|
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
|
|
|
BCE Drug Test Conf 8-14
|
Professional
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.59 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$699.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.96
|
| Rate for Payer: Aetna Managed Medicare |
$156.59
|
| Rate for Payer: Anthem Medicare Advantage |
$156.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.59
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.59
|
| Rate for Payer: Health EOS Commercial |
$669.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$552.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$552.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.59
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$323.84
|
| Rate for Payer: Quartz Commercial |
$419.52
|
| Rate for Payer: Quartz Medicare Advantage |
$156.59
|
| Rate for Payer: The Alliance Commercial |
$430.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.59
|
| Rate for Payer: WEA Trust Commercial |
$404.80
|
| Rate for Payer: WPS Commercial |
$274.03
|
|
|
BCE Fiducial Markers
|
Facility
IP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.24 |
| Max. Negotiated Rate |
$2,553.92 |
| Rate for Payer: Aetna Commercial |
$2,498.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.28
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,553.92
|
| Rate for Payer: Health EOS Commercial |
$2,470.64
|
| Rate for Payer: HFN Commercial |
$2,553.92
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.24
|
| Rate for Payer: Quartz Commercial |
$1,665.60
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
BCE Fiducial Markers
|
Professional
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,221.44 |
| Max. Negotiated Rate |
$2,637.20 |
| Rate for Payer: Aetna Commercial |
$2,637.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,637.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,388.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.60
|
| Rate for Payer: Health EOS Commercial |
$2,526.16
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,637.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.44
|
| Rate for Payer: Quartz Commercial |
$1,582.32
|
| Rate for Payer: The Alliance Commercial |
$1,388.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
BCE Fiducial Markers
|
Facility
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$777.28 |
| Max. Negotiated Rate |
$11,104.00 |
| Rate for Payer: Aetna Commercial |
$2,498.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Aetna Managed Medicare |
$777.28
|
| 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 |
$1,471.28
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,553.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,553.45
|
| Rate for Payer: Health EOS Commercial |
$2,470.64
|
| Rate for Payer: HFN Commercial |
$2,553.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.24
|
| Rate for Payer: Quartz Commercial |
$1,804.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,665.60
|
| Rate for Payer: The Alliance Commercial |
$11,104.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
BCE Fine Needle Aspiration
|
Professional
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.80
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: The Alliance Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
BCE Fine Needle Aspiration
|
Facility
OP
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$63.84
|
| 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 |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.59
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
BCE Fine Needle Aspiration
|
Facility
IP
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
BCE Fine Needle Aspiration ea additional
|
Facility
OP
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Aetna Managed Medicare |
$59.92
|
| 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 |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.75
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.50
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$139.10
|
| Rate for Payer: Quartz Medicare Advantage |
$128.40
|
| Rate for Payer: The Alliance Commercial |
$856.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
BCE Fine Needle Aspiration ea additional
|
Facility
IP
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.86 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$128.40
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
BCE Fine Needle Aspiration ea additional
|
Professional
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$94.16 |
| Max. Negotiated Rate |
$203.30 |
| Rate for Payer: Aetna Commercial |
$203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$203.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.40
|
| Rate for Payer: Health EOS Commercial |
$194.74
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Preferred Network Access Commercial |
$203.30
|
| Rate for Payer: Quartz Beloit One Network |
$94.16
|
| Rate for Payer: Quartz Commercial |
$121.98
|
| Rate for Payer: The Alliance Commercial |
$107.00
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
BCE Image Guided Fluid Drainage Catheter
|
Facility
OP
|
$7,649.00
|
|
|
Service Code
|
CPT 49406 TC
|
| Hospital Charge Code |
5649633
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$30,596.00 |
| Rate for Payer: Aetna Commercial |
$6,884.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,578.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,141.72
|
| 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 |
$4,053.97
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cigna Commercial |
$7,037.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,280.38
|
