|
US Fetal Biophysical Profile w/o N-Str
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
2544859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$50.46
|
| Rate for Payer: Anthem Medicare Advantage |
$50.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.46
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.46
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.46
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$75.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$50.46
|
| Rate for Payer: The Alliance Commercial |
$191.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.46
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$252.30
|
|
|
US Fetal Biophysical Profile w/o N-Str
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76819 TC
|
| Hospital Charge Code |
2544859
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal BPP ea add gestation
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6219448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal BPP ea add gestation
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6219448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$284.38 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| 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 |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$284.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
US Fetal BPP ea add gestation
|
Professional
|
Both
|
$1,692.00
|
|
|
Service Code
|
CPT 76818 TC
|
| Hospital Charge Code |
6219448
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.09 |
| Max. Negotiated Rate |
$1,671.70 |
| Rate for Payer: Aetna Commercial |
$1,671.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$71.09
|
| Rate for Payer: Anthem Medicare Advantage |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.09
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,671.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.09
|
| Rate for Payer: Health EOS Commercial |
$1,601.31
|
| Rate for Payer: HFN Commercial |
$1,671.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.09
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$106.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.70
|
| Rate for Payer: Quartz Beloit One Network |
$774.26
|
| Rate for Payer: Quartz Commercial |
$1,003.02
|
| Rate for Payer: Quartz Medicare Advantage |
$71.09
|
| Rate for Payer: The Alliance Commercial |
$270.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.09
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$355.47
|
|
|
US Gallbladder
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| 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 |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| 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 |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Gallbladder
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Gallbladder
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Gallbladder
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
661682
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Gallbladder
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| 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 |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Gallbladder
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544871
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Guidance Needle Placement
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,903.88 |
| Rate for Payer: Aetna Commercial |
$1,903.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,903.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,002.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$1,823.71
|
| Rate for Payer: HFN Commercial |
$1,903.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,903.88
|
| Rate for Payer: Quartz Beloit One Network |
$881.80
|
| Rate for Payer: Quartz Commercial |
$1,142.33
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
US Guidance Needle Placement
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$982.00 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,202.45
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guidance Needle Placement
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
3439543
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$1,843.75 |
| Rate for Payer: Aetna Commercial |
$1,803.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,723.51
|
| Rate for Payer: Aetna Managed Medicare |
$561.14
|
| 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 |
$1,062.16
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,843.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,121.51
|
| Rate for Payer: Health EOS Commercial |
$1,783.63
|
| Rate for Payer: HFN Commercial |
$1,843.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.06
|
| Rate for Payer: Multiplan Commercial |
$1,603.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,202.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,843.75
|
| Rate for Payer: Quartz Beloit One Network |
$982.00
|
| Rate for Payer: Quartz Commercial |
$1,302.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,202.45
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,102.24
|
| Rate for Payer: WPS Commercial |
$1,484.37
|
|
|
US Guided Amniocentesis
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$373.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$866.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.96
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$799.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$866.63
|
| Rate for Payer: Quartz Medicare Advantage |
$799.97
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
US Guided Amniocentesis
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna Commercial |
$1,317.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.81
|
| Rate for Payer: Anthem Medicare Advantage |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.81
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,317.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$693.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.81
|
| Rate for Payer: Health EOS Commercial |
$1,261.55
|
| Rate for Payer: HFN Commercial |
$1,317.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$1,109.06
|
| Rate for Payer: NAPHCARE Commercial |
$50.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.00
|
| Rate for Payer: Quartz Beloit One Network |
$609.98
|
| Rate for Payer: Quartz Commercial |
$790.20
|
| Rate for Payer: Quartz Medicare Advantage |
$33.81
|
| Rate for Payer: The Alliance Commercial |
$128.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.81
|
| Rate for Payer: WEA Trust Commercial |
$762.48
|
| Rate for Payer: WPS Commercial |
$169.05
|
|
|
US Guided Amniocentesis
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$1,266.62 |
| Rate for Payer: Aetna Commercial |
$1,266.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$33.81
|
| Rate for Payer: Anthem Medicare Advantage |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.81
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,266.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$666.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.81
|
| Rate for Payer: Health EOS Commercial |
$1,213.28
|
| Rate for Payer: HFN Commercial |
$1,266.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.81
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$50.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,266.62
|
| Rate for Payer: Quartz Beloit One Network |
$586.64
|
| Rate for Payer: Quartz Commercial |
