|
BCE CV VL LE PVR Resting Acquisition
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5388650
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL LE PVR w Exercise Acquisition
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5388649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$942.76 |
| Max. Negotiated Rate |
$1,770.08 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,154.40
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
|
BCE CV VL LE PVR w Exercise Acquisition
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5388649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,770.08 |
| Rate for Payer: Aetna Commercial |
$1,731.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,654.64
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,250.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$962.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$923.52
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,019.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,770.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,076.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$1,712.36
|
| Rate for Payer: HFN Commercial |
$1,770.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,770.08
|
| Rate for Payer: Quartz Beloit One Network |
$942.76
|
| Rate for Payer: Quartz Commercial |
$1,250.60
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,058.20
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$1,425.11
|
|
|
BCE Cyst Aspiration
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$38.92
|
| 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 |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$83.40
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
BCE Cyst Aspiration
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
BCE Cyst Aspiration
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$61.16 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: HFN Commercial |
$132.05
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
BCE Drug Test Conf 15-21
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$1,510.64 |
| Rate for Payer: Aetna Commercial |
$1,477.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.12
|
| Rate for Payer: Aetna Managed Medicare |
$198.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,067.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$821.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$788.16
|
| 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 |
$870.26
|
| 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 |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,510.64
|
| 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 |
$918.86
|
| 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 |
$1,461.38
|
| Rate for Payer: HFN Commercial |
$1,510.64
|
| 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 |
$1,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.80
|
| Rate for Payer: Quartz Beloit One Network |
$804.58
|
| Rate for Payer: Quartz Commercial |
$1,067.30
|
| Rate for Payer: Quartz Medicare Advantage |
$198.74
|
| Rate for Payer: The Alliance Commercial |
$794.96
|
| Rate for Payer: United Healthcare Medicaid |
$132.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: United Healthcare PPO |
$1,231.50
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: Wellcare Medicare |
$198.74
|
| Rate for Payer: WMAP Medicaid |
$132.80
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
BCE Drug Test Conf 15-21
|
Facility
|
IP
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$804.58 |
| Max. Negotiated Rate |
$1,510.64 |
| Rate for Payer: Aetna Commercial |
$1,477.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.26
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,510.64
|
| Rate for Payer: Health EOS Commercial |
$1,461.38
|
| Rate for Payer: HFN Commercial |
$1,510.64
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$985.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.64
|
| Rate for Payer: Quartz Beloit One Network |
$804.58
|
| Rate for Payer: Quartz Commercial |
$985.20
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
BCE Drug Test Conf 15-21
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$701.55 |
| Max. Negotiated Rate |
$1,559.90 |
| Rate for Payer: Aetna Commercial |
$1,559.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.12
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,559.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$821.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$985.20
|
| Rate for Payer: Health EOS Commercial |
$1,494.22
|
| Rate for Payer: HFN Commercial |
$1,559.90
|
| 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: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.90
|
| Rate for Payer: Quartz Beloit One Network |
$722.48
|
| Rate for Payer: Quartz Commercial |
$935.94
|
| Rate for Payer: The Alliance Commercial |
$821.00
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
BCE Drug Test Conf 1-7
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$457.72 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.28
|
| 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 |
$204.58
|
| 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 |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| 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 |
$216.01
|
| 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 |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| 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 |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$457.72
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$289.50
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
BCE Drug Test Conf 1-7
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.84 |
| Max. Negotiated Rate |
$403.94 |
| Rate for Payer: Aetna Commercial |
$366.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$366.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.60
|
| Rate for Payer: Health EOS Commercial |
$351.26
|
| Rate for Payer: HFN Commercial |
$366.70
|
| 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: Multiplan Commercial |
$308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.70
|
| Rate for Payer: Quartz Beloit One Network |
$169.84
|
| Rate for Payer: Quartz Commercial |
$220.02
|
| Rate for Payer: The Alliance Commercial |
$193.00
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
BCE Drug Test Conf 1-7
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
BCE Drug Test Conf 22+
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.18 |
| Max. Negotiated Rate |
$2,014.80 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Aetna Managed Medicare |
$246.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,423.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,051.20
|
| 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 |
$1,160.70
|
| 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 |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| 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 |
$1,225.52
|
| 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 |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| 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 |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$370.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$172.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,423.50
|
| Rate for Payer: Quartz Medicare Advantage |
$246.92
|
| Rate for Payer: The Alliance Commercial |
$987.68
|
| Rate for Payer: United Healthcare Medicaid |
$172.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.92
|
| Rate for Payer: United Healthcare PPO |
$1,642.50
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: Wellcare Medicare |
$246.92
|
| Rate for Payer: WMAP Medicaid |
