|
B Cell
|
Professional
|
$104.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4524628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$166.01 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| 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 |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$149.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$166.01
|
|
|
BCE MA Breast Ndl Loc Placement Left ea add
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 19282 TC,LT
|
| Hospital Charge Code |
4521246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,020.00 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Aetna Managed Medicare |
$351.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$602.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.30
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.25
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$815.75
|
| Rate for Payer: Quartz Medicare Advantage |
$753.00
|
| Rate for Payer: The Alliance Commercial |
$5,020.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
BCE MA Breast Ndl Loc Placement Left ea add
|
Professional
|
$1,255.00
|
|
|
Service Code
|
CPT 19282 TC,LT
|
| Hospital Charge Code |
4521246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$552.20 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna Commercial |
$1,192.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,192.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$627.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.00
|
| Rate for Payer: Health EOS Commercial |
$1,142.05
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.25
|
| Rate for Payer: Quartz Beloit One Network |
$552.20
|
| Rate for Payer: Quartz Commercial |
$715.35
|
| Rate for Payer: The Alliance Commercial |
$627.50
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
BCE MA Breast Ndl Loc Placement Left ea add
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 19282 TC,LT
|
| Hospital Charge Code |
4521246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$614.95 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$753.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
BCE MA Breast Ndl Loc Placement Right ea add
|
Facility
IP
|
$1,303.00
|
|
|
Service Code
|
CPT 19282 TC,RT
|
| Hospital Charge Code |
4521247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$638.47 |
| Max. Negotiated Rate |
$1,198.76 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$781.80
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
BCE MA Breast Ndl Loc Placement Right ea add
|
Facility
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 19282 TC,RT
|
| Hospital Charge Code |
4521247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,212.00 |
| Rate for Payer: Aetna Commercial |
$1,172.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Aetna Managed Medicare |
$364.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$625.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.59
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,198.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$729.16
|
| Rate for Payer: Health EOS Commercial |
$1,159.67
|
| Rate for Payer: HFN Commercial |
$1,198.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.25
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.76
|
| Rate for Payer: Quartz Beloit One Network |
$638.47
|
| Rate for Payer: Quartz Commercial |
$846.95
|
| Rate for Payer: Quartz Medicare Advantage |
$781.80
|
| Rate for Payer: The Alliance Commercial |
$5,212.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
BCE MA Breast Ndl Loc Placement Right ea add
|
Professional
|
$1,303.00
|
|
|
Service Code
|
CPT 19282 TC,RT
|
| Hospital Charge Code |
4521247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$573.32 |
| Max. Negotiated Rate |
$1,237.85 |
| Rate for Payer: Aetna Commercial |
$1,237.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,120.58
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,237.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$651.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.80
|
| Rate for Payer: Health EOS Commercial |
$1,185.73
|
| Rate for Payer: Multiplan Commercial |
$1,042.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,237.85
|
| Rate for Payer: Quartz Beloit One Network |
$573.32
|
| Rate for Payer: Quartz Commercial |
$742.71
|
| Rate for Payer: The Alliance Commercial |
$651.50
|
| Rate for Payer: WEA Trust Commercial |
$716.65
|
| Rate for Payer: WPS Commercial |
$965.13
|
|
|
BCE MA Stereotactic Localization ea additional lesion LT
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$633.36 |
| Max. Negotiated Rate |
$9,048.00 |
| Rate for Payer: Aetna Commercial |
$2,035.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Aetna Managed Medicare |
$633.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.86
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.82
|
| Rate for Payer: Health EOS Commercial |
$2,013.18
|
| Rate for Payer: HFN Commercial |
$2,081.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,696.50
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.38
|
| Rate for Payer: Quartz Commercial |
$1,470.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.20
|
| Rate for Payer: The Alliance Commercial |
$9,048.00
|
| Rate for Payer: United Healthcare PPO |
$1,696.50
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion LT
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,108.38 |
| Max. Negotiated Rate |
$2,081.04 |
| Rate for Payer: Aetna Commercial |
$2,035.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.86
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,081.04
|
| Rate for Payer: Health EOS Commercial |
$2,013.18
|
| Rate for Payer: HFN Commercial |
$2,081.04
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.38
|
| Rate for Payer: Quartz Commercial |
$1,357.20
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion LT
|
Professional
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$995.28 |
| Max. Negotiated Rate |
$2,148.90 |
| Rate for Payer: Aetna Commercial |