$759.97
|
| Rate for Payer: Quartz Medicare Advantage |
$33.81
|
| Rate for Payer: The Alliance Commercial |
$128.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.81
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$169.05
|
|
|
US Guided Amniocentesis
|
Facility
|
OP
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$1,275.41 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.24
|
| Rate for Payer: Aetna Managed Medicare |
$388.17
|
| 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 |
$734.75
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,275.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.81
|
| Rate for Payer: Health EOS Commercial |
$1,233.82
|
| Rate for Payer: HFN Commercial |
$1,275.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,039.74
|
| Rate for Payer: Multiplan Commercial |
$1,109.06
|
| Rate for Payer: NAPHCARE Commercial |
$831.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,275.41
|
| Rate for Payer: Quartz Beloit One Network |
$679.30
|
| Rate for Payer: Quartz Commercial |
$901.11
|
| Rate for Payer: Quartz Medicare Advantage |
$831.79
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$762.48
|
| Rate for Payer: WPS Commercial |
$1,026.81
|
|
|
US Guided Amniocentesis
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
625670
|
| Min. Negotiated Rate |
$653.31 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$799.97
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
US Guided Amniocentesis
|
Facility
|
IP
|
$1,333.00
|
|
|
Service Code
|
CPT 76946
|
| Hospital Charge Code |
2544877
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$679.30 |
| Max. Negotiated Rate |
$1,275.41 |
| Rate for Payer: Aetna Commercial |
$1,247.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.75
|
| Rate for Payer: Cash Price |
$399.90
|
| Rate for Payer: Cigna Commercial |
$1,275.41
|
| Rate for Payer: Health EOS Commercial |
$1,233.82
|
| Rate for Payer: HFN Commercial |
$1,275.41
|
| Rate for Payer: Multiplan Commercial |
$1,109.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,275.41
|
| Rate for Payer: Quartz Beloit One Network |
$679.30
|
| Rate for Payer: Quartz Commercial |
$831.79
|
| Rate for Payer: WEA Trust Commercial |
$762.48
|
| Rate for Payer: WPS Commercial |
$1,026.81
|
|
|
US Guided Intraoperative
|
Facility
|
OP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$446.12 |
| Max. Negotiated Rate |
$1,465.82 |
| Rate for Payer: Aetna Commercial |
$1,433.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,370.22
|
| Rate for Payer: Aetna Managed Medicare |
$446.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,035.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$796.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$764.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.44
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,465.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.62
|
| Rate for Payer: Health EOS Commercial |
$1,418.02
|
| Rate for Payer: HFN Commercial |
$1,465.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.96
|
| Rate for Payer: Multiplan Commercial |
$1,274.62
|
| Rate for Payer: NAPHCARE Commercial |
$955.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.82
|
| Rate for Payer: Quartz Beloit One Network |
$780.71
|
| Rate for Payer: Quartz Commercial |
$1,035.63
|
| Rate for Payer: Quartz Medicare Advantage |
$955.97
|
| Rate for Payer: The Alliance Commercial |
$796.64
|
| Rate for Payer: WEA Trust Commercial |
$876.30
|
| Rate for Payer: WPS Commercial |
$1,180.10
|
|
|
US Guided Intraoperative
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$394.88 |
| Max. Negotiated Rate |
$1,513.62 |
| Rate for Payer: Aetna Commercial |
$1,513.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,370.22
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,513.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$796.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.97
|
| Rate for Payer: Health EOS Commercial |
$1,449.88
|
| Rate for Payer: HFN Commercial |
$1,513.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.88
|
| Rate for Payer: Multiplan Commercial |
$1,274.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,513.62
|
| Rate for Payer: Quartz Beloit One Network |
$701.04
|
| Rate for Payer: Quartz Commercial |
$908.17
|
| Rate for Payer: The Alliance Commercial |
$796.64
|
| Rate for Payer: WEA Trust Commercial |
$876.30
|
| Rate for Payer: WPS Commercial |
$1,180.10
|
|
|
US Guided Intraoperative
|
Facility
|
IP
|
$1,532.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
631207
|
| Min. Negotiated Rate |
$780.71 |
| Max. Negotiated Rate |
$1,465.82 |
| Rate for Payer: Aetna Commercial |
$1,433.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,370.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$844.44
|
| Rate for Payer: Cash Price |
$459.60
|
| Rate for Payer: Cigna Commercial |
$1,465.82
|
| Rate for Payer: Health EOS Commercial |
$1,418.02
|
| Rate for Payer: HFN Commercial |
$1,465.82
|
| Rate for Payer: Multiplan Commercial |
$1,274.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,465.82
|
| Rate for Payer: Quartz Beloit One Network |
$780.71
|
| Rate for Payer: Quartz Commercial |
$955.97
|
| Rate for Payer: WEA Trust Commercial |
$876.30
|
| Rate for Payer: WPS Commercial |
$1,180.10
|
|
|
US Guided Intraoperative
|
Facility
|
OP
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$580.36 |
| Max. Negotiated Rate |
$1,906.90 |
| Rate for Payer: Aetna Commercial |
$1,865.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,782.54
|
| Rate for Payer: Aetna Managed Medicare |
$580.36
|
| 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 |
$1,098.54
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,906.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,159.93
|
| Rate for Payer: Health EOS Commercial |
$1,844.72
|
| Rate for Payer: HFN Commercial |
$1,906.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,554.54
|
| Rate for Payer: Multiplan Commercial |
$1,658.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,243.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,906.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,015.63
|
| Rate for Payer: Quartz Commercial |
$1,347.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,243.63
|
| Rate for Payer: The Alliance Commercial |
$1,036.36
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,140.00
|
| Rate for Payer: WPS Commercial |
$1,535.21
|
|
|
US Guided Intraoperative
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
2544881
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$394.88 |
| Max. Negotiated Rate |
$1,969.08 |
| Rate for Payer: Aetna Commercial |
$1,969.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,782.54
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cash Price |
$597.90
|
| Rate for Payer: Cigna Commercial |
$1,969.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,036.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,243.63
|
| Rate for Payer: Health EOS Commercial |
$1,886.18
|
| Rate for Payer: HFN Commercial |
$1,969.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.88
|
| Rate for Payer: Multiplan Commercial |
$1,658.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,969.08
|
| Rate for Payer: Quartz Beloit One Network |
$912.00
|
| Rate for Payer: Quartz Commercial |
$1,181.45
|
| Rate for Payer: The Alliance Commercial |
$1,036.36
|
| Rate for Payer: WEA Trust Commercial |
$1,140.00
|
| Rate for Payer: WPS Commercial |
$1,535.21
|
|
