|
US Pelvis Non-OB Complete
|
Facility
|
OP
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2544942
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.29 |
| Max. Negotiated Rate |
$1,711.72 |
| Rate for Payer: Aetna Commercial |
$1,674.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.08
|
| Rate for Payer: Aetna Managed Medicare |
$520.96
|
| 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 |
$986.10
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,711.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.20
|
| Rate for Payer: Health EOS Commercial |
$1,655.90
|
| Rate for Payer: HFN Commercial |
$1,711.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,395.42
|
| Rate for Payer: Multiplan Commercial |
$1,488.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,116.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,711.72
|
| Rate for Payer: Quartz Beloit One Network |
$911.67
|
| Rate for Payer: Quartz Commercial |
$1,209.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,116.34
|
| Rate for Payer: The Alliance Commercial |
$289.29
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,023.31
|
| Rate for Payer: WPS Commercial |
$1,378.07
|
|
|
US Pelvis Non-OB Complete
|
Facility
|
IP
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2544942
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$911.67 |
| Max. Negotiated Rate |
$1,711.72 |
| Rate for Payer: Aetna Commercial |
$1,674.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.10
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,711.72
|
| Rate for Payer: Health EOS Commercial |
$1,655.90
|
| Rate for Payer: HFN Commercial |
$1,711.72
|
| Rate for Payer: Multiplan Commercial |
$1,488.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,711.72
|
| Rate for Payer: Quartz Beloit One Network |
$911.67
|
| Rate for Payer: Quartz Commercial |
$1,116.34
|
| Rate for Payer: WEA Trust Commercial |
$1,023.31
|
| Rate for Payer: WPS Commercial |
$1,378.07
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
630925
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$594.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.08
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| 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 |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| 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 |
$951.81
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$773.34
|
| 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 |
$654.37
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
US Pelvis Non-OB Limited
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
630925
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$1,130.27 |
| Rate for Payer: Aetna Commercial |
$1,130.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Aetna Managed Medicare |
$50.73
|
| Rate for Payer: Anthem Medicare Advantage |
$50.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.73
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,130.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$594.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.73
|
| Rate for Payer: Health EOS Commercial |
$1,082.68
|
| Rate for Payer: HFN Commercial |
$1,130.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$170.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.73
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: NAPHCARE Commercial |
$76.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,130.27
|
| Rate for Payer: Quartz Beloit One Network |
$523.49
|
| Rate for Payer: Quartz Commercial |
$678.16
|
| Rate for Payer: Quartz Medicare Advantage |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$192.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.73
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$253.66
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2544944
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$622.22 |
| Max. Negotiated Rate |
$1,168.25 |
| Rate for Payer: Aetna Commercial |
$1,142.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.02
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,168.25
|
| Rate for Payer: Health EOS Commercial |
$1,130.16
|
| Rate for Payer: HFN Commercial |
$1,168.25
|
| Rate for Payer: Multiplan Commercial |
$1,015.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.25
|
| Rate for Payer: Quartz Beloit One Network |
$622.22
|
| Rate for Payer: Quartz Commercial |
$761.90
|
| Rate for Payer: WEA Trust Commercial |
$698.41
|
| Rate for Payer: WPS Commercial |
$940.54
|
|
|
US Pelvis Non-OB Limited
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2544944
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$27.06 |
| Max. Negotiated Rate |
$1,206.35 |
| Rate for Payer: Aetna Commercial |
$1,206.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.06
|
| Rate for Payer: Aetna Managed Medicare |
$27.06
|
| Rate for Payer: Anthem Medicare Advantage |
$27.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.06
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,206.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$634.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.06
|
| Rate for Payer: Health EOS Commercial |
$1,155.55
|
| Rate for Payer: HFN Commercial |
$1,206.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.06
|
| Rate for Payer: Multiplan Commercial |
$1,015.87
|
| Rate for Payer: NAPHCARE Commercial |
$40.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,206.35
|
| Rate for Payer: Quartz Beloit One Network |
$558.73
|
| Rate for Payer: Quartz Commercial |
$723.81
|
| Rate for Payer: Quartz Medicare Advantage |
$27.06
|
| Rate for Payer: The Alliance Commercial |
$102.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.06
|
| Rate for Payer: WEA Trust Commercial |
$698.41
|
| Rate for Payer: WPS Commercial |
$135.30
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
CPT 76857 TC
|
| Hospital Charge Code |
2544944
