|
US Thoracentesis
|
Facility
|
IP
|
$2,950.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2544979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,503.32 |
| Max. Negotiated Rate |
$2,822.56 |
| Rate for Payer: Aetna Commercial |
$2,761.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,638.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,626.04
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,822.56
|
| Rate for Payer: Health EOS Commercial |
$2,730.52
|
| Rate for Payer: HFN Commercial |
$2,822.56
|
| Rate for Payer: Multiplan Commercial |
$2,454.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,822.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,503.32
|
| Rate for Payer: Quartz Commercial |
$1,840.80
|
| Rate for Payer: WEA Trust Commercial |
$1,687.40
|
| Rate for Payer: WPS Commercial |
$2,272.39
|
|
|
US Thoracentesis
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$2,242.76 |
| Rate for Payer: Aetna Commercial |
$2,242.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.29
|
| Rate for Payer: Aetna Managed Medicare |
$91.77
|
| Rate for Payer: Anthem Medicare Advantage |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.77
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,242.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.77
|
| Rate for Payer: Health EOS Commercial |
$2,148.33
|
| Rate for Payer: HFN Commercial |
$2,242.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$388.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.77
|
| Rate for Payer: Multiplan Commercial |
$1,888.64
|
| Rate for Payer: NAPHCARE Commercial |
$137.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,242.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,038.75
|
| Rate for Payer: Quartz Commercial |
$1,345.66
|
| Rate for Payer: Quartz Medicare Advantage |
$91.77
|
| Rate for Payer: The Alliance Commercial |
$390.02
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.77
|
| Rate for Payer: WEA Trust Commercial |
$1,298.44
|
| Rate for Payer: WPS Commercial |
$412.96
|
|
|
US Thoracentesis
|
Facility
|
OP
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$660.17 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,124.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.29
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,534.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,180.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,133.18
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,171.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$2,101.11
|
| Rate for Payer: HFN Commercial |
$2,171.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$1,888.64
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.79
|
| Rate for Payer: Quartz Commercial |
$1,534.52
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: WEA Trust Commercial |
$1,298.44
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$1,748.58
|
|
|
US Thoracentesis
|
Professional
|
Both
|
$2,950.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2544979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$2,914.60 |
| Rate for Payer: Aetna Commercial |
$2,914.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,638.48
|
| Rate for Payer: Aetna Managed Medicare |
$91.77
|
| Rate for Payer: Anthem Medicare Advantage |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.77
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,914.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.77
|
| Rate for Payer: Health EOS Commercial |
$2,791.88
|
| Rate for Payer: HFN Commercial |
$2,914.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$388.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.77
|
| Rate for Payer: Multiplan Commercial |
$2,454.40
|
| Rate for Payer: NAPHCARE Commercial |
$137.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,914.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,349.92
|
| Rate for Payer: Quartz Commercial |
$1,748.76
|
| Rate for Payer: Quartz Medicare Advantage |
$91.77
|
| Rate for Payer: The Alliance Commercial |
$390.02
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.77
|
| Rate for Payer: WEA Trust Commercial |
$1,687.40
|
| Rate for Payer: WPS Commercial |
$412.96
|
|
|
US Thoracentesis
|
Facility
|
IP
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$1,156.79 |
| Max. Negotiated Rate |
$2,171.94 |
| Rate for Payer: Aetna Commercial |
$2,124.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,030.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.22
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,171.94
|
| Rate for Payer: Health EOS Commercial |
$2,101.11
|
| Rate for Payer: HFN Commercial |
$2,171.94
|
| Rate for Payer: Multiplan Commercial |
$1,888.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.79
|
| Rate for Payer: Quartz Commercial |
$1,416.48
|
| Rate for Payer: WEA Trust Commercial |
$1,298.44
|
| Rate for Payer: WPS Commercial |
$1,748.58
|
|
|
US Thoracentesis
|
Facility
|
OP
|
$2,950.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2544979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,761.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,638.48
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| 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: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,626.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,822.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$2,730.52
|
| Rate for Payer: HFN Commercial |
$2,822.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$2,454.40
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,822.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,503.32
|
| Rate for Payer: Quartz Commercial |
$1,994.20
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,687.40
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$2,272.39
|
|
|
US Thyroid
|
Professional
|
Both
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$1,670.71 |
| Rate for Payer: Aetna Commercial |
$1,670.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.43
|
| Rate for Payer: Aetna Managed Medicare |
$81.64
|
| Rate for Payer: Anthem Medicare Advantage |
$81.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.64
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,670.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$879.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.64
|
