|
US Pelvis, Transvaginal
|
Professional
|
Both
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2587178
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$259.10 |
| Max. Negotiated Rate |
$1,699.55 |
| Rate for Payer: Aetna Commercial |
$1,699.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,538.54
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,699.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$894.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.40
|
| Rate for Payer: Health EOS Commercial |
$1,627.99
|
| Rate for Payer: HFN Commercial |
$1,699.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.10
|
| Rate for Payer: Multiplan Commercial |
$1,431.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,699.55
|
| Rate for Payer: Quartz Beloit One Network |
$787.16
|
| Rate for Payer: Quartz Commercial |
$1,019.73
|
| Rate for Payer: The Alliance Commercial |
$894.50
|
| Rate for Payer: WEA Trust Commercial |
$983.95
|
| Rate for Payer: WPS Commercial |
$1,325.11
|
|
|
US Pelvis, Transvaginal
|
Facility
|
OP
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2587178
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$500.92 |
| Max. Negotiated Rate |
$7,156.00 |
| Rate for Payer: Aetna Commercial |
$1,610.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,538.54
|
| Rate for Payer: Aetna Managed Medicare |
$500.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$948.17
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,645.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,001.12
|
| Rate for Payer: Health EOS Commercial |
$1,592.21
|
| Rate for Payer: HFN Commercial |
$1,645.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,341.75
|
| Rate for Payer: Multiplan Commercial |
$1,431.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,073.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,645.88
|
| Rate for Payer: Quartz Beloit One Network |
$876.61
|
| Rate for Payer: Quartz Commercial |
$1,162.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,073.40
|
| Rate for Payer: The Alliance Commercial |
$7,156.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$983.95
|
| Rate for Payer: WPS Commercial |
$1,325.11
|
|
|
US Placenta Localization
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$728.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$560.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$728.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
US Placenta Localization
|
Professional
|
Both
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$177.91 |
| Max. Negotiated Rate |
$1,107.70 |
| Rate for Payer: Aetna Commercial |
$1,107.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.76
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,107.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$583.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$699.60
|
| Rate for Payer: Health EOS Commercial |
$1,061.06
|
| Rate for Payer: HFN Commercial |
$1,107.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.91
|
| Rate for Payer: Multiplan Commercial |
$932.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.70
|
| Rate for Payer: Quartz Beloit One Network |
$513.04
|
| Rate for Payer: Quartz Commercial |
$664.62
|
| Rate for Payer: The Alliance Commercial |
$583.00
|
| Rate for Payer: WEA Trust Commercial |
$641.30
|
| Rate for Payer: WPS Commercial |
$863.66
|
|
|
US Placenta Localization
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$1,031.32 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$594.13
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,031.32
|
| Rate for Payer: Health EOS Commercial |
$997.69
|
| Rate for Payer: HFN Commercial |
$1,031.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: NAPHCARE Commercial |
$672.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.32
|
| Rate for Payer: Quartz Beloit One Network |
$549.29
|
| Rate for Payer: Quartz Commercial |
$672.60
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
US Placenta Localization
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$571.34 |
| Max. Negotiated Rate |
$1,072.72 |
| Rate for Payer: Aetna Commercial |
$1,049.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.98
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,072.72
|
| Rate for Payer: Health EOS Commercial |
$1,037.74
|
| Rate for Payer: HFN Commercial |
$1,072.72
|
| Rate for Payer: Multiplan Commercial |
$932.80
|
| Rate for Payer: NAPHCARE Commercial |
$699.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.72
|
| Rate for Payer: Quartz Beloit One Network |
$571.34
|
| Rate for Payer: Quartz Commercial |
$699.60
|
| Rate for Payer: WEA Trust Commercial |
$641.30
|
| Rate for Payer: WPS Commercial |
$863.66
|
|
|
US Placenta Localization
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$287.27 |
| Max. Negotiated Rate |
$1,064.95 |
| Rate for Payer: Aetna Commercial |
$1,064.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$964.06
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,064.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$560.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$672.60
|
| Rate for Payer: Health EOS Commercial |
$1,020.11
|
| Rate for Payer: HFN Commercial |
$1,064.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$287.27
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,064.95
|
| Rate for Payer: Quartz Beloit One Network |
$493.24
|
| Rate for Payer: Quartz Commercial |
$638.97
|
| Rate for Payer: The Alliance Commercial |
$560.50
|
| Rate for Payer: WEA Trust Commercial |
$616.55
|
| Rate for Payer: WPS Commercial |
$830.32
|
|
|
US Placenta Localization
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$326.48 |
| Max. Negotiated Rate |
$4,664.00 |
| Rate for Payer: Aetna Commercial |
$1,049.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.76
|
| Rate for Payer: Aetna Managed Medicare |
$326.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.98
|
| 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 |
$1,072.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.49
|
| Rate for Payer: Health EOS Commercial |
$1,037.74
|
| Rate for Payer: HFN Commercial |
$1,072.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.50
|
| Rate for Payer: Multiplan Commercial |
$932.80
|
| Rate for Payer: NAPHCARE Commercial |
$699.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.72
|
| Rate for Payer: Quartz Beloit One Network |
$571.34
|
| Rate for Payer: Quartz Commercial |
$757.90
|
| Rate for Payer: Quartz Medicare Advantage |
$699.60
|
