|
US Thyroid
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$861.73 |
| Max. Negotiated Rate |
$1,617.95 |
| Rate for Payer: Aetna Commercial |
$1,582.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.08
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,617.95
|
| Rate for Payer: Health EOS Commercial |
$1,565.19
|
| Rate for Payer: HFN Commercial |
$1,617.95
|
| Rate for Payer: Multiplan Commercial |
$1,406.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,617.95
|
| Rate for Payer: Quartz Beloit One Network |
$861.73
|
| Rate for Payer: Quartz Commercial |
$1,055.18
|
| Rate for Payer: WEA Trust Commercial |
$967.25
|
| Rate for Payer: WPS Commercial |
$1,302.58
|
|
|
US, Transrectal 7687226
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3165709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$32.12
|
| Rate for Payer: Anthem Medicare Advantage |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.12
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.12
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.12
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$48.17
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$32.12
|
| Rate for Payer: The Alliance Commercial |
$122.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.12
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$160.58
|
|
|
US, Transrectal 7687226PP
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3303484
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$32.12
|
| Rate for Payer: Anthem Medicare Advantage |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.12
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.12
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.12
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$48.17
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$32.12
|
| Rate for Payer: The Alliance Commercial |
$122.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.12
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$160.58
|
|
|
US Transvaginal Non-Ob
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$1,049.26 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$84.41
|
| Rate for Payer: Anthem Medicare Advantage |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.41
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,049.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.41
|
| Rate for Payer: Health EOS Commercial |
$1,005.08
|
| Rate for Payer: HFN Commercial |
$1,049.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.41
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$126.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.26
|
| Rate for Payer: Quartz Beloit One Network |
$485.97
|
| Rate for Payer: Quartz Commercial |
$629.55
|
| Rate for Payer: Quartz Medicare Advantage |
$84.41
|
| Rate for Payer: The Alliance Commercial |
$320.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.41
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$422.03
|
|
|
US Transvaginal Non-Ob
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$662.69
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-Ob
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$309.25 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$309.25
|
| 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 |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.08
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.36
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$662.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$717.91
|
| Rate for Payer: Quartz Medicare Advantage |
$662.69
|
| Rate for Payer: The Alliance Commercial |
$337.63
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$964.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.18
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.74
|
| 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 |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$985.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$953.37
|
| Rate for Payer: HFN Commercial |
$985.50
|
| 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 |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$985.50
|
| Rate for Payer: Quartz Beloit One Network |
$524.89
|
| Rate for Payer: Quartz Commercial |
$696.28
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
|
US Transvaginal Non-OB
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$1,017.64 |
| Rate for Payer: Aetna Commercial |
$1,017.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$116.76
|
| Rate for Payer: Anthem Medicare Advantage |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.76
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$1,017.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$535.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.76
|
| Rate for Payer: Health EOS Commercial |
$974.79
|
| Rate for Payer: HFN Commercial |
$1,017.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.76
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$175.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.64
|
| Rate for Payer: Quartz Beloit One Network |
$471.33
|
| Rate for Payer: Quartz Commercial |
$610.58
|
| Rate for Payer: Quartz Medicare Advantage |
$116.76
|
| Rate for Payer: The Alliance Commercial |
$443.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.76
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$583.80
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$309.25 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$309.25
|
| 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 |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.08
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.36
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$662.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$717.91
|
| Rate for Payer: Quartz Medicare Advantage |
$662.69
|
| Rate for Payer: The Alliance Commercial |
$337.63
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-OB
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$1,049.26 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$84.41
|
| Rate for Payer: Anthem Medicare Advantage |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.41
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,049.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.41
|
| Rate for Payer: Health EOS Commercial |
$1,005.08
|
| Rate for Payer: HFN Commercial |
$1,049.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.41
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$126.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.26
|
| Rate for Payer: Quartz Beloit One Network |
$485.97
|
| Rate for Payer: Quartz Commercial |
$629.55
|
| Rate for Payer: Quartz Medicare Advantage |
$84.41
|
| Rate for Payer: The Alliance Commercial |
$320.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.41
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$422.03
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$524.89 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$964.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.74
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$985.50
|
