|
BCE CV Echo Complete WO Contrast Acqusition
|
Facility
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388647
|
|
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
|
|
|
BCE CV Echo Complete WO Contrast Acqusition
|
Facility
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388647
|
|
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 Echo TEE Adult wo Probe Plcmt Cong Acquisition
|
Facility
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5388648
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: United Healthcare PPO |
$1,437.75
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
BCE CV Echo TEE Adult wo Probe Plcmt Cong Acquisition
|
Facility
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5388648
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
BCE CV NM Cardiac Blood Pool Gated Single Acqusition
|
Facility
OP
|
$5,516.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5386670
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,797,760.00 |
| Rate for Payer: Aetna Commercial |
$4,964.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,743.76
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,923.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$5,074.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$4,909.24
|
| Rate for Payer: HFN Commercial |
$5,074.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,074.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,702.84
|
| Rate for Payer: Quartz Commercial |
$3,585.40
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,797,760.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$3,033.80
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$4,085.70
|
|
|
BCE CV NM Cardiac Blood Pool Gated Single Acqusition
|
Facility
IP
|
$5,516.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5386670
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,702.84 |
| Max. Negotiated Rate |
$5,074.72 |
| Rate for Payer: Aetna Commercial |
$4,964.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,923.48
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$5,074.72
|
| Rate for Payer: Health EOS Commercial |
$4,909.24
|
| Rate for Payer: HFN Commercial |
$5,074.72
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,309.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,074.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,702.84
|
| Rate for Payer: Quartz Commercial |
$3,309.60
|
| Rate for Payer: WEA Trust Commercial |
$3,033.80
|
| Rate for Payer: WPS Commercial |
$4,085.70
|
|
|
BCE CV VL Arterial Duplex Right
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5383360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.25
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$736.20
|
| Rate for Payer: The Alliance Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL Arterial Duplex Right
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5383360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL LE PVR Resting Acquisition
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5388650
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL LE PVR Resting Acquisition
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5388650
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL LE PVR w Exercise Acquisition
|
Facility
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5388649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,770.08 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,250.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$962.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$923.52
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,076.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,250.60
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
|
BCE CV VL LE PVR w Exercise Acquisition
|
Facility
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5388649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$942.76 |
| Max. Negotiated Rate |
$1,770.08 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,154.40
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
|
BCE Cyst Aspiration
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
BCE Cyst Aspiration
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$38.92
|
| 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 |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$83.40
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
BCE Cyst Aspiration
|
Professional
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
BCE Drug Test Conf 15-21
|
Facility
IP
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$804.58 |
| Max. Negotiated Rate |
$1,510.64 |
| Rate for Payer: Aetna Commercial |
$1,477.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.26
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,510.64
|
| Rate for Payer: Health EOS Commercial |
$1,461.38
|
| Rate for Payer: HFN Commercial |
$1,510.64
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$985.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.64
|
| Rate for Payer: Quartz Beloit One Network |
$804.58
|
| Rate for Payer: Quartz Commercial |
$985.20
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
BCE Drug Test Conf 15-21
|
Professional
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$1,559.90 |
| Rate for Payer: Aetna Commercial |
$1,559.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.12
|
| Rate for Payer: Aetna Managed Medicare |
$198.74
|
| Rate for Payer: Anthem Medicare Advantage |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.74
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,559.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$821.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.74
|
| Rate for Payer: Health EOS Commercial |
$1,494.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$701.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.74
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.90
|
| Rate for Payer: Quartz Beloit One Network |
$722.48
|
| Rate for Payer: Quartz Commercial |
$935.94
|
| Rate for Payer: Quartz Medicare Advantage |
$198.74
|
| Rate for Payer: The Alliance Commercial |
$546.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: WPS Commercial |
$347.80
|
|
|
BCE Drug Test Conf 15-21
|
Facility
OP
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$6,568.00 |
| Rate for Payer: Aetna Commercial |
$1,477.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.12
|
| Rate for Payer: Aetna Managed Medicare |