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$1,168.25 |
| Rate for Payer: Aetna Commercial |
$1,142.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.06
|
| Rate for Payer: Aetna Managed Medicare |
$355.56
|
| 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 |
$673.02
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,168.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.62
|
| Rate for Payer: Health EOS Commercial |
$1,130.16
|
| Rate for Payer: HFN Commercial |
$1,168.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$952.38
|
| Rate for Payer: Multiplan Commercial |
$1,015.87
|
| Rate for Payer: NAPHCARE Commercial |
$761.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.25
|
| Rate for Payer: Quartz Beloit One Network |
$622.22
|
| Rate for Payer: Quartz Commercial |
$825.40
|
| Rate for Payer: Quartz Medicare Advantage |
$761.90
|
| Rate for Payer: The Alliance Commercial |
$108.24
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$698.41
|
| Rate for Payer: WPS Commercial |
$940.54
|
|
|
US Pelvis Non-OB Limited
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
630925
|
| Min. Negotiated Rate |
$582.98 |
| Max. Negotiated Rate |
$1,094.58 |
| Rate for Payer: Aetna Commercial |
$1,070.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.57
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,094.58
|
| Rate for Payer: Health EOS Commercial |
$1,058.89
|
| Rate for Payer: HFN Commercial |
$1,094.58
|
| Rate for Payer: Multiplan Commercial |
$951.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.58
|
| Rate for Payer: Quartz Beloit One Network |
$582.98
|
| Rate for Payer: Quartz Commercial |
$713.86
|
| Rate for Payer: WEA Trust Commercial |
$654.37
|
| Rate for Payer: WPS Commercial |
$881.22
|
|
|
US Pelvis, Transvaginal
|
Facility
|
OP
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2587178
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$289.29 |
| Max. Negotiated Rate |
$1,711.72 |
| Rate for Payer: Aetna Commercial |
$1,674.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.08
|
| Rate for Payer: Aetna Managed Medicare |
$520.96
|
| 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 |
$986.10
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,711.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,041.20
|
| Rate for Payer: Health EOS Commercial |
$1,655.90
|
| Rate for Payer: HFN Commercial |
$1,711.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,395.42
|
| Rate for Payer: Multiplan Commercial |
$1,488.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,116.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,711.72
|
| Rate for Payer: Quartz Beloit One Network |
$911.67
|
| Rate for Payer: Quartz Commercial |
$1,209.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,116.34
|
| Rate for Payer: The Alliance Commercial |
$289.29
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,023.31
|
| Rate for Payer: WPS Commercial |
$1,378.07
|
|
|
US Pelvis, Transvaginal
|
Facility
|
IP
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2587178
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$911.67 |
| Max. Negotiated Rate |
$1,711.72 |
| Rate for Payer: Aetna Commercial |
$1,674.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$986.10
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,711.72
|
| Rate for Payer: Health EOS Commercial |
$1,655.90
|
| Rate for Payer: HFN Commercial |
$1,711.72
|
| Rate for Payer: Multiplan Commercial |
$1,488.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,711.72
|
| Rate for Payer: Quartz Beloit One Network |
$911.67
|
| Rate for Payer: Quartz Commercial |
$1,116.34
|
| Rate for Payer: WEA Trust Commercial |
$1,023.31
|
| Rate for Payer: WPS Commercial |
$1,378.07
|
|
|
US Pelvis, Transvaginal
|
Professional
|
Both
|
$1,789.00
|
|
|
Service Code
|
CPT 76856 TC
|
| Hospital Charge Code |
2587178
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.32 |
| Max. Negotiated Rate |
$1,767.53 |
| Rate for Payer: Aetna Commercial |
$1,767.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.08
|
| Rate for Payer: Aetna Managed Medicare |
$72.32
|
| Rate for Payer: Anthem Medicare Advantage |
$72.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.32
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cash Price |
$536.70
|
| Rate for Payer: Cigna Commercial |
$1,767.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$930.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.32
|
| Rate for Payer: Health EOS Commercial |
$1,693.11
|
| Rate for Payer: HFN Commercial |
$1,767.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$269.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.32
|
| Rate for Payer: Multiplan Commercial |
$1,488.45
|
| Rate for Payer: NAPHCARE Commercial |
$108.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,767.53
|
| Rate for Payer: Quartz Beloit One Network |
$818.65
|
| Rate for Payer: Quartz Commercial |
$1,060.52
|
| Rate for Payer: Quartz Medicare Advantage |
$72.32
|
| Rate for Payer: The Alliance Commercial |
$274.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.32
|
| Rate for Payer: WEA Trust Commercial |
$1,023.31
|
| Rate for Payer: WPS Commercial |
$361.61
|
|
|
US Placenta Localization
|
Professional
|
Both
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.36 |
| Max. Negotiated Rate |
$1,152.01 |
| Rate for Payer: Aetna Commercial |
$1,152.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Aetna Managed Medicare |
$50.36
|
| Rate for Payer: Anthem Medicare Advantage |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.36
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,152.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$606.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$1,103.50
|
| Rate for Payer: HFN Commercial |
$1,152.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.36
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: NAPHCARE Commercial |
$75.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,152.01
