|
BCE US Breast Biopsy each additional LT
|
Facility
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,LT
|
| Hospital Charge Code |
4076047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$414.68 |
| Max. Negotiated Rate |
$5,924.00 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Aetna Managed Medicare |
$414.68
|
| 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 |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.75
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$962.65
|
| Rate for Payer: Quartz Medicare Advantage |
$888.60
|
| Rate for Payer: The Alliance Commercial |
$5,924.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
BCE US Breast Biopsy each additional LT
|
Facility
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,LT
|
| Hospital Charge Code |
4076047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$888.60
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
BCE US Breast Biopsy each additional LT
|
Professional
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,LT
|
| Hospital Charge Code |
4076047
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$651.64 |
| Max. Negotiated Rate |
$1,406.95 |
| Rate for Payer: Aetna Commercial |
$1,406.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,406.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$740.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.60
|
| Rate for Payer: Health EOS Commercial |
$1,347.71
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.95
|
| Rate for Payer: Quartz Beloit One Network |
$651.64
|
| Rate for Payer: Quartz Commercial |
$844.17
|
| Rate for Payer: The Alliance Commercial |
$740.50
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
BCE US Breast Biopsy each additional RT
|
Professional
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
4076046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$651.64 |
| Max. Negotiated Rate |
$1,406.95 |
| Rate for Payer: Aetna Commercial |
$1,406.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,406.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$740.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.60
|
| Rate for Payer: Health EOS Commercial |
$1,347.71
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.95
|
| Rate for Payer: Quartz Beloit One Network |
$651.64
|
| Rate for Payer: Quartz Commercial |
$844.17
|
| Rate for Payer: The Alliance Commercial |
$740.50
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
BCE US Breast Biopsy each additional RT
|
Facility
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
4076046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$414.68 |
| Max. Negotiated Rate |
$5,924.00 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Aetna Managed Medicare |
$414.68
|
| 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 |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.75
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$962.65
|
| Rate for Payer: Quartz Medicare Advantage |
$888.60
|
| Rate for Payer: The Alliance Commercial |
$5,924.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
BCE US Breast Biopsy each additional RT
|
Facility
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
4076046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$888.60
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
BCE US Pregnancy Transvaginal
|
Facility
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3091485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$531.65 |
| Max. Negotiated Rate |
$998.20 |
| Rate for Payer: Aetna Commercial |
$976.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$575.05
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$998.20
|
| Rate for Payer: Health EOS Commercial |
$965.65
|
| Rate for Payer: HFN Commercial |
$998.20
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: NAPHCARE Commercial |
$651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$998.20
|
| Rate for Payer: Quartz Beloit One Network |
$531.65
|
| Rate for Payer: Quartz Commercial |
$651.00
|
| Rate for Payer: WEA Trust Commercial |
$596.75
|
| Rate for Payer: WPS Commercial |
$803.66
|
|
|
BCE US Pregnancy Transvaginal
|
Professional
|
$1,085.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3091485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$1,030.75 |
| Rate for Payer: Aetna Commercial |
$1,030.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.10
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Medicare Advantage |
$55.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55.16
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$1,030.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$542.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.16
|
| Rate for Payer: Health EOS Commercial |
$987.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$202.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55.16
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.75
|
| Rate for Payer: Quartz Beloit One Network |
$477.40
|
| Rate for Payer: Quartz Commercial |
$618.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.16
|
| Rate for Payer: The Alliance Commercial |
$209.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.16
|
| Rate for Payer: WEA Trust Commercial |
$596.75
|
| Rate for Payer: WPS Commercial |
$275.80
|
|
|
BCE US Pregnancy Transvaginal
|
Facility
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3091485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$4,340.00 |
| Rate for Payer: Aetna Commercial |
$976.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.10
|
| Rate for Payer: Aetna Managed Medicare |
$303.80
|
| 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 |
$575.05
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$998.20
|
| Rate for Payer: Health EOS Commercial |
$965.65
|
| Rate for Payer: HFN Commercial |
$998.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.75
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: NAPHCARE Commercial |
$651.00
|
| Rate for Payer: Preferred Network Access Commercial |
$998.20
|
| Rate for Payer: Quartz Beloit One Network |
$531.65
|
| Rate for Payer: Quartz Commercial |
$705.25
|
| Rate for Payer: Quartz Medicare Advantage |
$651.00
|
| Rate for Payer: The Alliance Commercial |
$4,340.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$596.75
|
| Rate for Payer: WPS Commercial |
$803.66
|
|
|
BCE US Renal
|
Professional
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3091460
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$1,552.30 |
| Rate for Payer: Aetna Commercial |
$1,552.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.24
|
| Rate for Payer: Aetna Managed Medicare |
$30.37
|
| Rate for Payer: Anthem Medicare Advantage |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.37
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,552.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$817.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.37
|
| Rate for Payer: Health EOS Commercial |
$1,486.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.37
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.30
|
| Rate for Payer: Quartz Beloit One Network |
$718.96
|
| Rate for Payer: Quartz Commercial |
$931.38
|
| Rate for Payer: Quartz Medicare Advantage |
$30.37
|
| Rate for Payer: The Alliance Commercial |
$115.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.37
|
| Rate for Payer: WEA Trust Commercial |
$898.70
|
| Rate for Payer: WPS Commercial |
$151.85
|
|
|
BCE US Renal
|
Facility
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3091460
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$800.66 |
| Max. Negotiated Rate |
$1,503.28 |
| Rate for Payer: Aetna Commercial |
$1,470.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$866.02
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,503.28
|
| Rate for Payer: Health EOS Commercial |
$1,454.26
|
| Rate for Payer: HFN Commercial |
$1,503.28
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$980.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.28
|
| Rate for Payer: Quartz Beloit One Network |
$800.66
|
| Rate for Payer: Quartz Commercial |
$980.40
|
| Rate for Payer: WEA Trust Commercial |
$898.70
|
| Rate for Payer: WPS Commercial |
$1,210.30
|
|
|
BCE US Renal
|
Facility
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3091460