| Rate for Payer: Health EOS Commercial |
$6,807.61
|
| Rate for Payer: HFN Commercial |
$7,037.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,736.75
|
| Rate for Payer: Multiplan Commercial |
$6,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,589.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,037.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,748.01
|
| Rate for Payer: Quartz Commercial |
$4,971.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,589.40
|
| Rate for Payer: The Alliance Commercial |
$30,596.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$4,206.95
|
| Rate for Payer: WPS Commercial |
$5,665.61
|
|
|
BCE Image Guided Fluid Drainage Catheter
|
Facility
IP
|
$7,649.00
|
|
|
Service Code
|
CPT 49406 TC
|
| Hospital Charge Code |
5649633
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,748.01 |
| Max. Negotiated Rate |
$7,037.08 |
| Rate for Payer: Aetna Commercial |
$6,884.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,053.97
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cigna Commercial |
$7,037.08
|
| Rate for Payer: Health EOS Commercial |
$6,807.61
|
| Rate for Payer: HFN Commercial |
$7,037.08
|
| Rate for Payer: Multiplan Commercial |
$6,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,589.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,037.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,748.01
|
| Rate for Payer: Quartz Commercial |
$4,589.40
|
| Rate for Payer: WEA Trust Commercial |
$4,206.95
|
| Rate for Payer: WPS Commercial |
$5,665.61
|
|
|
BCE Image Guided Fluid Drainage Catheter
|
Professional
|
$7,649.00
|
|
|
Service Code
|
CPT 49406 TC
|
| Hospital Charge Code |
5649633
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,365.56 |
| Max. Negotiated Rate |
$7,266.55 |
| Rate for Payer: Aetna Commercial |
$7,266.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,578.14
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cigna Commercial |
$7,266.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,824.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,589.40
|
| Rate for Payer: Health EOS Commercial |
$6,960.59
|
| Rate for Payer: Multiplan Commercial |
$6,119.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,266.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,365.56
|
| Rate for Payer: Quartz Commercial |
$4,359.93
|
| Rate for Payer: The Alliance Commercial |
$3,824.50
|
| Rate for Payer: WEA Trust Commercial |
$4,206.95
|
| Rate for Payer: WPS Commercial |
$5,665.61
|
|
|
BCE Image Guided Fluid Drainage Cath Perc
|
Facility
OP
|
$4,612.00
|
|
|
Service Code
|
CPT 10030 TC
|
| Hospital Charge Code |
5649640
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$18,448.00 |
| Rate for Payer: Aetna Commercial |
$4,150.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,291.36
|
| 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 |
$2,444.36
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$4,243.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,580.88
|
| Rate for Payer: Health EOS Commercial |
$4,104.68
|
| Rate for Payer: HFN Commercial |
$4,243.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,459.00
|
| Rate for Payer: Multiplan Commercial |
$3,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,259.88
|
| Rate for Payer: Quartz Commercial |
$2,997.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,767.20
|
| Rate for Payer: The Alliance Commercial |
$18,448.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$2,536.60
|
| Rate for Payer: WPS Commercial |
$3,416.11
|
|
|
BCE Image Guided Fluid Drainage Cath Perc
|
Facility
IP
|
$4,612.00
|
|
|
Service Code
|
CPT 10030 TC
|
| Hospital Charge Code |
5649640
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,259.88 |
| Max. Negotiated Rate |
$4,243.04 |
| Rate for Payer: Aetna Commercial |
$4,150.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,444.36
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$4,243.04
|
| Rate for Payer: Health EOS Commercial |
$4,104.68
|
| Rate for Payer: HFN Commercial |
$4,243.04
|
| Rate for Payer: Multiplan Commercial |
$3,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,243.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,259.88
|
| Rate for Payer: Quartz Commercial |
$2,767.20
|
| Rate for Payer: WEA Trust Commercial |
$2,536.60
|
| Rate for Payer: WPS Commercial |
$3,416.11
|
|
|
BCE Image Guided Fluid Drainage Cath Perc
|
Professional
|
$4,612.00
|
|
|
Service Code
|
CPT 10030 TC
|
| Hospital Charge Code |
5649640
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,029.28 |
| Max. Negotiated Rate |
$4,381.40 |
| Rate for Payer: Aetna Commercial |
$4,381.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,966.32
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$4,381.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,306.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,767.20
|
| Rate for Payer: Health EOS Commercial |
$4,196.92
|
| Rate for Payer: Multiplan Commercial |
$3,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,381.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,029.28
|
| Rate for Payer: Quartz Commercial |
$2,628.84
|
| Rate for Payer: The Alliance Commercial |
$2,306.00
|
| Rate for Payer: WEA Trust Commercial |
$2,536.60
|
| Rate for Payer: WPS Commercial |
$3,416.11
|
|
|
BCE Inj Knee Arthrogram
|
Facility
IP
|
$972.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
5577379
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$583.20
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
BCE Inj Knee Arthrogram
|
Professional
|
$972.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
5577379
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$923.40 |
| Rate for Payer: Aetna Commercial |
