: NAPHCARE Commercial |
$582.60
|
| Rate for Payer: Preferred Network Access Commercial |
$893.32
|
| Rate for Payer: Quartz Beloit One Network |
$475.79
|
| Rate for Payer: Quartz Commercial |
$631.15
|
| Rate for Payer: Quartz Medicare Advantage |
$582.60
|
| Rate for Payer: The Alliance Commercial |
$3,884.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
US Extremity Non-Vascular Right
|
Facility
|
IP
|
$934.00
|
|
|
Service Code
|
CPT 76881
|
| Hospital Charge Code |
631091
|
| Min. Negotiated Rate |
$457.66 |
| Max. Negotiated Rate |
$859.28 |
| Rate for Payer: Aetna Commercial |
$840.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$803.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.02
|
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Cigna Commercial |
$859.28
|
| Rate for Payer: Health EOS Commercial |
$831.26
|
| Rate for Payer: HFN Commercial |
$859.28
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: NAPHCARE Commercial |
$560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$859.28
|
| Rate for Payer: Quartz Beloit One Network |
$457.66
|
| Rate for Payer: Quartz Commercial |
$560.40
|
| Rate for Payer: WEA Trust Commercial |
$513.70
|
| Rate for Payer: WPS Commercial |
$691.81
|
|
|
US Extremity Non-Vascular Right
|
Facility
|
OP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544855
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$251.44 |
| Max. Negotiated Rate |
$3,592.00 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Aetna Managed Medicare |
$251.44
|
| 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 |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.52
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.50
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$583.70
|
| Rate for Payer: Quartz Medicare Advantage |
$538.80
|
| Rate for Payer: The Alliance Commercial |
$3,592.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
US Extremity Non-Vascular Right
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 76881 RT,TC
|
| Hospital Charge Code |
2544855
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$440.02 |
| Max. Negotiated Rate |
$826.16 |
| Rate for Payer: Aetna Commercial |
$808.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$475.94
|
| Rate for Payer: Cash Price |
$269.40
|
| Rate for Payer: Cigna Commercial |
$826.16
|
| Rate for Payer: Health EOS Commercial |
$799.22
|
| Rate for Payer: HFN Commercial |
$826.16
|
| Rate for Payer: Multiplan Commercial |
$718.40
|
| Rate for Payer: NAPHCARE Commercial |
$538.80
|
| Rate for Payer: Preferred Network Access Commercial |
$826.16
|
| Rate for Payer: Quartz Beloit One Network |
$440.02
|
| Rate for Payer: Quartz Commercial |
$538.80
|
| Rate for Payer: WEA Trust Commercial |
$493.90
|
| Rate for Payer: WPS Commercial |
$665.15
|
|
|
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 |
$427.24 |
| Max. Negotiated Rate |
$922.45 |
| Rate for Payer: Aetna Commercial |
$922.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.06
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cash Price |
$291.30
|
| Rate for Payer: Cigna Commercial |
$922.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$485.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.60
|
| Rate for Payer: Health EOS Commercial |
$883.61
|
| Rate for Payer: HFN Commercial |
$922.45
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.45
|
| Rate for Payer: Quartz Beloit One Network |
$427.24
|
| Rate for Payer: Quartz Commercial |
$553.47
|
| Rate for Payer: The Alliance Commercial |
$485.50
|
| Rate for Payer: WEA Trust Commercial |
$534.05
|
| Rate for Payer: WPS Commercial |
$719.22
|
|
|
US Fetal Biophysical Profile w/ Non-St
|
Professional
|
Both
|
$1,567.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
631102
|
| Min. Negotiated Rate |
$399.56 |
| Max. Negotiated Rate |
$1,488.65 |
| Rate for Payer: Aetna Commercial |
$1,488.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,347.62
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cigna Commercial |
$1,488.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$783.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$940.20
|
| Rate for Payer: Health EOS Commercial |
$1,425.97
|
| Rate for Payer: HFN Commercial |
$1,488.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.56
|
| Rate for Payer: Multiplan Commercial |
$1,253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.65
|
| Rate for Payer: Quartz Beloit One Network |
$689.48
|
| Rate for Payer: Quartz Commercial |
$893.19
|
| Rate for Payer: The Alliance Commercial |
$783.50
|
| Rate for Payer: WEA Trust Commercial |
$861.85
|
| Rate for Payer: WPS Commercial |
$1,160.68
|
|
|
US Fetal Biophysical Profile w/ Non-St
|
Facility
|
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
631102
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,441.64 |
| Rate for Payer: Aetna Commercial |
$1,410.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,347.62
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,018.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$783.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$752.16
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$830.51
|
| 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 |
$470.10
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cigna Commercial |
