|
US Thyroid
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$673.26 |
| Max. Negotiated Rate |
$1,264.08 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$824.40
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
US Thyroid
|
Professional
|
Both
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$1,606.45 |
| Rate for Payer: Aetna Commercial |
$1,606.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,454.26
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,606.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$845.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.60
|
| Rate for Payer: Health EOS Commercial |
$1,538.81
|
| Rate for Payer: HFN Commercial |
$1,606.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.03
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,606.45
|
| Rate for Payer: Quartz Beloit One Network |
$744.04
|
| Rate for Payer: Quartz Commercial |
$963.87
|
| Rate for Payer: The Alliance Commercial |
$845.50
|
| Rate for Payer: WEA Trust Commercial |
$930.05
|
| Rate for Payer: WPS Commercial |
$1,252.52
|
|
|
US Thyroid
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$828.59 |
| Max. Negotiated Rate |
$1,555.72 |
| Rate for Payer: Aetna Commercial |
$1,521.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,454.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.23
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,555.72
|
| Rate for Payer: Health EOS Commercial |
$1,504.99
|
| Rate for Payer: HFN Commercial |
$1,555.72
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,014.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,555.72
|
| Rate for Payer: Quartz Beloit One Network |
$828.59
|
| Rate for Payer: Quartz Commercial |
$1,014.60
|
| Rate for Payer: WEA Trust Commercial |
$930.05
|
| Rate for Payer: WPS Commercial |
$1,252.52
|
|
|
US, Transrectal 7687226
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3165709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.56
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
US, Transrectal 7687226PP
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3303484
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.56
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
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 |
$297.36 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$297.36
|
| 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 |
$562.86
|
| 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 |
$977.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.30
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.50
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$690.30
|
| Rate for Payer: Quartz Medicare Advantage |
$637.20
|
| Rate for Payer: The Alliance Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
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 |
$520.38 |
| Max. Negotiated Rate |
$977.04 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$637.20
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
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 |
$307.82 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,008.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$637.20
|
| Rate for Payer: Health EOS Commercial |
$966.42
|
| Rate for Payer: HFN Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.82
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.90
|
| Rate for Payer: Quartz Beloit One Network |
$467.28
|
| Rate for Payer: Quartz Commercial |
$605.34
|
| Rate for Payer: The Alliance Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
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 |
$307.82 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,008.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$637.20
|
| Rate for Payer: Health EOS Commercial |
$966.42
|
| Rate for Payer: HFN Commercial |
$1,008.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.82
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.90
|
| Rate for Payer: Quartz Beloit One Network |
$467.28
|
| Rate for Payer: Quartz Commercial |
$605.34
|
| Rate for Payer: The Alliance Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
US Transvaginal Non-OB
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$423.28 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna Commercial |
$978.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$978.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$515.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.00
|
| Rate for Payer: Health EOS Commercial |
$937.30
|
| Rate for Payer: HFN Commercial |
$978.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.28
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: Preferred Network Access Commercial |
$978.50
|
| Rate for Payer: Quartz Beloit One Network |
$453.20
|
| Rate for Payer: Quartz Commercial |
$587.10
|
| Rate for Payer: The Alliance Commercial |
$515.00
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.40
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| 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 |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| 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 |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$669.50
|
| 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 |
$566.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
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 |
$297.36 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$297.36
|
| 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 |
$562.86
|
| 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 |
$977.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.30
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.50
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$690.30
|
| Rate for Payer: Quartz Medicare Advantage |
$637.20
|
| Rate for Payer: The Alliance Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
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 |
$520.38 |
| Max. Negotiated Rate |
$977.04 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$637.20
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$618.00
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$618.00
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
US Transvaginal OB
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$318.08 |
| Max. Negotiated Rate |
$4,544.00 |
| Rate for Payer: Aetna Commercial |
$1,022.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Aetna Managed Medicare |
$318.08
|
| 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 |
$602.08
|
| 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 |
$1,045.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.71
|
| Rate for Payer: Health EOS Commercial |
$1,011.04
|
| Rate for Payer: HFN Commercial |
$1,045.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$852.00
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: NAPHCARE Commercial |
