|
BCE Asp/Inj, Thyroid Cyst
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 60300 TC
|
| Hospital Charge Code |
5484990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.49
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
BCE Asp/Inj, Thyroid Cyst
|
Facility
IP
|
$671.00
|
|
|
Service Code
|
CPT 60300 TC
|
| Hospital Charge Code |
5484990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
BCE Asp/Inj, Thyroid Cyst
|
Professional
|
$671.00
|
|
|
Service Code
|
CPT 60300 TC
|
| Hospital Charge Code |
5484990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
BCE Axumin
|
Facility
OP
|
$1,163.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5454652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.64 |
| Max. Negotiated Rate |
$1,069.96 |
| Rate for Payer: Aetna Commercial |
$1,046.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.18
|
| Rate for Payer: Aetna Managed Medicare |
$325.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.39
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cigna Commercial |
$1,069.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.81
|
| Rate for Payer: Health EOS Commercial |
$1,035.07
|
| Rate for Payer: HFN Commercial |
$1,069.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.25
|
| Rate for Payer: Multiplan Commercial |
$930.40
|
| Rate for Payer: NAPHCARE Commercial |
$697.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.96
|
| Rate for Payer: Quartz Beloit One Network |
$569.87
|
| Rate for Payer: Quartz Commercial |
$755.95
|
| Rate for Payer: Quartz Medicare Advantage |
$697.80
|
| Rate for Payer: WEA Trust Commercial |
$639.65
|
| Rate for Payer: WPS Commercial |
$861.43
|
|
|
BCE Axumin
|
Professional
|
$1,163.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5454652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$511.72 |
| Max. Negotiated Rate |
$1,104.85 |
| Rate for Payer: Aetna Commercial |
$1,104.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,000.18
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cigna Commercial |
$1,104.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$581.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$697.80
|
| Rate for Payer: Health EOS Commercial |
$1,058.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$701.68
|
| Rate for Payer: Multiplan Commercial |
$930.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.85
|
| Rate for Payer: Quartz Beloit One Network |
$511.72
|
| Rate for Payer: Quartz Commercial |
$662.91
|
| Rate for Payer: The Alliance Commercial |
$581.50
|
| Rate for Payer: WEA Trust Commercial |
$639.65
|
| Rate for Payer: WPS Commercial |
$861.43
|
|
|
BCE Axumin
|
Facility
IP
|
$1,163.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5454652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$569.87 |
| Max. Negotiated Rate |
$1,069.96 |
| Rate for Payer: Aetna Commercial |
$1,046.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.39
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cigna Commercial |
$1,069.96
|
| Rate for Payer: Health EOS Commercial |
$1,035.07
|
| Rate for Payer: HFN Commercial |
$1,069.96
|
| Rate for Payer: Multiplan Commercial |
$930.40
|
| Rate for Payer: NAPHCARE Commercial |
$697.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.96
|
| Rate for Payer: Quartz Beloit One Network |
$569.87
|
| Rate for Payer: Quartz Commercial |
$697.80
|
| Rate for Payer: WEA Trust Commercial |
$639.65
|
| Rate for Payer: WPS Commercial |
$861.43
|
|
|
BCE Biopsy Bone
|
Facility
IP
|
$4,258.00
|
|
|
Service Code
|
CPT 20220 TC
|
| Hospital Charge Code |
5518669
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,086.42 |
| Max. Negotiated Rate |
$3,917.36 |
| Rate for Payer: Aetna Commercial |
$3,832.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,256.74
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$3,917.36
|
| Rate for Payer: Health EOS Commercial |
$3,789.62
|
| Rate for Payer: HFN Commercial |
$3,917.36
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,554.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,917.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,086.42
|
| Rate for Payer: Quartz Commercial |
$2,554.80
|
| Rate for Payer: WEA Trust Commercial |
$2,341.90
|
| Rate for Payer: WPS Commercial |
$3,153.90
|
|
|
BCE Biopsy Bone
|
Facility
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 20220 TC
|
| Hospital Charge Code |
5518669
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,192.24 |
| Max. Negotiated Rate |
$17,032.00 |
| Rate for Payer: Aetna Commercial |
$3,832.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,661.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,192.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,256.74
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$3,917.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,382.78
|
| Rate for Payer: Health EOS Commercial |
$3,789.62
|
| Rate for Payer: HFN Commercial |
$3,917.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,193.50
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,554.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,917.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,086.42
|
| Rate for Payer: Quartz Commercial |
$2,767.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,554.80
|
| Rate for Payer: The Alliance Commercial |
$17,032.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,341.90
|
| Rate for Payer: WPS Commercial |
$3,153.90
|
|
|
BCE Biopsy Bone
|
Professional
|
$4,258.00
|
|
|
Service Code
|
