|
US Placenta Localization
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
US Placenta Localization
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$594.19 |
| Max. Negotiated Rate |
$1,115.63 |
| Rate for Payer: Aetna Commercial |
$1,091.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.70
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,115.63
|
| Rate for Payer: Health EOS Commercial |
$1,079.25
|
| Rate for Payer: HFN Commercial |
$1,115.63
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.63
|
| Rate for Payer: Quartz Beloit One Network |
$594.19
|
| Rate for Payer: Quartz Commercial |
$727.58
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$898.17
|
|
|
US Placenta Localization
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.43 |
| Max. Negotiated Rate |
$1,115.63 |
| Rate for Payer: Aetna Commercial |
$1,091.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Aetna Managed Medicare |
$339.54
|
| 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 |
$642.70
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,115.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.61
|
| Rate for Payer: Health EOS Commercial |
$1,079.25
|
| Rate for Payer: HFN Commercial |
$1,115.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.48
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: NAPHCARE Commercial |
$727.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.63
|
| Rate for Payer: Quartz Beloit One Network |
$594.19
|
| Rate for Payer: Quartz Commercial |
$788.22
|
| Rate for Payer: Quartz Medicare Advantage |
$727.58
|
| Rate for Payer: The Alliance Commercial |
$201.43
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$898.17
|
|
|
US Placenta Localization
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Aetna Commercial |
$1,107.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$80.98
|
| Rate for Payer: Anthem Medicare Advantage |
$80.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.98
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,107.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$582.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.98
|
| Rate for Payer: Health EOS Commercial |
$1,060.91
|
| Rate for Payer: HFN Commercial |
$1,107.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$121.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.55
|
| Rate for Payer: Quartz Beloit One Network |
$512.97
|
| Rate for Payer: Quartz Commercial |
$664.53
|
| Rate for Payer: Quartz Medicare Advantage |
$80.98
|
| Rate for Payer: The Alliance Commercial |
$307.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.98
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$404.92
|
|
|
US Placenta Localization
|
Professional
|
Both
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$1,152.01 |
| Rate for Payer: Aetna Commercial |
$1,152.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Aetna Managed Medicare |
$50.36
|
| Rate for Payer: Anthem Medicare Advantage |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.36
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,152.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$1,103.50
|
| Rate for Payer: HFN Commercial |
$1,152.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.36
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: NAPHCARE Commercial |
$75.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,152.01
|
| Rate for Payer: Quartz Beloit One Network |
$533.56
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: Quartz Medicare Advantage |
$50.36
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.36
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$251.78
|
|
|
US Placenta Localization
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| 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 |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| 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 |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$757.80
|
| 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 |
$641.21
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
2587184
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$1,823.85 |
| Rate for Payer: Aetna Commercial |
$1,823.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Medicare Advantage |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.97
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,823.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.97
|
| Rate for Payer: Health EOS Commercial |
$1,747.05
|
| Rate for Payer: HFN Commercial |
$1,823.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$31.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.85
|
| Rate for Payer: Quartz Beloit One Network |
$844.73
|
| Rate for Payer: Quartz Commercial |
$1,094.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.97
|
| Rate for Payer: The Alliance Commercial |
$79.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.97
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$104.83
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$1,272.98 |
| Max. Negotiated Rate |
$2,390.09 |
| Rate for Payer: Aetna Commercial |
$2,338.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.90
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,390.09
|
| Rate for Payer: Health EOS Commercial |
$2,312.15
|
| Rate for Payer: HFN Commercial |
$2,390.09
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.98
|
| Rate for Payer: Quartz Commercial |
$1,558.75
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$1,924.21
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$60.51 |
| Max. Negotiated Rate |
$2,468.02 |
| Rate for Payer: Aetna Commercial |
$2,468.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Aetna Managed Medicare |
$60.51
|
| Rate for Payer: Anthem Medicare Advantage |
$60.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.51
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,468.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,298.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.51
|
| Rate for Payer: Health EOS Commercial |
$2,364.11
|
| Rate for Payer: HFN Commercial |
$2,468.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.51
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: NAPHCARE Commercial |
$90.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.08
|
| Rate for Payer: Quartz Commercial |
$1,480.81
|
| Rate for Payer: Quartz Medicare Advantage |
$60.51
|
| Rate for Payer: The Alliance Commercial |
$229.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.51
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$302.54
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
2587184
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
2587184
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| 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 |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$83.87
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$242.03 |
| Max. Negotiated Rate |
$2,390.09 |
| Rate for Payer: Aetna Commercial |
$2,338.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Aetna Managed Medicare |
$727.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,688.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.90
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,390.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,453.84
|
| Rate for Payer: Health EOS Commercial |
$2,312.15
|
| Rate for Payer: HFN Commercial |
$2,390.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,948.44
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,558.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.98
|
| Rate for Payer: Quartz Commercial |
$1,688.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,558.75
|
| Rate for Payer: The Alliance Commercial |
$242.03
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$1,924.21
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,699.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
4568616
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,375.41 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,526.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,487.69
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,582.40
|
| Rate for Payer: Health EOS Commercial |
$2,498.19
|
| Rate for Payer: HFN Commercial |
$2,582.40
|
| Rate for Payer: Multiplan Commercial |
$2,245.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.41
|
| Rate for Payer: Quartz Commercial |
$1,684.18
|
| Rate for Payer: WEA Trust Commercial |
$1,543.83
|
| Rate for Payer: WPS Commercial |
$2,079.04
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,699.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
4568616
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$2,666.61 |