| Rate for Payer: Health EOS Commercial |
$1,600.36
|
| Rate for Payer: HFN Commercial |
$1,670.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.64
|
| Rate for Payer: Multiplan Commercial |
$1,406.91
|
| Rate for Payer: NAPHCARE Commercial |
$122.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,670.71
|
| Rate for Payer: Quartz Beloit One Network |
$773.80
|
| Rate for Payer: Quartz Commercial |
$1,002.42
|
| Rate for Payer: Quartz Medicare Advantage |
$81.64
|
| Rate for Payer: The Alliance Commercial |
$310.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.64
|
| Rate for Payer: WEA Trust Commercial |
$967.25
|
| Rate for Payer: WPS Commercial |
$408.20
|
|
|
US Thyroid
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$861.73 |
| Max. Negotiated Rate |
$1,617.95 |
| Rate for Payer: Aetna Commercial |
$1,582.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.08
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,617.95
|
| Rate for Payer: Health EOS Commercial |
$1,565.19
|
| Rate for Payer: HFN Commercial |
$1,617.95
|
| Rate for Payer: Multiplan Commercial |
$1,406.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,617.95
|
| Rate for Payer: Quartz Beloit One Network |
$861.73
|
| Rate for Payer: Quartz Commercial |
$1,055.18
|
| Rate for Payer: WEA Trust Commercial |
$967.25
|
| Rate for Payer: WPS Commercial |
$1,302.58
|
|
|
US Thyroid
|
Facility
|
OP
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$326.56 |
| Max. Negotiated Rate |
$1,617.95 |
| Rate for Payer: Aetna Commercial |
$1,582.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.43
|
| Rate for Payer: Aetna Managed Medicare |
$492.42
|
| 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 |
$932.08
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,617.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.16
|
| Rate for Payer: Health EOS Commercial |
$1,565.19
|
| Rate for Payer: HFN Commercial |
$1,617.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,318.98
|
| Rate for Payer: Multiplan Commercial |
$1,406.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,617.95
|
| Rate for Payer: Quartz Beloit One Network |
$861.73
|
| Rate for Payer: Quartz Commercial |
$1,143.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.18
|
| Rate for Payer: The Alliance Commercial |
$326.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$967.25
|
| Rate for Payer: WPS Commercial |
$1,302.58
|
|
|
US Thyroid
|
Facility
|
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
US Thyroid
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$1,357.51 |
| Rate for Payer: Aetna Commercial |
$1,357.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$108.06
|
| Rate for Payer: Anthem Medicare Advantage |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.06
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,357.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$714.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.06
|
| Rate for Payer: Health EOS Commercial |
$1,300.35
|
| Rate for Payer: HFN Commercial |
$1,357.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$412.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.06
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,357.51
|
| Rate for Payer: Quartz Beloit One Network |
$628.74
|
| Rate for Payer: Quartz Commercial |
$814.51
|
| Rate for Payer: Quartz Medicare Advantage |
$108.06
|
| Rate for Payer: The Alliance Commercial |
$410.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.06
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$540.28
|
|
|
US Thyroid
|
Facility
|
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| 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 |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| 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 |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| 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 |
$785.93
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
US, Transrectal 7687226
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3165709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$32.12
|
| Rate for Payer: Anthem Medicare Advantage |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.12
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.12
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.12
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$48.17
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$32.12
|
| Rate for Payer: The Alliance Commercial |
$122.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.12
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$160.58
|
|
|
US, Transrectal 7687226PP
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3303484
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$32.12
|
| Rate for Payer: Anthem Medicare Advantage |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.12
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.12
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.12
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$48.17
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$32.12
|
| Rate for Payer: The Alliance Commercial |
$122.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.12
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$160.58
|
|
|
US Transvaginal Non-Ob
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$662.69
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-Ob
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$1,049.26 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$84.41
|
| Rate for Payer: Anthem Medicare Advantage |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.41
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,049.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.41
|
| Rate for Payer: Health EOS Commercial |
$1,005.08
|
| Rate for Payer: HFN Commercial |
$1,049.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.41
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$126.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.26
|
| Rate for Payer: Quartz Beloit One Network |
$485.97
|
| Rate for Payer: Quartz Commercial |
$629.55
|
| Rate for Payer: Quartz Medicare Advantage |
$84.41
|
| Rate for Payer: The Alliance Commercial |
$320.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.41
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$422.03
|
|
|
US Transvaginal Non-Ob
