|
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
|
|
|
BCE Sacroiliac Joint Injection
|
Professional
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Aetna Commercial |
$607.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$607.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.40
|
| Rate for Payer: Health EOS Commercial |
$581.49
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Preferred Network Access Commercial |
$607.05
|
| Rate for Payer: Quartz Beloit One Network |
$281.16
|
| Rate for Payer: Quartz Commercial |
$364.23
|
| Rate for Payer: The Alliance Commercial |
$319.50
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
BCE Sacroiliac Joint Injection
|
Facility
OP
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$178.92 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Aetna Managed Medicare |
$178.92
|
| 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 |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.58
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$415.35
|
| Rate for Payer: Quartz Medicare Advantage |
$383.40
|
| Rate for Payer: The Alliance Commercial |
$2,556.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
BCE Sacroiliac Joint Injection
|
Facility
IP
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$587.88 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$383.40
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
BCE Saliva Confirmation 15-21
|
Facility
OP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Aetna Managed Medicare |
$198.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$416.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$320.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.20
|
| Rate for Payer: Anthem Medicaid |
$132.80
|
| Rate for Payer: Anthem Medicare Advantage |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.74
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$198.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.14
|
| Rate for Payer: Dean Health Medicaid |
$132.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$198.74
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$198.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$132.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.74
|
| Rate for Payer: Managed Health Services Medicaid |
$138.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$198.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$198.74
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$298.11
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$416.00
|
| Rate for Payer: Quartz Medicare Advantage |
$198.74
|
| Rate for Payer: The Alliance Commercial |
$2,560.00
|
| Rate for Payer: United Healthcare Medicaid |
$132.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: United Healthcare PPO |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: Wellcare Medicare |
$198.74
|
| Rate for Payer: WMAP Medicaid |
$132.80
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
BCE Saliva Confirmation 15-21
|
Facility
IP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
BCE Saliva Confirmation 15-21
|
Professional
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.74 |
| Max. Negotiated Rate |
$701.55 |
| Rate for Payer: Aetna Commercial |
$608.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Aetna Managed Medicare |
$198.74
|
| Rate for Payer: Anthem Medicare Advantage |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.74
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$608.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.74
|
| Rate for Payer: Health EOS Commercial |
$582.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$701.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.74
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$608.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.60
|
| Rate for Payer: Quartz Commercial |
$364.80
|
| Rate for Payer: Quartz Medicare Advantage |
$198.74
|
| Rate for Payer: The Alliance Commercial |
$546.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$347.80
|
|
|
BCE Saliva Confirmation 1-7
|
Facility
IP
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
BCE Saliva Confirmation 1-7
|
Facility
OP
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.44
|
| Rate for Payer: Anthem Medicaid |
$63.95
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$114.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Dean Health Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Managed Health Services Medicaid |
$66.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$712.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
BCE Saliva Confirmation 1-7
|
Professional
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$403.94 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$403.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$314.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$200.25
|
|
|
BCE Saliva Confirmation 22+
|
Facility
OP
|
$851.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$246.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Anthem Medicaid |
$172.18
|
| Rate for Payer: Anthem Medicare Advantage |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$246.92
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$246.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.22
|
| Rate for Payer: Dean Health Medicaid |
$172.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$246.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$918.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$172.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$246.92
|
| Rate for Payer: Managed Health Services Medicaid |
$179.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$246.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$246.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$370.38
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$172.18
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$246.92
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: United Healthcare Medicaid |
$172.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.92
|
| Rate for Payer: United Healthcare PPO |
$638.25
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: Wellcare Medicare |
$246.92
|
| Rate for Payer: WMAP Medicaid |
$172.18
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
BCE Saliva Confirmation 22+
|
Facility
IP
|
$851.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
BCE Saliva Confirmation 22+
|
Professional
|
$851.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$246.92 |
| Max. Negotiated Rate |
$871.63 |
| Rate for Payer: Aetna Commercial |
$808.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$246.92
|
| Rate for Payer: Anthem Medicare Advantage |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$246.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$246.92
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$808.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$425.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.92
|
| Rate for Payer: Health EOS Commercial |
$774.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$246.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$808.45
|
| Rate for Payer: Quartz Beloit One Network |
$374.44
|
| Rate for Payer: Quartz Commercial |
$485.07
|
| Rate for Payer: Quartz Medicare Advantage |
$246.92
|
| Rate for Payer: The Alliance Commercial |
$679.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.92
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$432.11
|
|
|
BCE Saliva Confirmation 5
|
Professional
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5260624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$272.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$272.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$261.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Preferred Network Access Commercial |
$272.65
|
| Rate for Payer: Quartz Beloit One Network |
$126.28
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$245.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: WPS Commercial |
$273.42
|
|
|
BCE Saliva Confirmation 5
|
Facility
IP
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5260624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.63 |
