|
US Biopsy Renal Left
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$561.14 |
| 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 |
$1,002.04
|
| 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 Biopsy Renal Left
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544815
|
|
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 Biopsy Renal Left
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 LT
|
| Hospital Charge Code |
2544815
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.78 |
| 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: 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 |
$1,202.45
|
| 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 |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| 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: The Alliance Commercial |
$1,002.04
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Biopsy Renal Left
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631306
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,830.76 |
| Rate for Payer: Aetna Commercial |
$1,830.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,830.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,753.68
|
| Rate for Payer: HFN Commercial |
$1,830.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.76
|
| Rate for Payer: Quartz Beloit One Network |
$847.93
|
| Rate for Payer: Quartz Commercial |
$1,098.46
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Biopsy Renal Left
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631306
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.45
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Biopsy Renal Left
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631306
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Biopsy Renal Right
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631291
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Biopsy Renal Right
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980120
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.78 |
| 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: 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 |
$1,202.45
|
| 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 |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| 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: The Alliance Commercial |
$1,002.04
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Biopsy Renal Right
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544817
|
|
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 Biopsy Renal Right
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631291
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$1,830.76 |
| Rate for Payer: Aetna Commercial |
$1,830.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$63.94
|
| Rate for Payer: Anthem Medicare Advantage |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.94
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,830.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$963.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.94
|
| Rate for Payer: Health EOS Commercial |
$1,753.68
|
| Rate for Payer: HFN Commercial |
$1,830.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.94
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$95.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.76
|
| Rate for Payer: Quartz Beloit One Network |
$847.93
|
| Rate for Payer: Quartz Commercial |
$1,098.46
|
| Rate for Payer: Quartz Medicare Advantage |
$63.94
|
| Rate for Payer: The Alliance Commercial |
$242.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.94
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$319.70
|
|
|
US Biopsy Renal Right
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$561.14 |
| 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 |
$1,002.04
|
| 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 Biopsy Renal Right
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
631291
|
| Min. Negotiated Rate |
$255.76 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,078.45
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$255.76
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
US Biopsy Renal Right
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980120
|
|
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 Biopsy Renal Right
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC,RT
|
| Hospital Charge Code |
2980120
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$561.14 |
| 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 |
$1,002.04
|
| 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 Biopsy Renal Right
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 RT
|
| Hospital Charge Code |
2544817
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$204.78 |
| 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: 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 |
$1,202.45
|
| 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 |
$204.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.78
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| 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: The Alliance Commercial |
$1,002.04
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Birth Center Fetal BPP w/o NST
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$50.46
|
| Rate for Payer: Anthem Medicare Advantage |
$50.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.46
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.46
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.46
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$75.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$50.46
|
| Rate for Payer: The Alliance Commercial |
$191.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.46
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$252.30
|
|
|
US Birth Center Fetal BPP w/o NST
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$201.84 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$201.84
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Birth Center Fetal BPP w/o NST
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
6210786
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Birth Center Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| 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 Birth Center Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$69.99 |
| 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 |
$69.99
|
| Rate for Payer: Anthem Medicare Advantage |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.99
|
| 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 |
$69.99
|
| 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 |
$259.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$104.99
|
| 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 |
$69.99
|
| Rate for Payer: The Alliance Commercial |
$265.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.99
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$349.96
|
|
|
US Birth Center Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
6210789
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$279.97 |
| 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 |
$1,247.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.52
|
| 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: 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 |
$279.97
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Birth Center Pregnancy After 1st Tri
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| 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 Birth Center Pregnancy After 1st Tri
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$88.07 |
| 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 |
$88.07
|
| Rate for Payer: Anthem Medicare Advantage |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.07
|
| 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 |
$88.07
|
| 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 |
$324.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.07
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$132.10
|
| 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 |
$88.07
|
| Rate for Payer: The Alliance Commercial |
$334.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.07
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$440.34
|
|
|
US Birth Center Pregnancy After 1st Tri
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
6210792
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$352.27 |
| 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 |
$1,247.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.52
|
| 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: 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 |
$352.27
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Birth Center Pregnancy Follow Up
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6210795
|
|
Hospital Revenue Code
|
520
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$1,306.14 |
| Rate for Payer: Aetna Commercial |
$1,306.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$69.99
|
| Rate for Payer: Anthem Medicare Advantage |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.99
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,306.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$687.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.99
|
| Rate for Payer: Health EOS Commercial |
$1,251.14
|
| Rate for Payer: HFN Commercial |
$1,306.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$255.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$104.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,306.14
|
| Rate for Payer: Quartz Beloit One Network |
$604.95
|
| Rate for Payer: Quartz Commercial |
$783.68
|
| Rate for Payer: Quartz Medicare Advantage |
$69.99
|
| Rate for Payer: The Alliance Commercial |
$265.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.99
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$349.96
|
|
