|
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
|
|
|
BCE Biopsy Pleura, Perc
|
Facility
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
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 Salivary Gland
|
Professional
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$383.68 |
| Max. Negotiated Rate |
$828.40 |
| Rate for Payer: Aetna Commercial |
$828.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.92
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$828.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$436.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.20
|
| Rate for Payer: Health EOS Commercial |
$793.52
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.40
|
| Rate for Payer: Quartz Beloit One Network |
$383.68
|
| Rate for Payer: Quartz Commercial |
$497.04
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: WEA Trust Commercial |
$479.60
|
| Rate for Payer: WPS Commercial |
$645.89
|
|
|
BCE Biopsy Salivary Gland
|
Facility
IP
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$802.24 |
| Rate for Payer: Aetna Commercial |
$784.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.16
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$802.24
|
| Rate for Payer: Health EOS Commercial |
$776.08
|
| Rate for Payer: HFN Commercial |
$802.24
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: NAPHCARE Commercial |
$523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$802.24
|
| Rate for Payer: Quartz Beloit One Network |
$427.28
|
| Rate for Payer: Quartz Commercial |
$523.20
|
| Rate for Payer: WEA Trust Commercial |
$479.60
|
| Rate for Payer: WPS Commercial |
$645.89
|
|
|
BCE Biopsy Salivary Gland
|
Facility
OP
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$244.16 |
| Max. Negotiated Rate |
$3,488.00 |
| Rate for Payer: Aetna Commercial |
$784.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.92
|
| Rate for Payer: Aetna Managed Medicare |
$244.16
|
| 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 |
$462.16
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$802.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$487.97
|
| Rate for Payer: Health EOS Commercial |
$776.08
|
| Rate for Payer: HFN Commercial |
$802.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.00
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: NAPHCARE Commercial |
$523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$802.24
|
| Rate for Payer: Quartz Beloit One Network |
$427.28
|
| Rate for Payer: Quartz Commercial |
$566.80
|
| Rate for Payer: Quartz Medicare Advantage |
$523.20
|
| Rate for Payer: The Alliance Commercial |
$3,488.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$479.60
|
| Rate for Payer: WPS Commercial |
$645.89
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Facility
OP
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$31,108.00 |
| Rate for Payer: Aetna Commercial |
$6,999.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,177.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,121.81
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,154.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,352.01
|
| Rate for Payer: Health EOS Commercial |
$6,921.53
|
| Rate for Payer: HFN Commercial |
$7,154.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,832.75
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,154.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,810.73
|
| Rate for Payer: Quartz Commercial |
$5,055.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,666.20
|
| Rate for Payer: The Alliance Commercial |
$31,108.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Facility
IP
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,810.73 |
| Max. Negotiated Rate |
$7,154.84 |
| Rate for Payer: Aetna Commercial |
$6,999.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,121.81
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,154.84
|
| Rate for Payer: Health EOS Commercial |
$6,921.53
|
| Rate for Payer: HFN Commercial |
$7,154.84
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,154.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,810.73
|
| Rate for Payer: Quartz Commercial |
$4,666.20
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Professional
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,421.88 |
| Max. Negotiated Rate |
$7,388.15 |
| Rate for Payer: Aetna Commercial |
$7,388.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,388.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,888.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,666.20
|
| Rate for Payer: Health EOS Commercial |
$7,077.07
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,388.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,421.88
|
| Rate for Payer: Quartz Commercial |
$4,432.89
|
| Rate for Payer: The Alliance Commercial |
$3,888.50
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Dean Health Medicaid |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.92
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WMAP Medicaid |
$3.92
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Professional
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.40
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.67
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$14.50
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
BCE Crossmatch IS
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BCE Crossmatch IS
|
Facility
OP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$633.08 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$70.50
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BCE Crossmatch IS
|
Professional
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$120.66 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.40
|
| Rate for Payer: Health EOS Commercial |
$85.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.66
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.30
|
| Rate for Payer: Quartz Beloit One Network |
$41.36
|
| Rate for Payer: Quartz Commercial |
$53.58
|
| Rate for Payer: The Alliance Commercial |
$47.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BCE CTA Abdomen
|
Professional
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$224.49 |
| Max. Negotiated Rate |
$5,829.20 |
| Rate for Payer: Aetna Commercial |
$5,829.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,276.96
|
| Rate for Payer: Aetna Managed Medicare |
$224.49
|
| Rate for Payer: Anthem Medicare Advantage |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$224.49
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,829.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,068.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.49
|
| Rate for Payer: Health EOS Commercial |
$5,583.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$817.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$224.49
|
| Rate for Payer: Multiplan Commercial |
$4,908.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,829.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,699.84
|
| Rate for Payer: Quartz Commercial |
$3,497.52
|
| Rate for Payer: Quartz Medicare Advantage |
$224.49
|
| Rate for Payer: The Alliance Commercial |
$853.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$224.49
|
| Rate for Payer: WEA Trust Commercial |
$3,374.80
|
| Rate for Payer: WPS Commercial |
$1,122.45
|
|
|
BCE CTA Abdomen
|
Facility
IP
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,006.64 |
| Max. Negotiated Rate |
$5,645.12 |
| Rate for Payer: Aetna Commercial |
$5,522.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,252.08
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,645.12
|
| Rate for Payer: Health EOS Commercial |
$5,461.04
|
| Rate for Payer: HFN Commercial |