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$457.52 |
| Max. Negotiated Rate |
$6,536.00 |
| Rate for Payer: Aetna Commercial |
$1,470.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.24
|
| Rate for Payer: Aetna Managed Medicare |
$457.52
|
| 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 |
$866.02
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,503.28
|
| Rate for Payer: Health EOS Commercial |
$1,454.26
|
| Rate for Payer: HFN Commercial |
$1,503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.50
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$980.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.28
|
| Rate for Payer: Quartz Beloit One Network |
$800.66
|
| Rate for Payer: Quartz Commercial |
$1,062.10
|
| Rate for Payer: Quartz Medicare Advantage |
$980.40
|
| Rate for Payer: The Alliance Commercial |
$6,536.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$898.70
|
| Rate for Payer: WPS Commercial |
$1,210.30
|
|
|
BCE Venous Draw
|
Professional
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3119360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$8.57
|
| Rate for Payer: Anthem Medicare Advantage |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.57
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$42.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.57
|
| Rate for Payer: Health EOS Commercial |
$40.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$42.75
|
| Rate for Payer: Quartz Beloit One Network |
$19.80
|
| Rate for Payer: Quartz Commercial |
$25.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.57
|
| Rate for Payer: The Alliance Commercial |
$36.42
|
| Rate for Payer: United Healthcare Medicaid |
$7.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$37.71
|
|
|
BCE Venous Draw
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3119360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
BCE Venous Draw
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3119360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$8.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicare Advantage |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.57
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.57
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.57
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.86
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.57
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.57
|
| Rate for Payer: United Healthcare PPO |
$33.75
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: Wellcare Medicare |
$8.57
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
BCE VL Ankle Pressure Single Level
|
Facility
OP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114946
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$2,084.00 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Aetna Managed Medicare |
$145.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.13
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$479.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.55
|
| Rate for Payer: Health EOS Commercial |
$463.69
|
| Rate for Payer: HFN Commercial |
$479.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.75
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: NAPHCARE Commercial |
$312.60
|
| Rate for Payer: Preferred Network Access Commercial |
$479.32
|
| Rate for Payer: Quartz Beloit One Network |
$255.29
|
| Rate for Payer: Quartz Commercial |
$338.65
|
| Rate for Payer: Quartz Medicare Advantage |
$312.60
|
| Rate for Payer: The Alliance Commercial |
$2,084.00
|
| Rate for Payer: United Healthcare PPO |
$390.75
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
BCE VL Ankle Pressure Single Level
|
Facility
IP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114946
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$255.29 |
| Max. Negotiated Rate |
$479.32 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.13
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$479.32
|
| Rate for Payer: Health EOS Commercial |
$463.69
|
| Rate for Payer: HFN Commercial |
$479.32
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: NAPHCARE Commercial |
$312.60
|
| Rate for Payer: Preferred Network Access Commercial |
$479.32
|
| Rate for Payer: Quartz Beloit One Network |
$255.29
|
| Rate for Payer: Quartz Commercial |
$312.60
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
BCE VL Ankle Pressure Single Level
|
Professional
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114946
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$67.17 |
| Max. Negotiated Rate |
$494.95 |
| Rate for Payer: Aetna Commercial |
$494.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Aetna Managed Medicare |
$67.17
|
| Rate for Payer: Anthem Medicare Advantage |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.17
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$494.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.17
|
| Rate for Payer: Health EOS Commercial |
$474.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.17
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.95
|
| Rate for Payer: Quartz Beloit One Network |
$229.24
|
| Rate for Payer: Quartz Commercial |
$296.97
|
| Rate for Payer: Quartz Medicare Advantage |
$67.17
|
| Rate for Payer: The Alliance Commercial |
$167.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.17
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$268.68
|
|
|
BCE VL Carotid Duplex Bilateral
|
Facility
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
3114947
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$501.48 |
| Max. Negotiated Rate |
$7,164.00 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Aetna Managed Medicare |
$501.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$859.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.24
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.25
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,164.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,074.60
|
| Rate for Payer: The Alliance Commercial |
$7,164.00
|
| Rate for Payer: United Healthcare PPO |
$1,343.25
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
BCE VL Carotid Duplex Bilateral
|
Professional
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
3114947
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$147.22 |
| Max. Negotiated Rate |
$1,701.45 |
| Rate for Payer: Aetna Commercial |
$1,701.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Aetna Managed Medicare |
$147.22
|
| Rate for Payer: Anthem Medicare Advantage |
$147.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.22
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,701.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$895.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.22
|
| Rate for Payer: Health EOS Commercial |
$1,629.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.22
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,701.45
|
| Rate for Payer: Quartz Beloit One Network |
$788.04
|
| Rate for Payer: Quartz Commercial |
$1,020.87
|
| Rate for Payer: Quartz Medicare Advantage |
$147.22
|
| Rate for Payer: The Alliance Commercial |
$368.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.22
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$588.88
|
|
|
BCE VL Carotid Duplex Bilateral
|
Facility
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
3114947
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$877.59 |
| Max. Negotiated Rate |
$1,647.72 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,074.60
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
BCE VL Carotid Duplex Left or Limited
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5266753
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
BCE VL Carotid Duplex Left or Limited
|
Professional
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5266753
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
BCE VL Carotid Duplex Left or Limited
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5266753
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$554.25
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
BCE VL Carotid Duplex Right or Limited
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5266752
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