|
| Rate for Payer: Quartz Beloit One Network |
$533.56
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: Quartz Medicare Advantage |
$50.36
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.36
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$251.78
|
|
|
US Placenta Localization
|
Facility
|
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$594.19 |
| Max. Negotiated Rate |
$1,115.63 |
| Rate for Payer: Aetna Commercial |
$1,091.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.70
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,115.63
|
| Rate for Payer: Health EOS Commercial |
$1,079.25
|
| Rate for Payer: HFN Commercial |
$1,115.63
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.63
|
| Rate for Payer: Quartz Beloit One Network |
$594.19
|
| Rate for Payer: Quartz Commercial |
$727.58
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$898.17
|
|
|
US Placenta Localization
|
Facility
|
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 76815 TC
|
| Hospital Charge Code |
2587181
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$201.43 |
| Max. Negotiated Rate |
$1,115.63 |
| Rate for Payer: Aetna Commercial |
$1,091.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.87
|
| Rate for Payer: Aetna Managed Medicare |
$339.54
|
| 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 |
$642.70
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cash Price |
$349.80
|
| Rate for Payer: Cigna Commercial |
$1,115.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.61
|
| Rate for Payer: Health EOS Commercial |
$1,079.25
|
| Rate for Payer: HFN Commercial |
$1,115.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.48
|
| Rate for Payer: Multiplan Commercial |
$970.11
|
| Rate for Payer: NAPHCARE Commercial |
$727.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.63
|
| Rate for Payer: Quartz Beloit One Network |
$594.19
|
| Rate for Payer: Quartz Commercial |
$788.22
|
| Rate for Payer: Quartz Medicare Advantage |
$727.58
|
| Rate for Payer: The Alliance Commercial |
$201.43
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$666.95
|
| Rate for Payer: WPS Commercial |
$898.17
|
|
|
US Placenta Localization
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Quartz Commercial |
$757.80
|
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$757.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$559.60
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| 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 |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$652.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| 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 |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| 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 |
$641.21
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
US Placenta Localization
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$571.26 |
| Max. Negotiated Rate |
$1,072.57 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$617.90
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,072.57
|
| Rate for Payer: Health EOS Commercial |
$1,037.60
|
| Rate for Payer: HFN Commercial |
$1,072.57
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.57
|
| Rate for Payer: Quartz Beloit One Network |
$571.26
|
| Rate for Payer: Quartz Commercial |
$699.50
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$863.51
|
|
|
US Placenta Localization
|
Professional
|
Both
|
$1,121.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
2552811
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$1,107.55 |
| Rate for Payer: Aetna Commercial |
$1,107.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,002.62
|
| Rate for Payer: Aetna Managed Medicare |
$80.98
|
| Rate for Payer: Anthem Medicare Advantage |
$80.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.98
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cash Price |
$336.30
|
| Rate for Payer: Cigna Commercial |
$1,107.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$582.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.98
|
| Rate for Payer: Health EOS Commercial |
$1,060.91
|
| Rate for Payer: HFN Commercial |
$1,107.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$932.67
|
| Rate for Payer: NAPHCARE Commercial |
$121.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.55
|
| Rate for Payer: Quartz Beloit One Network |
$512.97
|
| Rate for Payer: Quartz Commercial |
$664.53
|
| Rate for Payer: Quartz Medicare Advantage |
$80.98
|
| Rate for Payer: The Alliance Commercial |
$307.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.98
|
| Rate for Payer: WEA Trust Commercial |
$641.21
|
| Rate for Payer: WPS Commercial |
$404.92
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,699.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
4568616
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$2,666.61 |
| Rate for Payer: Aetna Commercial |
$2,666.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.99
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Medicare Advantage |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.97
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,666.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,403.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.97
|
| Rate for Payer: Health EOS Commercial |
$2,554.33
|
| Rate for Payer: HFN Commercial |
$2,666.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$2,245.57
|
| Rate for Payer: NAPHCARE Commercial |
$31.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,666.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.06
|
| Rate for Payer: Quartz Commercial |
$1,599.97
|
| Rate for Payer: Quartz Medicare Advantage |
$20.97
|
| Rate for Payer: The Alliance Commercial |
$79.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.97
|
| Rate for Payer: WEA Trust Commercial |
$1,543.83
|
| Rate for Payer: WPS Commercial |
$104.83