| Rate for Payer: Aetna Commercial |
$2,666.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.99
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Medicare Advantage |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.97
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,666.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,403.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.97
|
| Rate for Payer: Health EOS Commercial |
$2,554.33
|
| Rate for Payer: HFN Commercial |
$2,666.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$2,245.57
|
| Rate for Payer: NAPHCARE Commercial |
$31.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,666.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.06
|
| Rate for Payer: Quartz Commercial |
$1,599.97
|
| Rate for Payer: Quartz Medicare Advantage |
$20.97
|
| Rate for Payer: The Alliance Commercial |
$79.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.97
|
| Rate for Payer: WEA Trust Commercial |
$1,543.83
|
| Rate for Payer: WPS Commercial |
$104.83
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,699.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
4568616
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,526.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.99
|
| Rate for Payer: Aetna Managed Medicare |
$785.95
|
| 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 |
$1,487.69
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,582.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,570.82
|
| Rate for Payer: Health EOS Commercial |
$2,498.19
|
| Rate for Payer: HFN Commercial |
$2,582.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,105.22
|
| Rate for Payer: Multiplan Commercial |
$2,245.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.41
|
| Rate for Payer: Quartz Commercial |
$1,824.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.18
|
| Rate for Payer: The Alliance Commercial |
$83.87
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,543.83
|
| Rate for Payer: WPS Commercial |
$2,079.04
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
OP
|
$1,777.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
4568617
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$517.46
|
| 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 |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.21
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,386.06
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,108.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,201.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,108.85
|
| Rate for Payer: The Alliance Commercial |
$164.15
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,598.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
2587187
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$2,566.82 |
| Rate for Payer: Aetna Commercial |
$2,566.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$41.04
|
| Rate for Payer: Anthem Medicare Advantage |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.04
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,566.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,350.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.04
|
| Rate for Payer: Health EOS Commercial |
$2,458.75
|
| Rate for Payer: HFN Commercial |
$2,566.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.84
|
| Rate for Payer: Quartz Commercial |
$1,540.09
|
| Rate for Payer: Quartz Medicare Advantage |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$155.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.04
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$205.19
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2552800
|
| Min. Negotiated Rate |
$1,272.98 |
| Max. Negotiated Rate |
$2,390.09 |
| Rate for Payer: Aetna Commercial |
$2,338.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.90
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,390.09
|
| Rate for Payer: Health EOS Commercial |
$2,312.15
|
| Rate for Payer: HFN Commercial |
$2,390.09
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.98
|
| Rate for Payer: Quartz Commercial |
$1,558.75
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$1,924.21
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
IP
|
$1,777.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
4568617
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$905.56 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,108.85
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2552800
|
| Min. Negotiated Rate |
$88.23 |
| Max. Negotiated Rate |
$2,468.02 |
| Rate for Payer: Aetna Commercial |
$2,468.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Aetna Managed Medicare |
$88.23
|
| Rate for Payer: Anthem Medicare Advantage |
$88.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.23
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,468.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,298.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.23
|
| Rate for Payer: Health EOS Commercial |
$2,364.11
|
| Rate for Payer: HFN Commercial |
$2,468.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$325.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$325.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.23
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: NAPHCARE Commercial |
$132.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.08
|
| Rate for Payer: Quartz Commercial |
$1,480.81
|
| Rate for Payer: Quartz Medicare Advantage |
$88.23
|
| Rate for Payer: The Alliance Commercial |
$335.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.23
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$441.17
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2552800
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$2,390.09 |
| Rate for Payer: Aetna Commercial |
$2,338.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Aetna Managed Medicare |
$727.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,688.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.90
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,390.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,453.84
|
| Rate for Payer: Health EOS Commercial |
$2,312.15
|
| Rate for Payer: HFN Commercial |
$2,390.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,948.44
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,558.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.98
|
| Rate for Payer: Quartz Commercial |
$1,688.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,558.75
|
| Rate for Payer: The Alliance Commercial |
$352.93
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$1,924.21
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
2587187
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$756.54
|
| 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 |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.44
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,756.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.15
|
| Rate for Payer: The Alliance Commercial |
$164.15
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
4568617
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$41.04 |
| Max. Negotiated Rate |
$1,755.68 |
| Rate for Payer: Aetna Commercial |
$1,755.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$41.04
|
| Rate for Payer: Anthem Medicare Advantage |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.04
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,755.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$924.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.04
|
| Rate for Payer: Health EOS Commercial |
$1,681.75
|
| Rate for Payer: HFN Commercial |
$1,755.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$61.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,755.68
|
| Rate for Payer: Quartz Beloit One Network |
$813.16
|
| Rate for Payer: Quartz Commercial |
$1,053.41
|
| Rate for Payer: Quartz Medicare Advantage |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$155.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.04
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$205.19
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
2587187
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,323.94 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,621.15
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
630921
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| 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 |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| 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 |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| 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 |
$977.55
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