$198.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,067.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$821.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$788.16
|
| Rate for Payer: Anthem Medicaid |
$132.80
|
| Rate for Payer: Anthem Medicare Advantage |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.74
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,510.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$198.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.86
|
| Rate for Payer: Dean Health Medicaid |
$132.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$198.74
|
| Rate for Payer: Health EOS Commercial |
$1,461.38
|
| Rate for Payer: HFN Commercial |
$1,510.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$198.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$132.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.74
|
| Rate for Payer: Managed Health Services Medicaid |
$138.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$198.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$198.74
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.80
|
| Rate for Payer: Quartz Beloit One Network |
$804.58
|
| Rate for Payer: Quartz Commercial |
$1,067.30
|
| Rate for Payer: Quartz Medicare Advantage |
$198.74
|
| Rate for Payer: The Alliance Commercial |
$6,568.00
|
| Rate for Payer: United Healthcare Medicaid |
$132.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: United Healthcare PPO |
$1,231.50
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: Wellcare Medicare |
$198.74
|
| Rate for Payer: WMAP Medicaid |
$132.80
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
BCE Drug Test Conf 1-7
|
Facility
IP
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
BCE Drug Test Conf 1-7
|
Professional
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$403.94 |
| Rate for Payer: Aetna Commercial |
$366.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$366.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$351.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$403.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.70
|
| Rate for Payer: Quartz Beloit One Network |
$169.84
|
| Rate for Payer: Quartz Commercial |
$220.02
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$314.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$200.25
|
|
|
BCE Drug Test Conf 1-7
|
Facility
OP
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$1,544.00 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.28
|
| Rate for Payer: Anthem Medicaid |
$63.95
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$114.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.01
|
| Rate for Payer: Dean Health Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Managed Health Services Medicaid |
$66.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$1,544.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$289.50
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
BCE Drug Test Conf 22+
|
Facility
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$8,760.00 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Aetna Managed Medicare |
$246.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,423.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.20
|
| Rate for Payer: Anthem Medicaid |
$172.18
|
| Rate for Payer: Anthem Medicare Advantage |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$246.92
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$246.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,225.52
|
| Rate for Payer: Dean Health Medicaid |
$172.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$246.92
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$918.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$172.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$246.92
|
| Rate for Payer: Managed Health Services Medicaid |
$179.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$246.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$246.92
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$370.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$172.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,423.50
|
| Rate for Payer: Quartz Medicare Advantage |
$246.92
|
| Rate for Payer: The Alliance Commercial |
$8,760.00
|
| Rate for Payer: United Healthcare Medicaid |
$172.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.92
|
| Rate for Payer: United Healthcare PPO |
$1,642.50
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: Wellcare Medicare |
$246.92
|
| Rate for Payer: WMAP Medicaid |
$172.18
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
BCE Drug Test Conf 22+
|
Professional
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$2,080.50 |
| Rate for Payer: Aetna Commercial |
$2,080.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Aetna Managed Medicare |
$246.92
|
| Rate for Payer: Anthem Medicare Advantage |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$246.92
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,080.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,095.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.92
|
| Rate for Payer: Health EOS Commercial |
$1,992.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$246.92
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.50
|
| Rate for Payer: Quartz Beloit One Network |
$963.60
|
| Rate for Payer: Quartz Commercial |
$1,248.30
|
| Rate for Payer: Quartz Medicare Advantage |
$246.92
|
| Rate for Payer: The Alliance Commercial |
$679.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.92
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$432.11
|
|
|
BCE Drug Test Conf 22+
|
Facility
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$2,014.80 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,314.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
BCE Drug Test Conf 8-14
|
Facility
IP
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$360.64 |
| Max. Negotiated Rate |
$677.12 |
| Rate for Payer: Aetna Commercial |
$662.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.08
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$677.12
|
| Rate for Payer: Health EOS Commercial |
$655.04
|
| Rate for Payer: HFN Commercial |
$677.12
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: NAPHCARE Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$677.12
|
| Rate for Payer: Quartz Beloit One Network |
$360.64
|
| Rate for Payer: Quartz Commercial |
$441.60
|
| Rate for Payer: WEA Trust Commercial |
$404.80
|
| Rate for Payer: WPS Commercial |
$545.16
|
|
