|
BCE Biopsy Bone, Deep
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$766.85 |
| Max. Negotiated Rate |
$1,439.80 |
| Rate for Payer: Aetna Commercial |
$1,408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.45
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,439.80
|
| Rate for Payer: Health EOS Commercial |
$1,392.85
|
| Rate for Payer: HFN Commercial |
$1,439.80
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$939.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.80
|
| Rate for Payer: Quartz Beloit One Network |
$766.85
|
| Rate for Payer: Quartz Commercial |
$939.00
|
| Rate for Payer: WEA Trust Commercial |
$860.75
|
| Rate for Payer: WPS Commercial |
$1,159.20
|
|
|
BCE Biopsy Bone, Deep
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$438.20 |
| Max. Negotiated Rate |
$6,260.00 |
| Rate for Payer: Aetna Commercial |
$1,408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.90
|
| Rate for Payer: Aetna Managed Medicare |
$438.20
|
| 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 |
$829.45
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,439.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$875.77
|
| Rate for Payer: Health EOS Commercial |
$1,392.85
|
| Rate for Payer: HFN Commercial |
$1,439.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,173.75
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: NAPHCARE Commercial |
$939.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.80
|
| Rate for Payer: Quartz Beloit One Network |
$766.85
|
| Rate for Payer: Quartz Commercial |
$1,017.25
|
| Rate for Payer: Quartz Medicare Advantage |
$939.00
|
| Rate for Payer: The Alliance Commercial |
$6,260.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$860.75
|
| Rate for Payer: WPS Commercial |
$1,159.20
|
|
|
BCE Biopsy Bone, Deep
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$688.60 |
| Max. Negotiated Rate |
$1,486.75 |
| Rate for Payer: Aetna Commercial |
$1,486.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.90
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,486.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$782.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.00
|
| Rate for Payer: Health EOS Commercial |
$1,424.15
|
| Rate for Payer: HFN Commercial |
$1,486.75
|
| Rate for Payer: Multiplan Commercial |
$1,252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.75
|
| Rate for Payer: Quartz Beloit One Network |
$688.60
|
| Rate for Payer: Quartz Commercial |
$892.05
|
| Rate for Payer: The Alliance Commercial |
$782.50
|
| Rate for Payer: WEA Trust Commercial |
$860.75
|
| Rate for Payer: WPS Commercial |
$1,159.20
|
|
|
BCE Biopsy Liver
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$532.14 |
| Max. Negotiated Rate |
$999.12 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$651.60
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Liver
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Aetna Managed Medicare |
$304.08
|
| 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 |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.73
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.50
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$705.90
|
| Rate for Payer: Quartz Medicare Advantage |
$651.60
|
| Rate for Payer: The Alliance Commercial |
$4,344.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Liver
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$477.84 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Aetna Commercial |
$1,031.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,031.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$543.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.60
|
| Rate for Payer: Health EOS Commercial |
$988.26
|
| Rate for Payer: HFN Commercial |
$1,031.70
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.70
|
| Rate for Payer: Quartz Beloit One Network |
$477.84
|
| Rate for Payer: Quartz Commercial |
$619.02
|
| Rate for Payer: The Alliance Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Lung
|
Facility
|
OP
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$424.20 |
| Max. Negotiated Rate |
$6,060.00 |
| Rate for Payer: Aetna Commercial |
$1,363.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.90
|
| Rate for Payer: Aetna Managed Medicare |
$424.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$984.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$757.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.95
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,393.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.79
|
| Rate for Payer: Health EOS Commercial |
$1,348.35
|
| Rate for Payer: HFN Commercial |
$1,393.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,136.25
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$909.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.80
|
| Rate for Payer: Quartz Beloit One Network |
$742.35
|
| Rate for Payer: Quartz Commercial |
$984.75
|
| Rate for Payer: Quartz Medicare Advantage |
$909.00
|
| Rate for Payer: The Alliance Commercial |
$6,060.00
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
BCE Biopsy Lung
|
Professional
|
Both
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$666.60 |
| Max. Negotiated Rate |
$1,439.25 |
| Rate for Payer: Aetna Commercial |
$1,439.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.90
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,439.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$757.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$909.00
|
| Rate for Payer: Health EOS Commercial |
$1,378.65
|
| Rate for Payer: HFN Commercial |
$1,439.25
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,439.25
|
| Rate for Payer: Quartz Beloit One Network |
$666.60
|
| Rate for Payer: Quartz Commercial |
$863.55
|
| Rate for Payer: The Alliance Commercial |
$757.50