CPT 20220 TC
|
| Hospital Charge Code |
5518669
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,873.52 |
| Max. Negotiated Rate |
$4,045.10 |
| Rate for Payer: Aetna Commercial |
$4,045.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,661.88
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,045.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,129.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,554.80
|
| Rate for Payer: Health EOS Commercial |
$3,874.78
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,045.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,873.52
|
| Rate for Payer: Quartz Commercial |
$2,427.06
|
| Rate for Payer: The Alliance Commercial |
$2,129.00
|
| Rate for Payer: WEA Trust Commercial |
$2,341.90
|
| Rate for Payer: WPS Commercial |
$3,153.90
|
|
|
BCE Biopsy Bone, Deep
|
Professional
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$688.60 |
| Max. Negotiated Rate |
$1,486.75 |
| Rate for Payer: Aetna Commercial |
$1,486.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.90
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,486.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$782.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.00
|
| Rate for Payer: Health EOS Commercial |
$1,424.15
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.75
|
| Rate for Payer: Quartz Beloit One Network |
$688.60
|
| Rate for Payer: Quartz Commercial |
$892.05
|
| Rate for Payer: The Alliance Commercial |
$782.50
|
| Rate for Payer: WEA Trust Commercial |
$860.75
|
| Rate for Payer: WPS Commercial |
$1,159.20
|
|
|
BCE Biopsy Bone, Deep
|
Facility
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$438.20 |
| Max. Negotiated Rate |
$6,260.00 |
| Rate for Payer: Aetna Commercial |
$1,408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.90
|
| Rate for Payer: Aetna Managed Medicare |
$438.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.45
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,439.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$875.77
|
| Rate for Payer: Health EOS Commercial |
$1,392.85
|
| Rate for Payer: HFN Commercial |
$1,439.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.75
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$939.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.80
|
| Rate for Payer: Quartz Beloit One Network |
$766.85
|
| Rate for Payer: Quartz Commercial |
$1,017.25
|
| Rate for Payer: Quartz Medicare Advantage |
$939.00
|
| Rate for Payer: The Alliance Commercial |
$6,260.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$860.75
|
| Rate for Payer: WPS Commercial |
$1,159.20
|
|
|
BCE Biopsy Bone, Deep
|
Facility
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$766.85 |
| Max. Negotiated Rate |
$1,439.80 |
| Rate for Payer: Aetna Commercial |
$1,408.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.45
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,439.80
|
| Rate for Payer: Health EOS Commercial |
$1,392.85
|
| Rate for Payer: HFN Commercial |
$1,439.80
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$939.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.80
|
| Rate for Payer: Quartz Beloit One Network |
$766.85
|
| Rate for Payer: Quartz Commercial |
$939.00
|
| Rate for Payer: WEA Trust Commercial |
$860.75
|
| Rate for Payer: WPS Commercial |
$1,159.20
|
|
|
BCE Biopsy Liver
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Aetna Managed Medicare |
$304.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.73
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.50
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$705.90
|
| Rate for Payer: Quartz Medicare Advantage |
$651.60
|
| Rate for Payer: The Alliance Commercial |
$4,344.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Liver
|
Professional
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$477.84 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Aetna Commercial |
$1,031.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,031.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$543.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.60
|
| Rate for Payer: Health EOS Commercial |
$988.26
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.70
|
| Rate for Payer: Quartz Beloit One Network |
$477.84
|
| Rate for Payer: Quartz Commercial |
$619.02
|
| Rate for Payer: The Alliance Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Liver
|
Facility
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$532.14 |
| Max. Negotiated Rate |
$999.12 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$651.60
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Lung
|
Facility
OP
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$6,060.00 |
| Rate for Payer: Aetna Commercial |
$1,363.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.90
|
| Rate for Payer: Aetna Managed Medicare |
$424.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.95
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,393.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.79
|
| Rate for Payer: Health EOS Commercial |
$1,348.35
|
| Rate for Payer: HFN Commercial |
$1,393.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,136.25
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$909.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.80
|
| Rate for Payer: Quartz Beloit One Network |
$742.35
|
| Rate for Payer: Quartz Commercial |
$984.75
|
| Rate for Payer: Quartz Medicare Advantage |
$909.00
|
| Rate for Payer: The Alliance Commercial |
$6,060.00
