|
BCE Axumin
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
HCPCS A9588
|
| Hospital Charge Code |
5454652
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$592.66 |
| Max. Negotiated Rate |
$1,112.76 |
| Rate for Payer: Aetna Commercial |
$1,088.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,040.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$641.05
|
| Rate for Payer: Cash Price |
$348.90
|
| Rate for Payer: Cigna Commercial |
$1,112.76
|
| Rate for Payer: Health EOS Commercial |
$1,076.47
|
| Rate for Payer: HFN Commercial |
$1,112.76
|
| Rate for Payer: Multiplan Commercial |
$967.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,112.76
|
| Rate for Payer: Quartz Beloit One Network |
$592.66
|
| Rate for Payer: Quartz Commercial |
$725.71
|
| Rate for Payer: WEA Trust Commercial |
$665.24
|
| Rate for Payer: WPS Commercial |
$895.86
|
|
|
BCE Biopsy Bone
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 20220 TC
|
| Hospital Charge Code |
5518669
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,239.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$3,985.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.01
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,074.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$3,941.20
|
| Rate for Payer: HFN Commercial |
$4,074.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,321.24
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.88
|
| Rate for Payer: Quartz Commercial |
$2,878.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,656.99
|
| Rate for Payer: The Alliance Commercial |
$2,214.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
BCE Biopsy Bone
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
CPT 20220 TC
|
| Hospital Charge Code |
5518669
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,169.88 |
| Max. Negotiated Rate |
$4,074.05 |
| Rate for Payer: Aetna Commercial |
$3,985.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.01
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,074.05
|
| Rate for Payer: Health EOS Commercial |
$3,941.20
|
| Rate for Payer: HFN Commercial |
$4,074.05
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.88
|
| Rate for Payer: Quartz Commercial |
$2,656.99
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
BCE Biopsy Bone
|
Professional
|
Both
|
$4,258.00
|
|
|
Service Code
|
CPT 20220 TC
|
| Hospital Charge Code |
5518669
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$96.13 |
| Max. Negotiated Rate |
$4,206.90 |
| Rate for Payer: Aetna Commercial |
$4,206.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,206.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,656.99
|
| Rate for Payer: Health EOS Commercial |
$4,029.77
|
| Rate for Payer: HFN Commercial |
$4,206.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.54
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.46
|
| Rate for Payer: Quartz Commercial |
$2,524.14
|
| Rate for Payer: The Alliance Commercial |
$2,214.16
|
| Rate for Payer: United Healthcare Medicaid |
$96.13
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
BCE Biopsy Bone, Deep
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$797.52 |
| Max. Negotiated Rate |
$1,497.39 |
| Rate for Payer: Aetna Commercial |
$1,464.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,399.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$862.63
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,497.39
|
| Rate for Payer: Health EOS Commercial |
$1,448.56
|
| Rate for Payer: HFN Commercial |
$1,497.39
|
| Rate for Payer: Multiplan Commercial |
$1,302.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,497.39
|
| Rate for Payer: Quartz Beloit One Network |
$797.52
|
| Rate for Payer: Quartz Commercial |
$976.56
|
| Rate for Payer: WEA Trust Commercial |
$895.18
|
| Rate for Payer: WPS Commercial |
$1,205.52
|
|
|
BCE Biopsy Bone, Deep
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$289.83 |
| Max. Negotiated Rate |
$1,546.22 |
| Rate for Payer: Aetna Commercial |
$1,546.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,399.74
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,546.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$976.56
|
| Rate for Payer: Health EOS Commercial |
$1,481.12
|
| Rate for Payer: HFN Commercial |
$1,546.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.14
|
| Rate for Payer: Multiplan Commercial |
$1,302.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,546.22
|
| Rate for Payer: Quartz Beloit One Network |
$716.14
|
| Rate for Payer: Quartz Commercial |
$927.73
|
| Rate for Payer: The Alliance Commercial |
$813.80
|
| Rate for Payer: United Healthcare Medicaid |
$289.83
|
| Rate for Payer: WEA Trust Commercial |
$895.18
|
| Rate for Payer: WPS Commercial |
$1,205.52
|
|
|
BCE Biopsy Bone, Deep
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
CPT 20225 TC
|
| Hospital Charge Code |
5400646
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$455.73 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,464.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,399.74
|