$681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.12
|
| Rate for Payer: Quartz Beloit One Network |
$556.64
|
| Rate for Payer: Quartz Commercial |
$738.40
|
| Rate for Payer: Quartz Medicare Advantage |
$681.60
|
| Rate for Payer: The Alliance Commercial |
$4,544.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
US Transvaginal OB
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$556.64 |
| Max. Negotiated Rate |
$1,045.12 |
| Rate for Payer: Aetna Commercial |
$1,022.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.08
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,045.12
|
| Rate for Payer: Health EOS Commercial |
$1,011.04
|
| Rate for Payer: HFN Commercial |
$1,045.12
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: NAPHCARE Commercial |
$681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.12
|
| Rate for Payer: Quartz Beloit One Network |
$556.64
|
| Rate for Payer: Quartz Commercial |
$681.60
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
US Transvaginal OB
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$202.23 |
| Max. Negotiated Rate |
$1,079.20 |
| Rate for Payer: Aetna Commercial |
$1,079.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,079.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$568.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.60
|
| Rate for Payer: Health EOS Commercial |
$1,033.76
|
| Rate for Payer: HFN Commercial |
$1,079.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$202.23
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,079.20
|
| Rate for Payer: Quartz Beloit One Network |
$499.84
|
| Rate for Payer: Quartz Commercial |
$647.52
|
| Rate for Payer: The Alliance Commercial |
$568.00
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
US Umbilical Artery Doppler
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.60
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: HFN Commercial |
$594.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.62
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: The Alliance Commercial |
$313.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
US Umbilical Artery Doppler
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
US Umbilical Artery Doppler
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| 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 |
$331.78
|
| 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 |
$575.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
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 |
$423.72 |
| Max. Negotiated Rate |
$914.85 |
| Rate for Payer: Aetna Commercial |
$914.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$914.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$481.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.80
|
| Rate for Payer: Health EOS Commercial |
$876.33
|
| Rate for Payer: HFN Commercial |
$914.85
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Preferred Network Access Commercial |
$914.85
|
| Rate for Payer: Quartz Beloit One Network |
$423.72
|
| Rate for Payer: Quartz Commercial |
$548.91
|
| Rate for Payer: The Alliance Commercial |
$481.50
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
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 |
$269.64 |
| Max. Negotiated Rate |
$3,852.00 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Aetna Managed Medicare |
$269.64
|
| 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 |
$510.39
|
| 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 |
$885.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.89
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.25
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$625.95
|
| Rate for Payer: Quartz Medicare Advantage |
$577.80
|
| Rate for Payer: The Alliance Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
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 |
$471.87 |
| Max. Negotiated Rate |
$885.96 |
| Rate for Payer: Aetna Commercial |
$866.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$828.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.39
|
| Rate for Payer: Cash Price |
$288.90
|
| Rate for Payer: Cigna Commercial |
$885.96
|
| Rate for Payer: Health EOS Commercial |
$857.07
|
| Rate for Payer: HFN Commercial |
$885.96
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: NAPHCARE Commercial |
$577.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.96
|
| Rate for Payer: Quartz Beloit One Network |
$471.87
|
| Rate for Payer: Quartz Commercial |
$577.80
|
| Rate for Payer: WEA Trust Commercial |
$529.65
|
| Rate for Payer: WPS Commercial |
$713.29
|
|
|
US Unlisted Procedure
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
CPT 76999 TC
|
| Hospital Charge Code |
2544985
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$809.16 |
| Max. Negotiated Rate |
$1,747.05 |
| Rate for Payer: Aetna Commercial |
$1,747.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,581.54
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cash Price |
$551.70
|
| Rate for Payer: Cigna Commercial |
$1,747.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$919.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,103.40
|
| Rate for Payer: Health EOS Commercial |
$1,673.49
|
| Rate for Payer: HFN Commercial |
$1,747.05
|
| Rate for Payer: Multiplan Commercial |
$1,471.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,747.05
|
| Rate for Payer: Quartz Beloit One Network |
$809.16
|
| Rate for Payer: Quartz Commercial |
$1,048.23
|
| Rate for Payer: The Alliance Commercial |
$919.50
|
| Rate for Payer: WEA Trust Commercial |
$1,011.45
|
| Rate for Payer: WPS Commercial |
$1,362.15
|
|
|
US Unlisted Procedure
|
Facility
|
OP
|
$1,839.00
|
|
|
Service Code
|
CPT 76999 TC
|
| Hospital Charge Code |
2544985
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$514.92 |
| Max. Negotiated Rate |
$7,356.00 |
| Rate for Payer: Aetna Commercial |
$1,655.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,581.54
|
| Rate for Payer: Aetna Managed Medicare |
$514.92
|
| 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 |
$974.67
|
| 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 |
$1,691.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,029.10
|
| Rate for Payer: Health EOS Commercial |
$1,636.71
|
| Rate for Payer: HFN Commercial |
$1,691.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,379.25
|
| Rate for Payer: Multiplan Commercial |
$1,471.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,103.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,691.88
|
| Rate for Payer: Quartz Beloit One Network |
$901.11
|
| Rate for Payer: Quartz Commercial |
$1,195.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,103.40
|
| Rate for Payer: The Alliance Commercial |
$7,356.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,011.45
|
| Rate for Payer: WPS Commercial |
$1,362.15
|
|