$172.18
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
BCE Drug Test Conf 22+
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$2,014.80 |
| Rate for Payer: Aetna Commercial |
$1,971.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,160.70
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,014.80
|
| Rate for Payer: Health EOS Commercial |
$1,949.10
|
| Rate for Payer: HFN Commercial |
$2,014.80
|
| Rate for Payer: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,314.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,073.10
|
| Rate for Payer: Quartz Commercial |
$1,314.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
BCE Drug Test Conf 22+
|
Professional
|
Both
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$871.63 |
| Max. Negotiated Rate |
$2,080.50 |
| Rate for Payer: Aetna Commercial |
$2,080.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,883.40
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,080.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,095.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,314.00
|
| Rate for Payer: Health EOS Commercial |
$1,992.90
|
| Rate for Payer: HFN Commercial |
$2,080.50
|
| 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: Multiplan Commercial |
$1,752.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,080.50
|
| Rate for Payer: Quartz Beloit One Network |
$963.60
|
| Rate for Payer: Quartz Commercial |
$1,248.30
|
| Rate for Payer: The Alliance Commercial |
$1,095.00
|
| Rate for Payer: WEA Trust Commercial |
$1,204.50
|
| Rate for Payer: WPS Commercial |
$1,622.13
|
|
|
BCE Drug Test Conf 8-14
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$323.84 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$699.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.96
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$669.76
|
| Rate for Payer: HFN Commercial |
$699.20
|
| 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: Multiplan Commercial |
$588.80
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$323.84
|
| Rate for Payer: Quartz Commercial |
$419.52
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: WEA Trust Commercial |
$404.80
|
| Rate for Payer: WPS Commercial |
$545.16
|
|
|
BCE Drug Test Conf 8-14
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.39 |
| Max. Negotiated Rate |
$677.12 |
| Rate for Payer: Aetna Commercial |
$662.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.96
|
| Rate for Payer: Aetna Managed Medicare |
$156.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$478.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.28
|
| 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 |
$390.08
|
| 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 |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$677.12
|
| 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 |
$411.87
|
| 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 |
$655.04
|
| Rate for Payer: HFN Commercial |
$677.12
|
| 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 |
$588.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.88
|
| Rate for Payer: Preferred Network Access Commercial |
$677.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.39
|
| Rate for Payer: Quartz Beloit One Network |
$360.64
|
| Rate for Payer: Quartz Commercial |
$478.40
|
| Rate for Payer: Quartz Medicare Advantage |
$156.59
|
| Rate for Payer: The Alliance Commercial |
$626.36
|
| Rate for Payer: United Healthcare Medicaid |
$98.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.59
|
| Rate for Payer: United Healthcare PPO |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$404.80
|
| Rate for Payer: Wellcare Medicare |
$156.59
|
| Rate for Payer: WMAP Medicaid |
$98.39
|
| Rate for Payer: WPS Commercial |
$545.16
|
|
|
BCE Drug Test Conf 8-14
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$360.64 |
| Max. Negotiated Rate |
$677.12 |
| Rate for Payer: Aetna Commercial |
$662.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.08
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$677.12
|
| Rate for Payer: Health EOS Commercial |
$655.04
|
| Rate for Payer: HFN Commercial |
$677.12
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: NAPHCARE Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$677.12
|
| Rate for Payer: Quartz Beloit One Network |
$360.64
|
| Rate for Payer: Quartz Commercial |
$441.60
|
| Rate for Payer: WEA Trust Commercial |
$404.80
|
| Rate for Payer: WPS Commercial |
$545.16
|
|
|
BCE Fiducial Markers
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$777.28 |
| Max. Negotiated Rate |
$11,104.00 |
| Rate for Payer: Aetna Commercial |
$2,498.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Aetna Managed Medicare |
$777.28
|
| 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 |
$1,471.28
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,553.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,553.45
|
| Rate for Payer: Health EOS Commercial |
$2,470.64
|
| Rate for Payer: HFN Commercial |
$2,553.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,082.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.24
|
| Rate for Payer: Quartz Commercial |
$1,804.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,665.60
|
| Rate for Payer: The Alliance Commercial |
$11,104.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
BCE Fiducial Markers
|
Professional
|
Both
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,221.44 |
| Max. Negotiated Rate |
$2,637.20 |
| Rate for Payer: Aetna Commercial |
$2,637.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,637.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,388.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.60
|
| Rate for Payer: Health EOS Commercial |
$2,526.16
|
| Rate for Payer: HFN Commercial |
$2,637.20
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,637.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.44
|
| Rate for Payer: Quartz Commercial |
$1,582.32
|
| Rate for Payer: The Alliance Commercial |
$1,388.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
BCE Fiducial Markers
|
Facility
|
IP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.24 |
| Max. Negotiated Rate |
$2,553.92 |
| Rate for Payer: Aetna Commercial |
$2,498.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.28
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,553.92
|
| Rate for Payer: Health EOS Commercial |
$2,470.64
|
| Rate for Payer: HFN Commercial |
$2,553.92
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.24
|
| Rate for Payer: Quartz Commercial |
$1,665.60
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
BCE Fine Needle Aspiration
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
BCE Fine Needle Aspiration
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$63.84
|
| 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 |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.59
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
BCE Fine Needle Aspiration
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.80
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: HFN Commercial |
$216.60
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: The Alliance Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
BCE Fine Needle Aspiration ea additional
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Aetna Managed Medicare |
$59.92
|
| 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 |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.75
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.50
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$139.10
|
| Rate for Payer: Quartz Medicare Advantage |
$128.40
|
| Rate for Payer: The Alliance Commercial |
$856.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
