|
US Pregnancy Follow Up
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
630910
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$869.73 |
| Rate for Payer: Aetna Commercial |
$850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.01
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.77
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.04
|
| 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 |
$272.70
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna Commercial |
$869.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$841.37
|
| Rate for Payer: HFN Commercial |
$869.73
|
| 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 |
$756.29
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$869.73
|
| Rate for Payer: Quartz Beloit One Network |
$463.23
|
| Rate for Payer: Quartz Commercial |
$614.48
|
| 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 |
$519.95
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$700.20
|
|
|
US Pregnancy Follow Up
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
2544952
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$384.97
|
| 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 |
$728.69
|
| 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 |
$1,264.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.40
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.16
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$824.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$893.67
|
| Rate for Payer: Quartz Medicare Advantage |
$824.93
|
| Rate for Payer: The Alliance Commercial |
$279.97
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
US Pregnancy Follow Up
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
2544952
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$673.69 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.69
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,264.89
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$824.93
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
US Pregnancy Follow Up & BPP
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6196384
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$673.69 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.69
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,264.89
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$824.93
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
US Pregnancy Follow Up & BPP
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6196384
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$1,264.89 |
| Rate for Payer: Aetna Commercial |
$1,237.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$384.97
|
| 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 |
$728.69
|
| 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 |
$1,264.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.40
|
| Rate for Payer: Health EOS Commercial |
$1,223.64
|
| Rate for Payer: HFN Commercial |
$1,264.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.16
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$824.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.89
|
| Rate for Payer: Quartz Beloit One Network |
$673.69
|
| Rate for Payer: Quartz Commercial |
$893.67
|
| Rate for Payer: Quartz Medicare Advantage |
$824.93
|
| Rate for Payer: The Alliance Commercial |
$279.97
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$1,018.34
|
|
|
US Pregnancy Follow Up & BPP
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
6196384
|
|
Hospital Revenue Code
|
402
|
| 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
|
|
|
US Pregnancy Limited
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
630906
|
| 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 Pregnancy Limited
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2544954
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$1,011.71 |
| Rate for Payer: Aetna Commercial |
$1,011.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.87
|
| 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 |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$1,011.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$532.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$969.11
|
| Rate for Payer: HFN Commercial |
$1,011.71
|
| 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 |
$851.97
|
| Rate for Payer: NAPHCARE Commercial |
$75.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.71
|
| Rate for Payer: Quartz Beloit One Network |
$468.58
|
| Rate for Payer: Quartz Commercial |
$607.03
|
| 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 |
$585.73
|
| Rate for Payer: WPS Commercial |
$251.78
|
|
|
US Pregnancy Limited
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2544954
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$979.76 |
| Rate for Payer: Aetna Commercial |
$958.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.43
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Health EOS Commercial |
$947.81
|
| Rate for Payer: HFN Commercial |
$979.76
|
| Rate for Payer: Multiplan Commercial |
$851.97
|
| Rate for Payer: Preferred Network Access Commercial |
$979.76
|
| Rate for Payer: Quartz Beloit One Network |
$521.83
|
| Rate for Payer: Quartz Commercial |
$638.98
|
| Rate for Payer: WEA Trust Commercial |
$585.73
|
| Rate for Payer: WPS Commercial |
$788.79
|
|
|
US Pregnancy Limited
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
630906
|
| 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 Pregnancy Limited
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2544954
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.43 |
| Max. Negotiated Rate |
$979.76 |
| Rate for Payer: Aetna Commercial |
$958.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.87
|
| Rate for Payer: Aetna Managed Medicare |
$298.19
|
| 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 |
$564.43
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.97
|
| Rate for Payer: Health EOS Commercial |
$947.81
|
| Rate for Payer: HFN Commercial |
$979.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$851.97
|
| Rate for Payer: NAPHCARE Commercial |
$638.98
|
| Rate for Payer: Preferred Network Access Commercial |
$979.76
|
| Rate for Payer: Quartz Beloit One Network |
$521.83
|
| Rate for Payer: Quartz Commercial |
$692.22
|
| Rate for Payer: Quartz Medicare Advantage |
$638.98
|
| Rate for Payer: The Alliance Commercial |
$201.43
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$585.73
|
| Rate for Payer: WPS Commercial |
$788.79
|
|
|
US Pregnancy Limited
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
630906
|
| 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 Pregnancy Limited & BPP
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6196387
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$1,011.71 |
| Rate for Payer: Aetna Commercial |
$1,011.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.87
|
| 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 |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$1,011.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$532.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$969.11
|
| Rate for Payer: HFN Commercial |
$1,011.71
|
| 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 |
$851.97
|
| Rate for Payer: NAPHCARE Commercial |
$75.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.71
|
| Rate for Payer: Quartz Beloit One Network |
$468.58
|
| Rate for Payer: Quartz Commercial |
$607.03
|
| 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 |
$585.73
|
| Rate for Payer: WPS Commercial |
$251.78
|
|
|
US Pregnancy Limited & BPP
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6196387
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.43 |
| Max. Negotiated Rate |
$979.76 |