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,699.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
4568616
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$2,582.40 |
| Rate for Payer: Aetna Commercial |
$2,526.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,413.99
|
| Rate for Payer: Aetna Managed Medicare |
$785.95
|
| 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 |
$1,487.69
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cash Price |
$809.70
|
| Rate for Payer: Cigna Commercial |
$2,582.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,570.82
|
| Rate for Payer: Health EOS Commercial |
$2,498.19
|
| Rate for Payer: HFN Commercial |
$2,582.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,105.22
|
| Rate for Payer: Multiplan Commercial |
$2,245.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,582.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.41
|
| Rate for Payer: Quartz Commercial |
$1,824.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.18
|
| Rate for Payer: The Alliance Commercial |
$83.87
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,543.83
|
| Rate for Payer: WPS Commercial |
$2,079.04
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
IP
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$1,272.98 |
| Max. Negotiated Rate |
$2,390.09 |
| Rate for Payer: Aetna Commercial |
$2,338.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.90
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,390.09
|
| Rate for Payer: Health EOS Commercial |
$2,312.15
|
| Rate for Payer: HFN Commercial |
$2,390.09
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.98
|
| Rate for Payer: Quartz Commercial |
$1,558.75
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$1,924.21
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$242.03 |
| Max. Negotiated Rate |
$2,390.09 |
| Rate for Payer: Aetna Commercial |
$2,338.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Aetna Managed Medicare |
$727.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,688.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,298.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,247.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,376.90
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,390.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,453.84
|
| Rate for Payer: Health EOS Commercial |
$2,312.15
|
| Rate for Payer: HFN Commercial |
$2,390.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,948.44
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,558.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,390.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,272.98
|
| Rate for Payer: Quartz Commercial |
$1,688.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,558.75
|
| Rate for Payer: The Alliance Commercial |
$242.03
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$1,924.21
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$2,498.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
2552799
|
| Min. Negotiated Rate |
$60.51 |
| Max. Negotiated Rate |
$2,468.02 |
| Rate for Payer: Aetna Commercial |
$2,468.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,234.21
|
| Rate for Payer: Aetna Managed Medicare |
$60.51
|
| Rate for Payer: Anthem Medicare Advantage |
$60.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.51
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cash Price |
$749.40
|
| Rate for Payer: Cigna Commercial |
$2,468.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,298.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.51
|
| Rate for Payer: Health EOS Commercial |
$2,364.11
|
| Rate for Payer: HFN Commercial |
$2,468.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.51
|
| Rate for Payer: Multiplan Commercial |
$2,078.34
|
| Rate for Payer: NAPHCARE Commercial |
$90.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,468.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,143.08
|
| Rate for Payer: Quartz Commercial |
$1,480.81
|
| Rate for Payer: Quartz Medicare Advantage |
$60.51
|
| Rate for Payer: The Alliance Commercial |
$229.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.51
|
| Rate for Payer: WEA Trust Commercial |
$1,428.86
|
| Rate for Payer: WPS Commercial |
$302.54
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
2587184
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Preg 1st Tri Ea Add Gest
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
2587184
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$1,823.85 |
| Rate for Payer: Aetna Commercial |
$1,823.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$20.97
|
| Rate for Payer: Anthem Medicare Advantage |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.97
|
| 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 |
$1,823.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.97
|
| Rate for Payer: Health EOS Commercial |
$1,747.05
|
| Rate for Payer: HFN Commercial |
$1,823.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.97
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$31.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.85
|
| Rate for Payer: Quartz Beloit One Network |
$844.73
|
| Rate for Payer: Quartz Commercial |
$1,094.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.97
|
| Rate for Payer: The Alliance Commercial |
$79.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.97
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$104.83
|
|
|
US Preg 1st Tri Ea Add Gest
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76802 TC
|
| Hospital Charge Code |
2587184
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.87 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| 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 |
$1,017.52
|
| 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 |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$83.87
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