| Rate for Payer: The Alliance Commercial |
$4,664.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$641.30
|
| Rate for Payer: WPS Commercial |
$863.66
|
|
|
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 |
$75.44 |
| Max. Negotiated Rate |
$2,564.05 |
| Rate for Payer: Aetna Commercial |
$2,564.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.14
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,564.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,349.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,619.40
|
| Rate for Payer: Health EOS Commercial |
$2,456.09
|
| Rate for Payer: HFN Commercial |
$2,564.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$2,159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,564.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.56
|
| Rate for Payer: Quartz Commercial |
$1,538.43
|
| Rate for Payer: The Alliance Commercial |
$1,349.50
|
| Rate for Payer: WEA Trust Commercial |
$1,484.45
|
| Rate for Payer: WPS Commercial |
$1,999.15
|
|
|
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 |
$1,322.51 |
| Max. Negotiated Rate |
$2,483.08 |
| Rate for Payer: Aetna Commercial |
$2,429.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.47
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,483.08
|
| Rate for Payer: Health EOS Commercial |
$2,402.11
|
| Rate for Payer: HFN Commercial |
$2,483.08
|
| Rate for Payer: Multiplan Commercial |
$2,159.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.51
|
| Rate for Payer: Quartz Commercial |
$1,619.40
|
| Rate for Payer: WEA Trust Commercial |
$1,484.45
|
| Rate for Payer: WPS Commercial |
$1,999.15
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$215.08 |
| Max. Negotiated Rate |
$2,373.10 |
| Rate for Payer: Aetna Commercial |
$2,373.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.28
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,373.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,249.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,498.80
|
| Rate for Payer: Health EOS Commercial |
$2,273.18
|
| Rate for Payer: HFN Commercial |
$2,373.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.08
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,373.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,099.12
|
| Rate for Payer: Quartz Commercial |
$1,423.86
|
| Rate for Payer: The Alliance Commercial |
$1,249.00
|
| Rate for Payer: WEA Trust Commercial |
$1,373.90
|
| Rate for Payer: WPS Commercial |
$1,850.27
|
|
|
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 |
$516.88 |
| Max. Negotiated Rate |
$7,384.00 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| 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 |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.02
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$7,384.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$1,224.02 |
| Max. Negotiated Rate |
$2,298.16 |
| Rate for Payer: Aetna Commercial |
$2,248.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.94
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,298.16
|
| Rate for Payer: Health EOS Commercial |
$2,223.22
|
| Rate for Payer: HFN Commercial |
$2,298.16
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.02
|
| Rate for Payer: Quartz Commercial |
$1,498.80
|
| Rate for Payer: WEA Trust Commercial |
$1,373.90
|
| Rate for Payer: WPS Commercial |
$1,850.27
|
|
|
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 |
$574.00 |
| Max. Negotiated Rate |
$10,796.00 |
| Rate for Payer: Aetna Commercial |
$2,429.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,321.14
|
| Rate for Payer: Aetna Managed Medicare |
$755.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.47
|
| 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 |
$2,483.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,510.36
|
| Rate for Payer: Health EOS Commercial |
$2,402.11
|
| Rate for Payer: HFN Commercial |
$2,483.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.25
|
| Rate for Payer: Multiplan Commercial |
$2,159.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,483.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.51
|
| Rate for Payer: Quartz Commercial |
$1,754.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,619.40
|
| Rate for Payer: The Alliance Commercial |
$10,796.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,484.45
|
| Rate for Payer: WPS Commercial |
$1,999.15
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$699.44 |
| Max. Negotiated Rate |
$9,992.00 |
| Rate for Payer: Aetna Commercial |
$2,248.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.28
|
| Rate for Payer: Aetna Managed Medicare |
$699.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,623.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,249.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,199.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.94
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,298.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,397.88
|
| Rate for Payer: Health EOS Commercial |
$2,223.22
|
| Rate for Payer: HFN Commercial |
$2,298.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,873.50
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.02
|
| Rate for Payer: Quartz Commercial |
$1,623.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,498.80
|
| Rate for Payer: The Alliance Commercial |
$9,992.00
|
| Rate for Payer: WEA Trust Commercial |
$1,373.90
|
| Rate for Payer: WPS Commercial |
$1,850.27
|
|
|
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 |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
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 |
$75.44 |
| Max. Negotiated Rate |
$1,753.70 |
| Rate for Payer: Aetna Commercial |
$1,753.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,753.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$923.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,107.60
|
| Rate for Payer: Health EOS Commercial |
$1,679.86
|
| Rate for Payer: HFN Commercial |
$1,753.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,753.70
|
| Rate for Payer: Quartz Beloit One Network |
$812.24
|
| Rate for Payer: Quartz Commercial |
$1,052.22
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.33
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2552800
|
| Min. Negotiated Rate |
$699.44 |
| Max. Negotiated Rate |
$9,992.00 |
| Rate for Payer: Aetna Commercial |
$2,248.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.28
|
| Rate for Payer: Aetna Managed Medicare |