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
BCE Biopsy Lung
|
Facility
|
IP
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$742.35 |
| Max. Negotiated Rate |
$1,393.80 |
| Rate for Payer: Aetna Commercial |
$1,363.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,302.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.95
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,393.80
|
| Rate for Payer: Health EOS Commercial |
$1,348.35
|
| Rate for Payer: HFN Commercial |
$1,393.80
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: NAPHCARE Commercial |
$909.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.80
|
| Rate for Payer: Quartz Beloit One Network |
$742.35
|
| Rate for Payer: Quartz Commercial |
$909.00
|
| Rate for Payer: WEA Trust Commercial |
$833.25
|
| Rate for Payer: WPS Commercial |
$1,122.16
|
|
|
BCE Biopsy Lymph Node
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$369.60
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
BCE Biopsy Lymph Node
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$172.48 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Aetna Managed Medicare |
$172.48
|
| 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 |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.71
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$462.00
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$400.40
|
| Rate for Payer: Quartz Medicare Advantage |
$369.60
|
| Rate for Payer: The Alliance Commercial |
$2,464.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
BCE Biopsy Lymph Node
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$585.20 |
| Rate for Payer: Aetna Commercial |
$585.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$585.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.60
|
| Rate for Payer: Health EOS Commercial |
$560.56
|
| Rate for Payer: HFN Commercial |
$585.20
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$585.20
|
| Rate for Payer: Quartz Beloit One Network |
$271.04
|
| Rate for Payer: Quartz Commercial |
$351.12
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
BCE Biopsy Pancreas
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,839.88 |
| Max. Negotiated Rate |
$26,284.00 |
| Rate for Payer: Aetna Commercial |
$5,913.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,839.88
|
| 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 |
$3,482.63
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,045.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.13
|
| Rate for Payer: Health EOS Commercial |
$5,848.19
|
| Rate for Payer: HFN Commercial |
$6,045.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,928.25
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,045.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.79
|
| Rate for Payer: Quartz Commercial |
$4,271.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,942.60
|
| Rate for Payer: The Alliance Commercial |
$26,284.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,614.05
|
| Rate for Payer: WPS Commercial |
$4,867.14
|
|
|
BCE Biopsy Pancreas
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,219.79 |
| Max. Negotiated Rate |
$6,045.32 |
| Rate for Payer: Aetna Commercial |
$5,913.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,482.63
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,045.32
|
| Rate for Payer: Health EOS Commercial |
$5,848.19
|
| Rate for Payer: HFN Commercial |
$6,045.32
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,045.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.79
|
| Rate for Payer: Quartz Commercial |
$3,942.60
|
| Rate for Payer: WEA Trust Commercial |
$3,614.05
|
| Rate for Payer: WPS Commercial |
$4,867.14
|
|
|
BCE Biopsy Pancreas
|
Professional
|
Both
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,891.24 |
| Max. Negotiated Rate |
$6,242.45 |
| Rate for Payer: Aetna Commercial |
$6,242.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,651.06
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,242.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,942.60
|
| Rate for Payer: Health EOS Commercial |
$5,979.61
|
| Rate for Payer: HFN Commercial |
$6,242.45
|
| Rate for Payer: Multiplan Commercial |
$5,256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,242.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,891.24
|
| Rate for Payer: Quartz Commercial |
$3,745.47
|
| Rate for Payer: The Alliance Commercial |
$3,285.50
|
| Rate for Payer: WEA Trust Commercial |
$3,614.05
|
| Rate for Payer: WPS Commercial |
$4,867.14
|
|
|
BCE Biopsy Pleura, Perc
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$304.08 |
| Max. Negotiated Rate |
$4,344.00 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Aetna Managed Medicare |
$304.08
|
| 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 |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.73
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.50
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$705.90
|
| Rate for Payer: Quartz Medicare Advantage |
$651.60
|
| Rate for Payer: The Alliance Commercial |
$4,344.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Pleura, Perc
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$532.14 |
| Max. Negotiated Rate |
$999.12 |
| Rate for Payer: Aetna Commercial |
$977.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.58
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$999.12
|
| Rate for Payer: Health EOS Commercial |
$966.54
|
| Rate for Payer: HFN Commercial |
$999.12
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: NAPHCARE Commercial |
$651.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.12
|
| Rate for Payer: Quartz Beloit One Network |
$532.14
|
| Rate for Payer: Quartz Commercial |
$651.60
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Pleura, Perc