| Rate for Payer: Health EOS Commercial |
$953.37
|
| Rate for Payer: HFN Commercial |
$985.50
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: Preferred Network Access Commercial |
$985.50
|
| Rate for Payer: Quartz Beloit One Network |
$524.89
|
| Rate for Payer: Quartz Commercial |
$642.72
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$662.69
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal OB
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
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 Transvaginal OB
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
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 Transvaginal OB
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
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 Umbilical Artery Doppler
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| 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 |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
US Umbilical Artery Doppler
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
US Umbilical Artery Doppler
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$20.74
|
| Rate for Payer: Anthem Medicare Advantage |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.74
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.74
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$31.11
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$20.74
|
| Rate for Payer: The Alliance Commercial |
$78.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.74
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$103.69
|
|
|
US Unilateral Breast Left
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC,LT
|
| Hospital Charge Code |
4444805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$490.74 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$600.91
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Unilateral Breast Left
|
Professional
|
Both
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC,LT
|
| Hospital Charge Code |
4444805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$377.77 |
| Max. Negotiated Rate |
$951.44 |
| Rate for Payer: Aetna Commercial |
$951.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$951.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.91
|
| Rate for Payer: Health EOS Commercial |
$911.38
|
| Rate for Payer: HFN Commercial |
$951.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.77
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: Preferred Network Access Commercial |
$951.44
|
| Rate for Payer: Quartz Beloit One Network |
$440.67
|
| Rate for Payer: Quartz Commercial |
$570.87
|
| Rate for Payer: The Alliance Commercial |
$500.76
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Unilateral Breast Left
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 76641 TC,LT
|
| Hospital Charge Code |
4444805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$280.43 |
| Max. Negotiated Rate |
$921.40 |
| Rate for Payer: Aetna Commercial |
$901.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$861.31
|
| Rate for Payer: Aetna Managed Medicare |
$280.43
|
| 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 |
$530.81
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$921.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.47
|
| Rate for Payer: Health EOS Commercial |
$891.35
|
| Rate for Payer: HFN Commercial |
$921.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.14
|
| Rate for Payer: Multiplan Commercial |
$801.22
|
| Rate for Payer: NAPHCARE Commercial |
$600.91
|
| Rate for Payer: Preferred Network Access Commercial |
$921.40
|
| Rate for Payer: Quartz Beloit One Network |
$490.74
|
| Rate for Payer: Quartz Commercial |
$650.99
|
| Rate for Payer: Quartz Medicare Advantage |
$600.91
|
| Rate for Payer: The Alliance Commercial |
$500.76
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$550.84
|
| Rate for Payer: WPS Commercial |
$741.80
|
|
|
US Unlisted Procedure
|
Facility
|
OP
|
$1,839.00
|
|
|
Service Code
|
CPT 76999 TC
|
| Hospital Charge Code |
2544985
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$535.52 |
| Max. Negotiated Rate |
$1,759.56 |
| Rate for Payer: Aetna Commercial |
$1,721.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.80
|
| Rate for Payer: Aetna Managed Medicare |
$535.52
|
| 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 |
$1,013.66
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,759.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,070.30
|
| Rate for Payer: Health EOS Commercial |
$1,702.18
|
| Rate for Payer: HFN Commercial |
$1,759.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,434.42
|
| Rate for Payer: Multiplan Commercial |
$1,530.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,147.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.56
|
| Rate for Payer: Quartz Beloit One Network |
$937.15
|
| Rate for Payer: Quartz Commercial |
$1,243.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,147.54
|
| Rate for Payer: The Alliance Commercial |
$956.28
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,051.91
|
| Rate for Payer: WPS Commercial |
$1,416.58
|
|
|
US Unlisted Procedure
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
CPT 76999 TC
|
| Hospital Charge Code |
2544985
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$841.53 |
| Max. Negotiated Rate |
$1,816.93 |
| Rate for Payer: Aetna Commercial |
$1,816.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.80
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,816.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$956.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.54
|
| Rate for Payer: Health EOS Commercial |
$1,740.43
|
| Rate for Payer: HFN Commercial |
$1,816.93
|
| Rate for Payer: Multiplan Commercial |
$1,530.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,816.93
|
| Rate for Payer: Quartz Beloit One Network |
$841.53
|
| Rate for Payer: Quartz Commercial |
$1,090.16
|
| Rate for Payer: The Alliance Commercial |
$956.28
|
| Rate for Payer: WEA Trust Commercial |
$1,051.91
|
| Rate for Payer: WPS Commercial |
$1,416.58
|
|
|
US Unlisted Procedure
|
Facility
|
IP
|
$1,839.00
|
|
|
Service Code
|
CPT 76999 TC
|
| Hospital Charge Code |
2544985
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$937.15 |
| Max. Negotiated Rate |
$1,759.56 |
| Rate for Payer: Aetna Commercial |
$1,721.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,644.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,013.66
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,759.56
|
| Rate for Payer: Health EOS Commercial |
$1,702.18
|
| Rate for Payer: HFN Commercial |
$1,759.56
|
| Rate for Payer: Multiplan Commercial |
$1,530.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,759.56
|
| Rate for Payer: Quartz Beloit One Network |
$937.15
|
| Rate for Payer: Quartz Commercial |
$1,147.54
|
| Rate for Payer: WEA Trust Commercial |
$1,051.91
|
| Rate for Payer: WPS Commercial |
$1,416.58
|
|
|
US Upper Extremity Non-Vascular Bilat
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544987
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