| Rate for Payer: Aetna Commercial |
$958.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.87
|
| Rate for Payer: Aetna Managed Medicare |
$298.19
|
| 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 |
$564.43
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.97
|
| Rate for Payer: Health EOS Commercial |
$947.81
|
| Rate for Payer: HFN Commercial |
$979.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$798.72
|
| Rate for Payer: Multiplan Commercial |
$851.97
|
| Rate for Payer: NAPHCARE Commercial |
$638.98
|
| Rate for Payer: Preferred Network Access Commercial |
$979.76
|
| Rate for Payer: Quartz Beloit One Network |
$521.83
|
| Rate for Payer: Quartz Commercial |
$692.22
|
| Rate for Payer: Quartz Medicare Advantage |
$638.98
|
| Rate for Payer: The Alliance Commercial |
$201.43
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$585.73
|
| Rate for Payer: WPS Commercial |
$788.79
|
|
|
US Pregnancy Limited & BPP
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
6196387
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$521.83 |
| Max. Negotiated Rate |
$979.76 |
| Rate for Payer: Aetna Commercial |
$958.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.43
|
| Rate for Payer: Cash Price |
$307.20
|
| Rate for Payer: Cigna Commercial |
$979.76
|
| Rate for Payer: Health EOS Commercial |
$947.81
|
| Rate for Payer: HFN Commercial |
$979.76
|
| Rate for Payer: Multiplan Commercial |
$851.97
|
| Rate for Payer: Preferred Network Access Commercial |
$979.76
|
| Rate for Payer: Quartz Beloit One Network |
$521.83
|
| Rate for Payer: Quartz Commercial |
$638.98
|
| Rate for Payer: WEA Trust Commercial |
$585.73
|
| Rate for Payer: WPS Commercial |
$788.79
|
|
|
US Pregnancy Transvaginal
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3072734
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$1,122.37 |
| Rate for Payer: Aetna Commercial |
$1,122.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$57.01
|
| Rate for Payer: Anthem Medicare Advantage |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.01
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,122.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$590.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.01
|
| Rate for Payer: Health EOS Commercial |
$1,075.11
|
| Rate for Payer: HFN Commercial |
$1,122.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.01
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$85.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,122.37
|
| Rate for Payer: Quartz Beloit One Network |
$519.83
|
| Rate for Payer: Quartz Commercial |
$673.42
|
| Rate for Payer: Quartz Medicare Advantage |
$57.01
|
| Rate for Payer: The Alliance Commercial |
$216.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.01
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$285.06
|
|
|
US Pregnancy Transvaginal
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4500656
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$578.91 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$708.86
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
|
US Pregnancy Transvaginal
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3072734
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$578.91 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$708.86
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
|
US Pregnancy Transvaginal
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4500656
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$330.80
|
| 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 |
$626.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.15
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$886.08
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$708.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$767.94
|
| Rate for Payer: Quartz Medicare Advantage |
$708.86
|
| Rate for Payer: The Alliance Commercial |
$228.05
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
|
US Pregnancy Transvaginal
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4500656
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$1,122.37 |
| Rate for Payer: Aetna Commercial |
$1,122.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$57.01
|
| Rate for Payer: Anthem Medicare Advantage |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.01
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,122.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$590.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.01
|
| Rate for Payer: Health EOS Commercial |
$1,075.11
|
| Rate for Payer: HFN Commercial |
$1,122.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.01
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$85.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,122.37
|
| Rate for Payer: Quartz Beloit One Network |
$519.83
|
| Rate for Payer: Quartz Commercial |
$673.42
|
| Rate for Payer: Quartz Medicare Advantage |
$57.01
|
| Rate for Payer: The Alliance Commercial |
$216.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.01
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$285.06
|
|
|
US Pregnancy Transvaginal
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3072734
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$330.80
|
| 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 |
$626.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.15
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$886.08
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$708.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$767.94
|
| Rate for Payer: Quartz Medicare Advantage |
$708.86
|
| Rate for Payer: The Alliance Commercial |
$228.05
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
|
US Pregnancy, Transvaginal
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2587190
|
|
Hospital Revenue Code
|
402
|
| 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 |
$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 |
$279.97
|
| 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 Pregnancy, Transvaginal
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2587190
|
|
Hospital Revenue Code
|
402
|
| 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 Pregnancy, Transvaginal
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2587190
|
|
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 Prostate Transrectal
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
CPT 76872 TC
|
| Hospital Charge Code |
2544961
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$87.73 |
| Max. Negotiated Rate |
$1,494.84 |
| Rate for Payer: Aetna Commercial |
$1,494.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,353.23
|
| Rate for Payer: Aetna Managed Medicare |
$87.73
|
| Rate for Payer: Anthem Medicare Advantage |
$87.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.73
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cash Price |
$453.90
|
| Rate for Payer: Cigna Commercial |
$1,494.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$786.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.73
|
| Rate for Payer: Health EOS Commercial |
$1,431.90
|
| Rate for Payer: HFN Commercial |
$1,494.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$549.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.73
|
| Rate for Payer: Multiplan Commercial |
$1,258.82
|
| Rate for Payer: NAPHCARE Commercial |
$131.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,494.84
|
| Rate for Payer: Quartz Beloit One Network |
$692.35
|
| Rate for Payer: Quartz Commercial |
$896.91
|
| Rate for Payer: Quartz Medicare Advantage |
$87.73
|
| Rate for Payer: The Alliance Commercial |
$333.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.73
|
| Rate for Payer: WEA Trust Commercial |
$865.44
|
| Rate for Payer: WPS Commercial |
$438.67
|
|