$699.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,623.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,249.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,199.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.94
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,298.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,397.88
|
| Rate for Payer: Health EOS Commercial |
$2,223.22
|
| Rate for Payer: HFN Commercial |
$2,298.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,873.50
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.02
|
| Rate for Payer: Quartz Commercial |
$1,623.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,498.80
|
| Rate for Payer: The Alliance Commercial |
$9,992.00
|
| Rate for Payer: WEA Trust Commercial |
$1,373.90
|
| Rate for Payer: WPS Commercial |
$1,850.27
|
|
|
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 |
$870.73 |
| Max. Negotiated Rate |
$1,634.84 |
| Rate for Payer: Aetna Commercial |
$1,599.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.81
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,634.84
|
| Rate for Payer: Health EOS Commercial |
$1,581.53
|
| Rate for Payer: HFN Commercial |
$1,634.84
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.84
|
| Rate for Payer: Quartz Beloit One Network |
$870.73
|
| Rate for Payer: Quartz Commercial |
$1,066.20
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
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 |
$147.73 |
| Max. Negotiated Rate |
$1,688.15 |
| Rate for Payer: Aetna Commercial |
$1,688.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,688.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$888.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,066.20
|
| Rate for Payer: Health EOS Commercial |
$1,617.07
|
| Rate for Payer: HFN Commercial |
$1,688.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.73
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,688.15
|
| Rate for Payer: Quartz Beloit One Network |
$781.88
|
| Rate for Payer: Quartz Commercial |
$1,012.89
|
| Rate for Payer: The Alliance Commercial |
$888.50
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
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 |
$497.56 |
| Max. Negotiated Rate |
$7,108.00 |
| Rate for Payer: Aetna Commercial |
$1,599.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.22
|
| Rate for Payer: Aetna Managed Medicare |
$497.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.81
|
| 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 |
$1,634.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.41
|
| Rate for Payer: Health EOS Commercial |
$1,581.53
|
| Rate for Payer: HFN Commercial |
$1,634.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.75
|
| Rate for Payer: Multiplan Commercial |
$1,421.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.84
|
| Rate for Payer: Quartz Beloit One Network |
$870.73
|
| Rate for Payer: Quartz Commercial |
$1,155.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.20
|
| Rate for Payer: The Alliance Commercial |
$7,108.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$977.35
|
| Rate for Payer: WPS Commercial |
$1,316.22
|
|
|
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 |
$1,273.02 |
| Max. Negotiated Rate |
$2,390.16 |
| Rate for Payer: Aetna Commercial |
$2,338.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.94
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,390.16
|
| Rate for Payer: Health EOS Commercial |
$2,312.22
|
| Rate for Payer: HFN Commercial |
$2,390.16
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,558.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.02
|
| Rate for Payer: Quartz Commercial |
$1,558.80
|
| Rate for Payer: WEA Trust Commercial |
$1,428.90
|
| Rate for Payer: WPS Commercial |
$1,924.34
|
|
|
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 |
$574.00 |
| Max. Negotiated Rate |
$10,392.00 |
| Rate for Payer: Aetna Commercial |
$2,338.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.28
|
| Rate for Payer: Aetna Managed Medicare |
$727.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.94
|
| 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 |
$2,390.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,453.84
|
| Rate for Payer: Health EOS Commercial |
$2,312.22
|
| Rate for Payer: HFN Commercial |
$2,390.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,948.50
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,558.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,273.02
|
| Rate for Payer: Quartz Commercial |
$1,688.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,558.80
|
| Rate for Payer: The Alliance Commercial |
$10,392.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,428.90
|
| Rate for Payer: WPS Commercial |
$1,924.34
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2552800
|
| Min. Negotiated Rate |
$312.83 |
| Max. Negotiated Rate |
$2,373.10 |
| Rate for Payer: Aetna Commercial |
$2,373.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.28
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,373.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,249.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,498.80
|
| Rate for Payer: Health EOS Commercial |
$2,273.18
|
| Rate for Payer: HFN Commercial |
$2,373.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.83
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,373.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,099.12
|
| Rate for Payer: Quartz Commercial |
$1,423.86
|
| Rate for Payer: The Alliance Commercial |
$1,249.00
|
| Rate for Payer: WEA Trust Commercial |
$1,373.90
|
| Rate for Payer: WPS Commercial |
$1,850.27
|
|
|
US Preg After 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
2552800
|
| Min. Negotiated Rate |
$1,224.02 |
| Max. Negotiated Rate |
$2,298.16 |
| Rate for Payer: Aetna Commercial |
$2,248.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,148.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,323.94
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,298.16
|
| Rate for Payer: Health EOS Commercial |
$2,223.22
|
| Rate for Payer: HFN Commercial |
$2,298.16
|
| Rate for Payer: Multiplan Commercial |
$1,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,498.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,298.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,224.02
|
| Rate for Payer: Quartz Commercial |
$1,498.80
|
| Rate for Payer: WEA Trust Commercial |
$1,373.90
|
| Rate for Payer: WPS Commercial |
$1,850.27
|
|
