|
BCE Nephrostomy Tube
|
Facility
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BCE Nephrostomy Tube
|
Professional
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$442.64 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Aetna Commercial |
$955.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$955.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$503.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$603.60
|
| Rate for Payer: Health EOS Commercial |
$915.46
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$955.70
|
| Rate for Payer: Quartz Beloit One Network |
$442.64
|
| Rate for Payer: Quartz Commercial |
$573.42
|
| Rate for Payer: The Alliance Commercial |
$503.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BCE Nephrostomy Tube
|
Facility
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BCE NG Tube Placement
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE NG Tube Placement
|
Professional
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE NG Tube Placement
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE NM Brain Spect
|
Professional
|
$10,997.00
|
|
| Hospital Charge Code |
5709723
|
| Min. Negotiated Rate |
$4,838.68 |
| Max. Negotiated Rate |
$10,447.15 |
| Rate for Payer: Aetna Commercial |
$10,447.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,457.42
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,447.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,498.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,598.20
|
| Rate for Payer: Health EOS Commercial |
$10,007.27
|
| Rate for Payer: Multiplan Commercial |
$8,797.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,447.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.68
|
| Rate for Payer: Quartz Commercial |
$6,268.29
|
| Rate for Payer: The Alliance Commercial |
$5,498.50
|
| Rate for Payer: WEA Trust Commercial |
$6,048.35
|
| Rate for Payer: WPS Commercial |
$8,145.48
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
OP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$59.88 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,855.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$59.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
IP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,660.30 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,482.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,482.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Professional
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$421.99 |
| Max. Negotiated Rate |
$7,096.50 |
| Rate for Payer: Aetna Commercial |
$7,096.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Aetna Managed Medicare |
$421.99
|
| Rate for Payer: Anthem Medicare Advantage |
$421.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$421.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$421.99
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$7,096.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,735.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.99
|
| Rate for Payer: Health EOS Commercial |
$6,797.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,620.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,620.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$421.99
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,096.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.80
|
| Rate for Payer: Quartz Commercial |
$4,257.90
|
| Rate for Payer: Quartz Medicare Advantage |
$421.99
|
| Rate for Payer: The Alliance Commercial |
$1,603.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$421.99
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: WPS Commercial |
$2,109.95
|
|
|
BCE Peritoneal Cath
|
Facility
IP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5360638
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,316.63 |
| Max. Negotiated Rate |
$2,472.04 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,612.20
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Peritoneal Cath
|
Facility
OP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5360638
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$752.36 |
| Max. Negotiated Rate |
$2,472.04 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.82
|
| Rate for Payer: Aetna Managed Medicare |
$752.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.65
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.25
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,746.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.20
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Facility
OP
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| 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: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,389.05
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Professional
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$79.48 |
| Max. Negotiated Rate |
$2,030.15 |
| Rate for Payer: Aetna Commercial |
$2,030.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Aetna Managed Medicare |
$79.48
|
| Rate for Payer: Anthem Medicare Advantage |
$79.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.48
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,030.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,068.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.48
|
| Rate for Payer: Health EOS Commercial |
$1,944.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.48
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,030.15
|
| Rate for Payer: Quartz Beloit One Network |
$940.28
|
| Rate for Payer: Quartz Commercial |
$1,218.09
|
| Rate for Payer: Quartz Medicare Advantage |
$79.48
|
| Rate for Payer: The Alliance Commercial |
$337.79
|
| Rate for Payer: United Healthcare Medicaid |
$415.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.48
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$357.66
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Facility
IP
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,047.13 |
| Max. Negotiated Rate |
$1,966.04 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,282.20
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
BCE Plueral Cath
|
Facility
OP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5228671
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$752.36 |
| Max. Negotiated Rate |
$2,472.04 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.82
|
| Rate for Payer: Aetna Managed Medicare |
$752.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.65
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.25
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,746.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.20
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Plueral Cath
|
Facility
IP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5228671
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,316.63 |
| Max. Negotiated Rate |
$2,472.04 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,612.20
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
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 Protein/Creatinine Ratio Urine
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
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 Protein/Creatinine Ratio Urine
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
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 Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Facility
IP
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Professional
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.20
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: The Alliance Commercial |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Facility
OP
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BCE Renal Biopsy
|
Facility
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$893.76 |
| Max. Negotiated Rate |
$1,678.08 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,094.40
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
BCE Renal Biopsy
|
Professional
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$802.56 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,732.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,732.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$912.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.40
|
| Rate for Payer: Health EOS Commercial |
$1,659.84
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.80
|
| Rate for Payer: Quartz Beloit One Network |
$802.56
|
| Rate for Payer: Quartz Commercial |
$1,039.68
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