$923.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$37.78
|
| Rate for Payer: Anthem Medicare Advantage |
$37.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.78
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$923.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$486.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.78
|
| Rate for Payer: Health EOS Commercial |
$884.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.78
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$923.40
|
| Rate for Payer: Quartz Beloit One Network |
$427.68
|
| Rate for Payer: Quartz Commercial |
$554.04
|
| Rate for Payer: Quartz Medicare Advantage |
$37.78
|
| Rate for Payer: The Alliance Commercial |
$160.56
|
| Rate for Payer: United Healthcare Medicaid |
$111.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.78
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$170.01
|
|
|
BCE Inj Knee Arthrogram
|
Facility
OP
|
$972.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
5577379
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$272.16 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Commercial |
$874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$835.92
|
| Rate for Payer: Aetna Managed Medicare |
$272.16
|
| 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 |
$515.16
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$894.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$865.08
|
| Rate for Payer: HFN Commercial |
$894.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.00
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: NAPHCARE Commercial |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$894.24
|
| Rate for Payer: Quartz Beloit One Network |
$476.28
|
| Rate for Payer: Quartz Commercial |
$631.80
|
| Rate for Payer: Quartz Medicare Advantage |
$583.20
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$534.60
|
| Rate for Payer: WPS Commercial |
$719.96
|
|
|
BCE Inj Procedure Retrograde Urethrocystography
|
Facility
IP
|
$889.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
5506847
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$435.61 |
| Max. Negotiated Rate |
$817.88 |
| Rate for Payer: Aetna Commercial |
$800.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.17
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$817.88
|
| Rate for Payer: Health EOS Commercial |
$791.21
|
| Rate for Payer: HFN Commercial |
$817.88
|
| Rate for Payer: Multiplan Commercial |
$711.20
|
| Rate for Payer: NAPHCARE Commercial |
$533.40
|
| Rate for Payer: Preferred Network Access Commercial |
$817.88
|
| Rate for Payer: Quartz Beloit One Network |
$435.61
|
| Rate for Payer: Quartz Commercial |
$533.40
|
| Rate for Payer: WEA Trust Commercial |
$488.95
|
| Rate for Payer: WPS Commercial |
$658.48
|
|
|
BCE Inj Procedure Retrograde Urethrocystography
|
Facility
OP
|
$889.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
5506847
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$13,185.36 |
| Rate for Payer: Aetna Commercial |
$800.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.54
|
| Rate for Payer: Aetna Managed Medicare |
$248.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.17
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$817.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$791.21
|
| Rate for Payer: HFN Commercial |
$817.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.75
|
| Rate for Payer: Multiplan Commercial |
$711.20
|
| Rate for Payer: NAPHCARE Commercial |
$533.40
|
| Rate for Payer: Preferred Network Access Commercial |
$817.88
|
| Rate for Payer: Quartz Beloit One Network |
$435.61
|
| Rate for Payer: Quartz Commercial |
$577.85
|
| Rate for Payer: Quartz Medicare Advantage |
$533.40
|
| Rate for Payer: The Alliance Commercial |
$13,185.36
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$488.95
|
| Rate for Payer: WPS Commercial |
$658.48
|
|
|
BCE Inj Procedure Retrograde Urethrocystography
|
Professional
|
$889.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
5506847
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.54
|
| Rate for Payer: Aetna Managed Medicare |
$60.04
|
| Rate for Payer: Anthem Medicare Advantage |
$60.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.04
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$844.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$444.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.04
|
| Rate for Payer: Health EOS Commercial |
$808.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.04
|
| Rate for Payer: Multiplan Commercial |
$711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$844.55
|
| Rate for Payer: Quartz Beloit One Network |
$391.16
|
| Rate for Payer: Quartz Commercial |
$506.73
|
| Rate for Payer: Quartz Medicare Advantage |
$60.04
|
| Rate for Payer: The Alliance Commercial |
$255.17
|
| Rate for Payer: United Healthcare Medicaid |
$24.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.04
|
| Rate for Payer: WEA Trust Commercial |
$488.95
|
| Rate for Payer: WPS Commercial |
$270.18
|
|
|
B Cell
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4524628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.63
|
| Rate for Payer: Anthem Medicaid |
$38.99
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicaid |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Managed Health Services Medicaid |
$40.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.99
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$37.73
|
| Rate for Payer: WMAP Medicaid |
$38.99
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
B Cell
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4524628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