$2,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,148.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,131.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.20
|
| Rate for Payer: Health EOS Commercial |
$2,058.42
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.90
|
| Rate for Payer: Quartz Beloit One Network |
$995.28
|
| Rate for Payer: Quartz Commercial |
$1,289.34
|
| Rate for Payer: The Alliance Commercial |
$1,131.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Professional
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$995.28 |
| Max. Negotiated Rate |
$2,148.90 |
| Rate for Payer: Aetna Commercial |
$2,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,148.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,131.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.20
|
| Rate for Payer: Health EOS Commercial |
$2,058.42
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.90
|
| Rate for Payer: Quartz Beloit One Network |
$995.28
|
| Rate for Payer: Quartz Commercial |
$1,289.34
|
| Rate for Payer: The Alliance Commercial |
$1,131.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Facility
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,108.38 |
| Max. Negotiated Rate |
$2,081.04 |
| Rate for Payer: Aetna Commercial |
$2,035.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.86
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,081.04
|
| Rate for Payer: Health EOS Commercial |
$2,013.18
|
| Rate for Payer: HFN Commercial |
$2,081.04
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.38
|
| Rate for Payer: Quartz Commercial |
$1,357.20
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Facility
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$633.36 |
| Max. Negotiated Rate |
$9,048.00 |
| Rate for Payer: Aetna Commercial |
$2,035.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Aetna Managed Medicare |
$633.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.86
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.82
|
| Rate for Payer: Health EOS Commercial |
$2,013.18
|
| Rate for Payer: HFN Commercial |
$2,081.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,696.50
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.38
|
| Rate for Payer: Quartz Commercial |
$1,470.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.20
|
| Rate for Payer: The Alliance Commercial |
$9,048.00
|
| Rate for Payer: United Healthcare PPO |
$1,696.50
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Midline Catheter
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$61.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.11
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$143.00
|
| Rate for Payer: Quartz Medicare Advantage |
$132.00
|
| Rate for Payer: The Alliance Commercial |
$880.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
BCE Midline Catheter
|
Professional
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
BCE Midline Catheter
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Facility
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Facility
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$862.33 |
| Max. Negotiated Rate |
$23,860.00 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,473.75
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.00
|
| Rate for Payer: The Alliance Commercial |
$23,860.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$862.33
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Professional
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$123.19 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$123.19
|
| Rate for Payer: Anthem Medicare Advantage |
$123.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.19
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.19
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.19
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: Quartz Medicare Advantage |
$123.19
|
| Rate for Payer: The Alliance Commercial |
$468.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.19
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$615.95
|
|
|
BCE Muscle Biopsy
|
Facility
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$297.64 |
| Max. Negotiated Rate |
$4,252.00 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.64
|
| 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 |
$563.39
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$977.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.85
|
| Rate for Payer: Health EOS Commercial |
$946.07
|
| Rate for Payer: HFN Commercial |
$977.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.25
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: NAPHCARE Commercial |
$637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$977.96
|
| Rate for Payer: Quartz Beloit One Network |
$520.87
|
| Rate for Payer: Quartz Commercial |
$690.95
|
| Rate for Payer: Quartz Medicare Advantage |
$637.80
|
| Rate for Payer: The Alliance Commercial |
$4,252.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
BCE Muscle Biopsy
|
Professional
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$467.72 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Aetna Commercial |
$1,009.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$1,009.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$637.80
|
| Rate for Payer: Health EOS Commercial |
$967.33
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.85
|
| Rate for Payer: Quartz Beloit One Network |
$467.72
|
| Rate for Payer: Quartz Commercial |
$605.91
|
| Rate for Payer: The Alliance Commercial |
$531.50
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
BCE Muscle Biopsy
|
Facility
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$520.87 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.39
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$977.96
|
| Rate for Payer: Health EOS Commercial |
$946.07
|
| Rate for Payer: HFN Commercial |
$977.96
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: NAPHCARE Commercial |
$637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$977.96
|
| Rate for Payer: Quartz Beloit One Network |
$520.87
|
| Rate for Payer: Quartz Commercial |
$637.80
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