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$309.25 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$309.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.08
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.36
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$662.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$717.91
|
| Rate for Payer: Quartz Medicare Advantage |
$662.69
|
| Rate for Payer: The Alliance Commercial |
$337.63
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$964.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.18
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$985.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$953.37
|
| Rate for Payer: HFN Commercial |
$985.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$985.50
|
| Rate for Payer: Quartz Beloit One Network |
$524.89
|
| Rate for Payer: Quartz Commercial |
$696.28
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
|
US Transvaginal Non-OB
|
Facility
|
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$309.25 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$309.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.08
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.36
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$662.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$717.91
|
| Rate for Payer: Quartz Medicare Advantage |
$662.69
|
| Rate for Payer: The Alliance Commercial |
$337.63
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-OB
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$116.76 |
| Max. Negotiated Rate |
$1,017.64 |
| Rate for Payer: Aetna Commercial |
$1,017.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$116.76
|
| Rate for Payer: Anthem Medicare Advantage |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.76
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$1,017.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$535.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.76
|
| Rate for Payer: Health EOS Commercial |
$974.79
|
| Rate for Payer: HFN Commercial |
$1,017.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.76
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$175.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.64
|
| Rate for Payer: Quartz Beloit One Network |
$471.33
|
| Rate for Payer: Quartz Commercial |
$610.58
|
| Rate for Payer: Quartz Medicare Advantage |
$116.76
|
| Rate for Payer: The Alliance Commercial |
$443.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.76
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$583.80
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$524.89 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$964.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.74
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$985.50
|
| Rate for Payer: Health EOS Commercial |
$953.37
|
| Rate for Payer: HFN Commercial |
$985.50
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: Preferred Network Access Commercial |
$985.50
|
| Rate for Payer: Quartz Beloit One Network |
$524.89
|
| Rate for Payer: Quartz Commercial |
$642.72
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
|
US Transvaginal Non-OB
|
Facility
|
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$662.69
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
US Transvaginal Non-OB
|
Professional
|
Both
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$1,049.26 |
| Rate for Payer: Aetna Commercial |
$1,049.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$84.41
|
| Rate for Payer: Anthem Medicare Advantage |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.41
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,049.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.41
|
| Rate for Payer: Health EOS Commercial |
$1,005.08
|
| Rate for Payer: HFN Commercial |
$1,049.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.41
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$126.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,049.26
|
| Rate for Payer: Quartz Beloit One Network |
$485.97
|
| Rate for Payer: Quartz Commercial |
$629.55
|
| Rate for Payer: Quartz Medicare Advantage |
$84.41
|
| Rate for Payer: The Alliance Commercial |
$320.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.41
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$422.03
|
|
|
US Transvaginal OB
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$1,122.37 |
| Rate for Payer: Aetna Commercial |
$1,122.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$57.01
|
| Rate for Payer: Anthem Medicare Advantage |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.01
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,122.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$590.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.01
|
| Rate for Payer: Health EOS Commercial |
$1,075.11
|
| Rate for Payer: HFN Commercial |
$1,122.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.01
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$85.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,122.37
|
| Rate for Payer: Quartz Beloit One Network |
$519.83
|
| Rate for Payer: Quartz Commercial |
$673.42
|
| Rate for Payer: Quartz Medicare Advantage |
$57.01
|
| Rate for Payer: The Alliance Commercial |
$216.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.01
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$285.06
|
|
|
US Transvaginal OB
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$1,086.92 |
| Rate for Payer: Aetna Commercial |
$1,063.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.04
|
| Rate for Payer: Aetna Managed Medicare |
$330.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,086.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.15
|
| Rate for Payer: Health EOS Commercial |
$1,051.48
|
| Rate for Payer: HFN Commercial |
$1,086.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$886.08
|
| Rate for Payer: Multiplan Commercial |
$945.15
|
| Rate for Payer: NAPHCARE Commercial |
$708.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.92
|
| Rate for Payer: Quartz Beloit One Network |
$578.91
|
| Rate for Payer: Quartz Commercial |
$767.94
|
| Rate for Payer: Quartz Medicare Advantage |
$708.86
|
| Rate for Payer: The Alliance Commercial |
$228.05
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$649.79
|
| Rate for Payer: WPS Commercial |
$875.06
|
|