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
BCE Biopsy Lung
|
Professional
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$666.60 |
| Max. Negotiated Rate |
$1,439.25 |
| Rate for Payer: Aetna Commercial |
$1,439.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.90
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,439.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$757.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$909.00
|
| Rate for Payer: Health EOS Commercial |
$1,378.65
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.25
|
| Rate for Payer: Quartz Beloit One Network |
$666.60
|
| Rate for Payer: Quartz Commercial |
$863.55
|
| Rate for Payer: The Alliance Commercial |
$757.50
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
BCE Biopsy Lung
|
Facility
IP
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$742.35 |
| Max. Negotiated Rate |
$1,393.80 |
| Rate for Payer: Aetna Commercial |
$1,363.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.95
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,393.80
|
| Rate for Payer: Health EOS Commercial |
$1,348.35
|
| Rate for Payer: HFN Commercial |
$1,393.80
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$909.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.80
|
| Rate for Payer: Quartz Beloit One Network |
$742.35
|
| Rate for Payer: Quartz Commercial |
$909.00
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
BCE Biopsy Lymph Node
|
Facility
OP
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$172.48 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Aetna Managed Medicare |
$172.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.71
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$462.00
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$400.40
|
| Rate for Payer: Quartz Medicare Advantage |
$369.60
|
| Rate for Payer: The Alliance Commercial |
$2,464.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
BCE Biopsy Lymph Node
|
Professional
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$585.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.60
|
| Rate for Payer: Health EOS Commercial |
$560.56
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$585.20
|
| Rate for Payer: Quartz Beloit One Network |
$271.04
|
| Rate for Payer: Quartz Commercial |
$351.12
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
BCE Biopsy Lymph Node
|
Facility
IP
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$369.60
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
BCE Biopsy Pancreas
|
Facility
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,839.88 |
| Max. Negotiated Rate |
$26,284.00 |
| Rate for Payer: Aetna Commercial |
$5,913.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,839.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,482.63
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,045.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.13
|
| Rate for Payer: Health EOS Commercial |
$5,848.19
|
| Rate for Payer: HFN Commercial |
$6,045.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.25
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,045.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.79
|
| Rate for Payer: Quartz Commercial |
$4,271.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,942.60
|
| Rate for Payer: The Alliance Commercial |
$26,284.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,614.05
|
| Rate for Payer: WPS Commercial |
$4,867.14
|
|
|
BCE Biopsy Pancreas
|
Professional
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,891.24 |
| Max. Negotiated Rate |
$6,242.45 |
| Rate for Payer: Aetna Commercial |
$6,242.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.06
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,242.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,942.60
|
| Rate for Payer: Health EOS Commercial |
$5,979.61
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,242.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.24
|
| Rate for Payer: Quartz Commercial |
$3,745.47
|
| Rate for Payer: The Alliance Commercial |
$3,285.50
|
| Rate for Payer: WEA Trust Commercial |
$3,614.05
|
| Rate for Payer: WPS Commercial |
$4,867.14
|
|
|
BCE Biopsy Pancreas
|
Facility
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,219.79 |
| Max. Negotiated Rate |
$6,045.32 |
| Rate for Payer: Aetna Commercial |
$5,913.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,482.63
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,045.32
|
| Rate for Payer: Health EOS Commercial |
$5,848.19
|
| Rate for Payer: HFN Commercial |
$6,045.32
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,045.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.79
|
| Rate for Payer: Quartz Commercial |
$3,942.60
|
| Rate for Payer: WEA Trust Commercial |
$3,614.05
|
| Rate for Payer: WPS Commercial |
$4,867.14
|
|
|
BCE Biopsy Pleura, Perc
|
Professional
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$477.84 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Aetna Commercial |
$1,031.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,031.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$543.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.60
|
| Rate for Payer: Health EOS Commercial |
$988.26
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.70
|
| Rate for Payer: Quartz Beloit One Network |
$477.84
|
| Rate for Payer: Quartz Commercial |
$619.02
|
| Rate for Payer: The Alliance Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
