|
BCE MA Stereotactic Localization ea additional lesion LT
|
Professional
|
Both
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$995.28 |
| Max. Negotiated Rate |
$2,148.90 |
| Rate for Payer: Aetna Commercial |
$2,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,148.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,131.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.20
|
| Rate for Payer: Health EOS Commercial |
$2,058.42
|
| Rate for Payer: HFN Commercial |
$2,148.90
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.90
|
| Rate for Payer: Quartz Beloit One Network |
$995.28
|
| Rate for Payer: Quartz Commercial |
$1,289.34
|
| Rate for Payer: The Alliance Commercial |
$1,131.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Professional
|
Both
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$995.28 |
| Max. Negotiated Rate |
$2,148.90 |
| Rate for Payer: Aetna Commercial |
$2,148.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,148.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,131.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.20
|
| Rate for Payer: Health EOS Commercial |
$2,058.42
|
| Rate for Payer: HFN Commercial |
$2,148.90
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,148.90
|
| Rate for Payer: Quartz Beloit One Network |
$995.28
|
| Rate for Payer: Quartz Commercial |
$1,289.34
|
| Rate for Payer: The Alliance Commercial |
$1,131.00
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$633.36 |
| Max. Negotiated Rate |
$9,048.00 |
| Rate for Payer: Aetna Commercial |
$2,035.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Aetna Managed Medicare |
$633.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,470.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,131.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,085.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.86
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,265.82
|
| Rate for Payer: Health EOS Commercial |
$2,013.18
|
| Rate for Payer: HFN Commercial |
$2,081.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,696.50
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.38
|
| Rate for Payer: Quartz Commercial |
$1,470.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,357.20
|
| Rate for Payer: The Alliance Commercial |
$9,048.00
|
| Rate for Payer: United Healthcare PPO |
$1,696.50
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,108.38 |
| Max. Negotiated Rate |
$2,081.04 |
| Rate for Payer: Aetna Commercial |
$2,035.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,945.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,198.86
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,081.04
|
| Rate for Payer: Health EOS Commercial |
$2,013.18
|
| Rate for Payer: HFN Commercial |
$2,081.04
|
| Rate for Payer: Multiplan Commercial |
$1,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,357.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,081.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,108.38
|
| Rate for Payer: Quartz Commercial |
$1,357.20
|
| Rate for Payer: WEA Trust Commercial |
$1,244.10
|
| Rate for Payer: WPS Commercial |
$1,675.46
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Midline Catheter
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
BCE Midline Catheter
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$61.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.11
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.00
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$143.00
|
| Rate for Payer: Quartz Medicare Advantage |
$132.00
|
| Rate for Payer: The Alliance Commercial |
$880.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
BCE Midline Catheter
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$1,670.20 |
| Max. Negotiated Rate |
$23,860.00 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,473.75
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.00
|
| Rate for Payer: The Alliance Commercial |
$23,860.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.93 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.93
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
BCE Muscle Biopsy
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$520.87 |
| Max. Negotiated Rate |
$977.96 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.39
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$977.96
|
| Rate for Payer: Health EOS Commercial |
$946.07
|
| Rate for Payer: HFN Commercial |
$977.96
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: NAPHCARE Commercial |
$637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$977.96
|
| Rate for Payer: Quartz Beloit One Network |
$520.87
|
| Rate for Payer: Quartz Commercial |
$637.80
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
BCE Muscle Biopsy
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$467.72 |
| Max. Negotiated Rate |
$1,009.85 |
| Rate for Payer: Aetna Commercial |
$1,009.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$1,009.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$637.80
|
| Rate for Payer: Health EOS Commercial |
$967.33
|
| Rate for Payer: HFN Commercial |
$1,009.85
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.85
|
| Rate for Payer: Quartz Beloit One Network |
$467.72
|
| Rate for Payer: Quartz Commercial |
$605.91
|
| Rate for Payer: The Alliance Commercial |
$531.50
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
BCE Muscle Biopsy
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$297.64 |
| Max. Negotiated Rate |
$4,252.00 |
| Rate for Payer: Aetna Commercial |
$956.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.64
|
| 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 |
$563.39
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$977.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.85
|
| Rate for Payer: Health EOS Commercial |
$946.07
|
| Rate for Payer: HFN Commercial |
$977.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$797.25
|
| Rate for Payer: Multiplan Commercial |
$850.40
|
| Rate for Payer: NAPHCARE Commercial |
$637.80
|
| Rate for Payer: Preferred Network Access Commercial |
$977.96
|
| Rate for Payer: Quartz Beloit One Network |
$520.87
|
| Rate for Payer: Quartz Commercial |
$690.95
|
| Rate for Payer: Quartz Medicare Advantage |
$637.80
|
| Rate for Payer: The Alliance Commercial |
$4,252.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$584.65
|
| Rate for Payer: WPS Commercial |
$787.36
|
|
|
BCE Nephrostomy Tube
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$442.64 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Aetna Commercial |
$955.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$955.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$503.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$603.60
|
| Rate for Payer: Health EOS Commercial |
$915.46
|
| Rate for Payer: HFN Commercial |
$955.70
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$955.70
|
| Rate for Payer: Quartz Beloit One Network |
$442.64
|
| Rate for Payer: Quartz Commercial |
$573.42
|
| Rate for Payer: The Alliance Commercial |
$503.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BCE Nephrostomy Tube
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BCE Nephrostomy Tube
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
BCE NG Tube Placement
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE NG Tube Placement
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: HFN Commercial |
$474.05
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE NG Tube Placement
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE NM Brain Spect
|
Professional
|
Both
|
$10,997.00
|
|
| Hospital Charge Code |
5709723
|
| Min. Negotiated Rate |
$4,838.68 |
| Max. Negotiated Rate |
$10,447.15 |
| Rate for Payer: Aetna Commercial |
$10,447.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,457.42
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,447.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,498.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,598.20
|
| Rate for Payer: Health EOS Commercial |
$10,007.27
|
| Rate for Payer: HFN Commercial |
$10,447.15
|
| Rate for Payer: Multiplan Commercial |
$8,797.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,447.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.68
|
| Rate for Payer: Quartz Commercial |
$6,268.29
|
| Rate for Payer: The Alliance Commercial |
$5,498.50
|
| Rate for Payer: WEA Trust Commercial |
$6,048.35
|
| Rate for Payer: WPS Commercial |
$8,145.48
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
|
IP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,660.30 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,482.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,482.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
|
OP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,180.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,855.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