| Rate for Payer: Aetna Managed Medicare |
$455.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$862.63
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cash Price |
$469.50
|
| Rate for Payer: Cigna Commercial |
$1,497.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,448.56
|
| Rate for Payer: HFN Commercial |
$1,497.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,220.70
|
| Rate for Payer: Multiplan Commercial |
$1,302.08
|
| Rate for Payer: NAPHCARE Commercial |
$976.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,497.39
|
| Rate for Payer: Quartz Beloit One Network |
$797.52
|
| Rate for Payer: Quartz Commercial |
$1,057.94
|
| Rate for Payer: Quartz Medicare Advantage |
$976.56
|
| Rate for Payer: The Alliance Commercial |
$813.80
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$895.18
|
| Rate for Payer: WPS Commercial |
$1,205.52
|
|
|
BCE Biopsy Liver
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$316.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Aetna Managed Medicare |
$316.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.60
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,039.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,005.20
|
| Rate for Payer: HFN Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$847.08
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: NAPHCARE Commercial |
$677.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.08
|
| Rate for Payer: Quartz Beloit One Network |
$553.43
|
| Rate for Payer: Quartz Commercial |
$734.14
|
| Rate for Payer: Quartz Medicare Advantage |
$677.66
|
| Rate for Payer: The Alliance Commercial |
$564.72
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BCE Biopsy Liver
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.13 |
| Max. Negotiated Rate |
$1,072.97 |
| Rate for Payer: Aetna Commercial |
$1,072.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,072.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$677.66
|
| Rate for Payer: Health EOS Commercial |
$1,027.79
|
| Rate for Payer: HFN Commercial |
$1,072.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$308.74
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.97
|
| Rate for Payer: Quartz Beloit One Network |
$496.95
|
| Rate for Payer: Quartz Commercial |
$643.78
|
| Rate for Payer: The Alliance Commercial |
$564.72
|
| Rate for Payer: United Healthcare Medicaid |
$126.13
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BCE Biopsy Liver
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 47000 TC
|
| Hospital Charge Code |
5400643
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$553.43 |
| Max. Negotiated Rate |
$1,039.08 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.60
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,039.08
|
| Rate for Payer: Health EOS Commercial |
$1,005.20
|
| Rate for Payer: HFN Commercial |
$1,039.08
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.08
|
| Rate for Payer: Quartz Beloit One Network |
$553.43
|
| Rate for Payer: Quartz Commercial |
$677.66
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BCE Biopsy Lung
|
Facility
|
IP
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$772.04 |
| Max. Negotiated Rate |
$1,449.55 |
| Rate for Payer: Aetna Commercial |
$1,418.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.07
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,449.55
|
| Rate for Payer: Health EOS Commercial |
$1,402.28
|
| Rate for Payer: HFN Commercial |
$1,449.55
|
| Rate for Payer: Multiplan Commercial |
$1,260.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.55
|
| Rate for Payer: Quartz Beloit One Network |
$772.04
|
| Rate for Payer: Quartz Commercial |
$945.36
|
| Rate for Payer: WEA Trust Commercial |
$866.58
|
| Rate for Payer: WPS Commercial |
$1,167.00
|
|
|
BCE Biopsy Lung
|
Professional
|
Both
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$693.26 |
| Max. Negotiated Rate |
$1,496.82 |
| Rate for Payer: Aetna Commercial |
$1,496.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.02
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,496.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$787.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$945.36
|
| Rate for Payer: Health EOS Commercial |
$1,433.80
|
| Rate for Payer: HFN Commercial |
$1,496.82
|
| Rate for Payer: Multiplan Commercial |
$1,260.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,496.82
|
| Rate for Payer: Quartz Beloit One Network |
$693.26
|
| Rate for Payer: Quartz Commercial |
$898.09
|
| Rate for Payer: The Alliance Commercial |
$787.80
|
| Rate for Payer: WEA Trust Commercial |
$866.58
|
| Rate for Payer: WPS Commercial |
$1,167.00
|
|
|
BCE Biopsy Lung
|
Facility
|
OP
|
$1,515.00
|
|
| Hospital Charge Code |
5400648
|
| Min. Negotiated Rate |
$441.17 |
| Max. Negotiated Rate |
$1,449.55 |
| Rate for Payer: Aetna Commercial |
$1,418.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.02
|
| Rate for Payer: Aetna Managed Medicare |
$441.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,024.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.07
|