| Max. Negotiated Rate |
$264.04 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$172.20
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$172.20
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
BCE Saliva Confirmation 5
|
Facility
OP
|
$287.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5260624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$1,148.00 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.15
|
| Rate for Payer: Anthem Medicaid |
$63.40
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Managed Health Services Medicaid |
$65.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$186.55
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare Medicaid |
$63.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Healthcare PPO |
$215.25
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
BCE Saliva Confirmation 8-14
|
Professional
|
$426.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.59 |
| Max. Negotiated Rate |
$552.76 |
| Rate for Payer: Aetna Commercial |
$404.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| 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 |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$404.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.59
|
| Rate for Payer: Health EOS Commercial |
$387.66
|
| 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 |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$404.70
|
| Rate for Payer: Quartz Beloit One Network |
$187.44
|
| Rate for Payer: Quartz Commercial |
$242.82
|
| 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 |
$234.30
|
| Rate for Payer: WPS Commercial |
$274.03
|
|
|
BCE Saliva Confirmation 8-14
|
Facility
OP
|
$426.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.39 |
| Max. Negotiated Rate |
$1,704.00 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.36
|
| Rate for Payer: Aetna Managed Medicare |
$156.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$276.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.48
|
| Rate for Payer: Anthem Medicaid |
$98.39
|
| Rate for Payer: Anthem Medicare Advantage |
$156.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| 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 |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$156.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.39
|
| Rate for Payer: Dean Health Medicaid |
$98.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$156.59
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.59
|
| Rate for Payer: Managed Health Services Medicaid |
$102.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$156.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$156.59
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.88
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.39
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$276.90
|
| Rate for Payer: Quartz Medicare Advantage |
$156.59
|
| Rate for Payer: The Alliance Commercial |
$1,704.00
|
| Rate for Payer: United Healthcare Medicaid |
$98.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.59
|
| Rate for Payer: United Healthcare PPO |
$319.50
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: Wellcare Medicare |
$156.59
|
| Rate for Payer: WMAP Medicaid |
$98.39
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
BCE Saliva Confirmation 8-14
|
Facility
IP
|
$426.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.74 |
| Max. Negotiated Rate |
$391.92 |
| Rate for Payer: Aetna Commercial |
$383.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.78
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$391.92
|
| Rate for Payer: Health EOS Commercial |
$379.14
|
| Rate for Payer: HFN Commercial |
$391.92
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: NAPHCARE Commercial |
$255.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.92
|
| Rate for Payer: Quartz Beloit One Network |
$208.74
|
| Rate for Payer: Quartz Commercial |
$255.60
|
| Rate for Payer: WEA Trust Commercial |
$234.30
|
| Rate for Payer: WPS Commercial |
$315.54
|
|
|
BCE Tc-99m Ceretec(HMPAO)
|
Facility
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
5709754
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$953.54 |
| Max. Negotiated Rate |
$1,790.32 |
| Rate for Payer: Aetna Commercial |
$1,751.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.38
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$1,790.32
|
| Rate for Payer: Health EOS Commercial |
$1,731.94
|
| Rate for Payer: HFN Commercial |
$1,790.32
|
| Rate for Payer: Multiplan Commercial |
$1,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,790.32
|
| Rate for Payer: Quartz Beloit One Network |
$953.54
|
| Rate for Payer: Quartz Commercial |
$1,167.60
|
| Rate for Payer: WEA Trust Commercial |
$1,070.30
|
| Rate for Payer: WPS Commercial |
$1,441.40
|
|
|
BCE Tc-99m Ceretec(HMPAO)
|
Facility
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
5709754
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$544.88 |
| Max. Negotiated Rate |
$1,790.32 |
| Rate for Payer: Aetna Commercial |
$1,751.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,673.56
|
| Rate for Payer: Aetna Managed Medicare |
$544.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,264.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$973.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$934.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.38
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$1,790.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,088.98
|
| Rate for Payer: Health EOS Commercial |
$1,731.94
|
| Rate for Payer: HFN Commercial |
$1,790.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,459.50
|
| Rate for Payer: Multiplan Commercial |
$1,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,790.32
|
| Rate for Payer: Quartz Beloit One Network |
$953.54
|
| Rate for Payer: Quartz Commercial |
$1,264.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,167.60
|
| Rate for Payer: WEA Trust Commercial |
$1,070.30
|
| Rate for Payer: WPS Commercial |
$1,441.40
|
|
|
BCE Tc-99m Ceretec(HMPAO)
|
Professional
|
$1,946.00
|
|
|
Service Code
|
HCPCS A9521
|
| Hospital Charge Code |
5709754
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$856.24 |
| Max. Negotiated Rate |
$2,550.85 |
| Rate for Payer: Aetna Commercial |
$1,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,673.56
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cash Price |
$583.80
|
| Rate for Payer: Cigna Commercial |
$1,848.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$973.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,167.60
|
| Rate for Payer: Health EOS Commercial |
$1,770.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,550.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,550.85
|
| Rate for Payer: Multiplan Commercial |
$1,556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,848.70
|
| Rate for Payer: Quartz Beloit One Network |
$856.24
|
| Rate for Payer: Quartz Commercial |
$1,109.22
|
| Rate for Payer: The Alliance Commercial |
$973.00
|
| Rate for Payer: WEA Trust Commercial |
$1,070.30
|
| Rate for Payer: WPS Commercial |
$1,441.40
|
|
|
BCE US Biopsy of Thyroid
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
4464946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| 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 |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
BCE US Biopsy of Thyroid
|
Professional
|
$447.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
4464946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$196.68 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$424.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$424.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.20
|
| Rate for Payer: Health EOS Commercial |
$406.77
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.65
|
| Rate for Payer: Quartz Beloit One Network |
$196.68
|
| Rate for Payer: Quartz Commercial |
$254.79
|
| Rate for Payer: The Alliance Commercial |
$223.50
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
BCE US Biopsy of Thyroid
|
Facility
IP
|
$447.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
4464946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