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$477.84 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Aetna Commercial |
$1,031.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.96
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,031.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$543.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.60
|
| Rate for Payer: Health EOS Commercial |
$988.26
|
| Rate for Payer: HFN Commercial |
$1,031.70
|
| Rate for Payer: Multiplan Commercial |
$868.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,031.70
|
| Rate for Payer: Quartz Beloit One Network |
$477.84
|
| Rate for Payer: Quartz Commercial |
$619.02
|
| Rate for Payer: The Alliance Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$597.30
|
| Rate for Payer: WPS Commercial |
$804.40
|
|
|
BCE Biopsy Salivary Gland
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$383.68 |
| Max. Negotiated Rate |
$828.40 |
| Rate for Payer: Aetna Commercial |
$828.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.92
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$828.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$436.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.20
|
| Rate for Payer: Health EOS Commercial |
$793.52
|
| Rate for Payer: HFN Commercial |
$828.40
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.40
|
| Rate for Payer: Quartz Beloit One Network |
$383.68
|
| Rate for Payer: Quartz Commercial |
$497.04
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: WEA Trust Commercial |
$479.60
|
| Rate for Payer: WPS Commercial |
$645.89
|
|
|
BCE Biopsy Salivary Gland
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$244.16 |
| Max. Negotiated Rate |
$3,488.00 |
| Rate for Payer: Aetna Commercial |
$784.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.92
|
| Rate for Payer: Aetna Managed Medicare |
$244.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.16
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$802.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$487.97
|
| Rate for Payer: Health EOS Commercial |
$776.08
|
| Rate for Payer: HFN Commercial |
$802.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.00
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: NAPHCARE Commercial |
$523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$802.24
|
| Rate for Payer: Quartz Beloit One Network |
$427.28
|
| Rate for Payer: Quartz Commercial |
$566.80
|
| Rate for Payer: Quartz Medicare Advantage |
$523.20
|
| Rate for Payer: The Alliance Commercial |
$3,488.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$479.60
|
| Rate for Payer: WPS Commercial |
$645.89
|
|
|
BCE Biopsy Salivary Gland
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$802.24 |
| Rate for Payer: Aetna Commercial |
$784.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$749.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.16
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$802.24
|
| Rate for Payer: Health EOS Commercial |
$776.08
|
| Rate for Payer: HFN Commercial |
$802.24
|
| Rate for Payer: Multiplan Commercial |
$697.60
|
| Rate for Payer: NAPHCARE Commercial |
$523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$802.24
|
| Rate for Payer: Quartz Beloit One Network |
$427.28
|
| Rate for Payer: Quartz Commercial |
$523.20
|
| Rate for Payer: WEA Trust Commercial |
$479.60
|
| Rate for Payer: WPS Commercial |
$645.89
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Facility
|
IP
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,810.73 |
| Max. Negotiated Rate |
$7,154.84 |
| Rate for Payer: Aetna Commercial |
$6,999.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,121.81
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,154.84
|
| Rate for Payer: Health EOS Commercial |
$6,921.53
|
| Rate for Payer: HFN Commercial |
$7,154.84
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,154.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,810.73
|
| Rate for Payer: Quartz Commercial |
$4,666.20
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Professional
|
Both
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,421.88 |
| Max. Negotiated Rate |
$7,388.15 |
| Rate for Payer: Aetna Commercial |
$7,388.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,388.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,888.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,666.20
|
| Rate for Payer: Health EOS Commercial |
$7,077.07
|
| Rate for Payer: HFN Commercial |
$7,388.15
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,388.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,421.88
|
| Rate for Payer: Quartz Commercial |
$4,432.89
|
| Rate for Payer: The Alliance Commercial |
$3,888.50
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Facility
|
OP
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$31,108.00 |
| Rate for Payer: Aetna Commercial |
$6,999.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,688.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,177.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,121.81
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,154.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,352.01
|
| Rate for Payer: Health EOS Commercial |
$6,921.53
|
| Rate for Payer: HFN Commercial |
$7,154.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,832.75
|
| Rate for Payer: Multiplan Commercial |
$6,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,666.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,154.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,810.73
|
| Rate for Payer: Quartz Commercial |
$5,055.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,666.20
|
| Rate for Payer: The Alliance Commercial |
$31,108.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$4,277.35
|
| Rate for Payer: WPS Commercial |
$5,760.42
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
