|
US Preg After 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,598.00
|
|
|
Service Code
|
CPT 76810 TC
|
| Hospital Charge Code |
2587187
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$2,468.10 |
| Rate for Payer: Aetna Commercial |
$2,468.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.28
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,468.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,299.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,558.80
|
| Rate for Payer: Health EOS Commercial |
$2,364.18
|
| Rate for Payer: HFN Commercial |
$2,468.10
|
| 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 |
$2,078.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.12
|
| Rate for Payer: Quartz Commercial |
$1,480.86
|
| Rate for Payer: The Alliance Commercial |
$1,299.00
|
| Rate for Payer: WEA Trust Commercial |
$1,428.90
|
| Rate for Payer: WPS Commercial |
$1,924.34
|
|
|
US Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.82 |
| 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 |
$249.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.82
|
| 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 Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,777.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544947
|
|
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 Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
630921
|
| Min. Negotiated Rate |
$416.15 |
| Max. Negotiated Rate |
$1,623.55 |
| Rate for Payer: Aetna Commercial |
$1,623.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,623.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.40
|
| Rate for Payer: Health EOS Commercial |
$1,555.19
|
| Rate for Payer: HFN Commercial |
$1,623.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.15
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,623.55
|
| Rate for Payer: Quartz Beloit One Network |
$751.96
|
| Rate for Payer: Quartz Commercial |
$974.13
|
| Rate for Payer: The Alliance Commercial |
$854.50
|
| Rate for Payer: WEA Trust Commercial |
$939.95
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544946
|
|
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 Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544947
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.82 |
| 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 |
$249.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.82
|
| 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 Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,777.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544947
|
|
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 Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
630921
|
| Min. Negotiated Rate |
$837.41 |
| Max. Negotiated Rate |
$1,572.28 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.77
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,572.28
|
| Rate for Payer: Health EOS Commercial |
$1,521.01
|
| Rate for Payer: HFN Commercial |
$1,572.28
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.28
|
| Rate for Payer: Quartz Beloit One Network |
$837.41
|
| Rate for Payer: Quartz Commercial |
$1,025.40
|
| Rate for Payer: WEA Trust Commercial |
$939.95
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544946
|
|
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 Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
630921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,572.28 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.32
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.77
|
| 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 |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,572.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,521.01
|
| Rate for Payer: HFN Commercial |
$1,572.28
|
| 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 |
$1,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.28
|
| Rate for Payer: Quartz Beloit One Network |
$837.41
|
| Rate for Payer: Quartz Commercial |
$1,110.85
|
| 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 |
$939.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
US Pregnancy After 1st Trimester
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
2544948
|
|
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 Pregnancy After 1st Trimester
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
630919
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,572.28 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.32
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.77
|
| 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 |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,572.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,521.01
|
| Rate for Payer: HFN Commercial |
$1,572.28
|
| 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 |
$1,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.28
|
| Rate for Payer: Quartz Beloit One Network |
$837.41
|
| Rate for Payer: Quartz Commercial |
$1,110.85
|
| 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 |
$939.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
US Pregnancy After 1st Trimester
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
2544948
|
|
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 Pregnancy After 1st Trimester
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
2544948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.48 |
| 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 |
$312.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.48
|
| 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 Pregnancy After 1st Trimester
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
630919
|
| Min. Negotiated Rate |
$837.41 |
| Max. Negotiated Rate |
$1,572.28 |
| Rate for Payer: Aetna Commercial |
$1,538.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.77
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,572.28
|
| Rate for Payer: Health EOS Commercial |
$1,521.01
|
| Rate for Payer: HFN Commercial |
$1,572.28
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.28
|
| Rate for Payer: Quartz Beloit One Network |
$837.41
|
| Rate for Payer: Quartz Commercial |
$1,025.40
|
| Rate for Payer: WEA Trust Commercial |
$939.95
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
US Pregnancy After 1st Trimester
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
630919
|
| Min. Negotiated Rate |
$478.81 |
| Max. Negotiated Rate |
$1,623.55 |
| Rate for Payer: Aetna Commercial |
$1,623.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.74
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,623.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$854.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.40
|
| Rate for Payer: Health EOS Commercial |
$1,555.19
|
| Rate for Payer: HFN Commercial |
$1,623.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.81
|
| Rate for Payer: Multiplan Commercial |
$1,367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,623.55
|
| Rate for Payer: Quartz Beloit One Network |
$751.96
|
| Rate for Payer: Quartz Commercial |
$974.13
|
| Rate for Payer: The Alliance Commercial |
$854.50
|
| Rate for Payer: WEA Trust Commercial |
$939.95
|
| Rate for Payer: WPS Commercial |
$1,265.86
|
|
|
US Pregnancy After 1St Trimester
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
3072698
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.48 |
| 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 |
$312.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.48
|
| 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 Pregnancy After 1St Trimester
|
Facility
|
OP
|
$1,777.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
3072698
|
|
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 Pregnancy After 1St Trimester
|
Facility
|
IP
|
$1,777.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
3072698
|
|
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 Pregnancy After 1st Trimester TWINS
|
Professional
|
Both
|
$2,598.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
4566911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$312.48 |
| Max. Negotiated Rate |
$2,468.10 |
| Rate for Payer: Aetna Commercial |
$2,468.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.28
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,468.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,299.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,558.80
|
| Rate for Payer: Health EOS Commercial |
$2,364.18
|
| Rate for Payer: HFN Commercial |
$2,468.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.48
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.12
|
| Rate for Payer: Quartz Commercial |
$1,480.86
|
| Rate for Payer: The Alliance Commercial |
$1,299.00
|
| Rate for Payer: WEA Trust Commercial |
$1,428.90
|
| Rate for Payer: WPS Commercial |
$1,924.34
|
|
|
US Pregnancy After 1st Trimester TWINS
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
4566911
|
|
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 Pregnancy After 1st Trimester TWINS
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
4566911
|
|
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 Pregnancy Before 1st Trimester TWINS
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
4566914
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$249.82 |
| 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 |
$249.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.82
|
| 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 Pregnancy Before 1st Trimester TWINS
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
4566914
|
|
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 Pregnancy Before 1st Trimester TWINS
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
4566914
|
|
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
|
|