$5,645.12
|
| Rate for Payer: Multiplan Commercial |
$4,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,645.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,006.64
|
| Rate for Payer: Quartz Commercial |
$3,681.60
|
| Rate for Payer: WEA Trust Commercial |
$3,374.80
|
| Rate for Payer: WPS Commercial |
$4,544.94
|
|
|
BCE CTA Abdomen
|
Facility
OP
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,571.43 |
| Max. Negotiated Rate |
$24,544.00 |
| Rate for Payer: Aetna Commercial |
$5,522.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,276.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,718.08
|
| 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 |
$3,252.08
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,645.12
|
| Rate for Payer: Health EOS Commercial |
$5,461.04
|
| Rate for Payer: HFN Commercial |
$5,645.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,602.00
|
| Rate for Payer: Multiplan Commercial |
$4,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,645.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,006.64
|
| Rate for Payer: Quartz Commercial |
$3,988.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,681.60
|
| Rate for Payer: The Alliance Commercial |
$24,544.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,374.80
|
| Rate for Payer: WPS Commercial |
$1,571.43
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Facility
OP
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,171.52 |
| Max. Negotiated Rate |
$16,736.00 |
| Rate for Payer: Aetna Commercial |
$3,765.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,598.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,171.52
|
| 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 |
$2,217.52
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$3,849.28
|
| Rate for Payer: Health EOS Commercial |
$3,723.76
|
| Rate for Payer: HFN Commercial |
$3,849.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,138.00
|
| Rate for Payer: Multiplan Commercial |
$3,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,510.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,849.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,050.16
|
| Rate for Payer: Quartz Commercial |
$2,719.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,510.40
|
| Rate for Payer: The Alliance Commercial |
$16,736.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,301.20
|
| Rate for Payer: WPS Commercial |
$1,386.63
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Professional
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$3,974.80 |
| Rate for Payer: Aetna Commercial |
$3,974.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,598.24
|
| Rate for Payer: Aetna Managed Medicare |
$198.09
|
| Rate for Payer: Anthem Medicare Advantage |
$198.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.09
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$3,974.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,092.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.09
|
| Rate for Payer: Health EOS Commercial |
$3,807.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$727.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$727.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.09
|
| Rate for Payer: Multiplan Commercial |
$3,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.96
|
| Rate for Payer: Quartz Commercial |
$2,384.88
|
| Rate for Payer: Quartz Medicare Advantage |
$198.09
|
| Rate for Payer: The Alliance Commercial |
$752.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.09
|
| Rate for Payer: WEA Trust Commercial |
$2,301.20
|
| Rate for Payer: WPS Commercial |
$990.45
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Facility
IP
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,050.16 |
| Max. Negotiated Rate |
$3,849.28 |
| Rate for Payer: Aetna Commercial |
$3,765.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,217.52
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$3,849.28
|
| Rate for Payer: Health EOS Commercial |
$3,723.76
|
| Rate for Payer: HFN Commercial |
$3,849.28
|
| Rate for Payer: Multiplan Commercial |
$3,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,510.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,849.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,050.16
|
| Rate for Payer: Quartz Commercial |
$2,510.40
|
| Rate for Payer: WEA Trust Commercial |
$2,301.20
|
| Rate for Payer: WPS Commercial |
$3,099.09
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Professional
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,672.88 |
| Max. Negotiated Rate |
$3,611.90 |
| Rate for Payer: Aetna Commercial |
$3,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.72
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,611.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,901.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,281.20
|
| Rate for Payer: Health EOS Commercial |
$3,459.82
|
| Rate for Payer: Multiplan Commercial |
$3,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,611.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.88
|
| Rate for Payer: Quartz Commercial |
$2,167.14
|
| Rate for Payer: The Alliance Commercial |
$1,901.00
|
| Rate for Payer: WEA Trust Commercial |
$2,091.10
|
| Rate for Payer: WPS Commercial |
$2,816.14
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Facility
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,064.56 |
| Max. Negotiated Rate |
$15,208.00 |
| Rate for Payer: Aetna Commercial |
$3,421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.56
|
| 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 |
$2,015.06
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,497.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,127.60
|
| Rate for Payer: Health EOS Commercial |
$3,383.78
|
| Rate for Payer: HFN Commercial |
$3,497.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,851.50
|
| Rate for Payer: Multiplan Commercial |
$3,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,497.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,862.98
|
| Rate for Payer: Quartz Commercial |
$2,471.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.20
|
| Rate for Payer: The Alliance Commercial |
$15,208.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,091.10
|
| Rate for Payer: WPS Commercial |
$2,816.14
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Facility
IP
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,862.98 |
| Max. Negotiated Rate |
$3,497.84 |
| Rate for Payer: Aetna Commercial |
$3,421.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.06
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,497.84
|
| Rate for Payer: Health EOS Commercial |
$3,383.78
|
| Rate for Payer: HFN Commercial |
$3,497.84
|
| Rate for Payer: Multiplan Commercial |
$3,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,497.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,862.98
|
| Rate for Payer: Quartz Commercial |
$2,281.20
|
| Rate for Payer: WEA Trust Commercial |
$2,091.10
|
| Rate for Payer: WPS Commercial |
$2,816.14
|
|
|
BCE CV Echocardiogram W Contrast Acquisition
|
Facility
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388711
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,246.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.88
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,246.40
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
BCE CV Echocardiogram W Contrast Acquisition
|
Facility
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388711
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,693.44 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,073.60
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