$1,441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$876.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,394.63
|
| Rate for Payer: HFN Commercial |
$1,441.64
|
| 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 |
$1,253.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,441.64
|
| Rate for Payer: Quartz Beloit One Network |
$767.83
|
| Rate for Payer: Quartz Commercial |
$1,018.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$861.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,160.68
|
|
|
US Fetal Biophysical Profile w/ Non-St
|
Facility
|
IP
|
$1,567.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
631102
|
| Min. Negotiated Rate |
$767.83 |
| Max. Negotiated Rate |
$1,441.64 |
| Rate for Payer: Aetna Commercial |
$1,410.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,347.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$830.51
|
| Rate for Payer: Cash Price |
$470.10
|
| Rate for Payer: Cigna Commercial |
$1,441.64
|
| Rate for Payer: Health EOS Commercial |
$1,394.63
|
| Rate for Payer: HFN Commercial |
$1,441.64
|
| Rate for Payer: Multiplan Commercial |
$1,253.60
|
| Rate for Payer: NAPHCARE Commercial |
$940.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,441.64
|
| Rate for Payer: Quartz Beloit One Network |
$767.83
|
| Rate for Payer: Quartz Commercial |
$940.20
|
| Rate for Payer: WEA Trust Commercial |
$861.85
|
| Rate for Payer: WPS Commercial |
$1,160.68
|
|
|
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 |
$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: Dean Health DHI/DHP/ASO |
$946.84
|
| 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 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 |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US 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 |
$222.35 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$846.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.35
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
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 |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US 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 |
$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: Dean Health DHI/DHP/ASO |
$946.84
|
| 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 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 |
$222.35 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$846.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.35
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
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 |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US 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 |
$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: Dean Health DHI/DHP/ASO |
$946.84
|
| 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 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 |
$165.13 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$846.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.13
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
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 |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
US 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 |
$222.35 |
| Max. Negotiated Rate |
$1,607.40 |
| Rate for Payer: Aetna Commercial |
$1,607.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,607.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$846.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,015.20
|
| Rate for Payer: Health EOS Commercial |
$1,539.72
|
| Rate for Payer: HFN Commercial |
$1,607.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$222.35
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.48
|
| Rate for Payer: Quartz Commercial |
$964.44
|
| Rate for Payer: The Alliance Commercial |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
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: Dean Health DHI/DHP/ASO |
$946.84
|
| 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: Dean Health DHI/DHP/ASO |
$986.57
|
| 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 |
$108.67 |
| 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 DHI/DHP/ASO |
$838.84
|
| 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 |
$434.68
|
| 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
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$211.55 |
| 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: 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 |
$1,057.80
|
| Rate for Payer: Health EOS Commercial |
$1,604.33
|
| Rate for Payer: HFN Commercial |
$1,674.85
|
| 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: 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: The Alliance Commercial |
$881.50
|
| Rate for Payer: WEA Trust Commercial |
$969.65
|
| Rate for Payer: WPS Commercial |
$1,305.85
|
|
|
US Gallbladder
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$310.04 |
| 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: 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 |
$899.40
|
| Rate for Payer: Health EOS Commercial |
$1,364.09
|
| Rate for Payer: HFN Commercial |
$1,424.05
|
| 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: 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: The Alliance Commercial |
$749.50
|
| Rate for Payer: WEA Trust Commercial |
$824.45
|
| Rate for Payer: WPS Commercial |
$1,110.31
|
|