| Rate for Payer: Cash Price |
$454.50
|
| Rate for Payer: Cigna Commercial |
$1,449.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.73
|
| Rate for Payer: Health EOS Commercial |
$1,402.28
|
| Rate for Payer: HFN Commercial |
$1,449.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.70
|
| Rate for Payer: Multiplan Commercial |
$1,260.48
|
| Rate for Payer: NAPHCARE Commercial |
$945.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.55
|
| Rate for Payer: Quartz Beloit One Network |
$772.04
|
| Rate for Payer: Quartz Commercial |
$1,024.14
|
| Rate for Payer: Quartz Medicare Advantage |
$945.36
|
| Rate for Payer: The Alliance Commercial |
$787.80
|
| Rate for Payer: WEA Trust Commercial |
$866.58
|
| Rate for Payer: WPS Commercial |
$1,167.00
|
|
|
BCE Biopsy Lymph Node
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$313.91 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$384.38
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
BCE Biopsy Lymph Node
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$179.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.48
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$416.42
|
| Rate for Payer: Quartz Medicare Advantage |
$384.38
|
| Rate for Payer: The Alliance Commercial |
$320.32
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
BCE Biopsy Lymph Node
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
CPT 38505 TC
|
| Hospital Charge Code |
5400644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna Commercial |
$608.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$608.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.38
|
| Rate for Payer: Health EOS Commercial |
$582.98
|
| Rate for Payer: HFN Commercial |
$608.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.11
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: Preferred Network Access Commercial |
$608.61
|
| Rate for Payer: Quartz Beloit One Network |
$281.88
|
| Rate for Payer: Quartz Commercial |
$365.16
|
| Rate for Payer: The Alliance Commercial |
$320.32
|
| Rate for Payer: United Healthcare Medicaid |
$141.52
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
BCE Biopsy Pancreas
|
Professional
|
Both
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$500.43 |
| Max. Negotiated Rate |
$6,492.15 |
| Rate for Payer: Aetna Commercial |
$6,492.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,877.10
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,492.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,100.30
|
| Rate for Payer: Health EOS Commercial |
$6,218.79
|
| Rate for Payer: HFN Commercial |
$6,492.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.18
|
| Rate for Payer: Multiplan Commercial |
$5,467.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,492.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,006.89
|
| Rate for Payer: Quartz Commercial |
$3,895.29
|
| Rate for Payer: The Alliance Commercial |
$3,416.92
|
| Rate for Payer: United Healthcare Medicaid |
$500.43
|
| Rate for Payer: WEA Trust Commercial |
$3,758.61
|
| Rate for Payer: WPS Commercial |
$5,061.64
|
|
|
BCE Biopsy Pancreas
|
Facility
|
IP
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,348.58 |
| Max. Negotiated Rate |
$6,287.13 |
| Rate for Payer: Aetna Commercial |
$6,150.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,877.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,621.94
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,287.13
|
| Rate for Payer: Health EOS Commercial |
$6,082.12
|
| Rate for Payer: HFN Commercial |
$6,287.13
|
| Rate for Payer: Multiplan Commercial |
$5,467.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,287.13
|
| Rate for Payer: Quartz Beloit One Network |
$3,348.58
|
| Rate for Payer: Quartz Commercial |
$4,100.30
|
| Rate for Payer: WEA Trust Commercial |
$3,758.61
|
| Rate for Payer: WPS Commercial |
$5,061.64
|
|
|
BCE Biopsy Pancreas
|
Facility
|
OP
|
$6,571.00
|
|
|
Service Code
|
CPT 48102 TC
|
| Hospital Charge Code |
5518668
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,913.48 |
| Max. Negotiated Rate |
$6,287.13 |
| Rate for Payer: Aetna Commercial |
$6,150.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,877.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,913.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,621.94
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cash Price |
$1,971.30
|
| Rate for Payer: Cigna Commercial |
$6,287.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$6,082.12
|
| Rate for Payer: HFN Commercial |
$6,287.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,125.38
|
| Rate for Payer: Multiplan Commercial |
$5,467.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,100.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,287.13
|
| Rate for Payer: Quartz Beloit One Network |
$3,348.58
|
| Rate for Payer: Quartz Commercial |
$4,442.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,100.30
|
| Rate for Payer: The Alliance Commercial |
$3,416.92
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,758.61
|
| Rate for Payer: WPS Commercial |
$5,061.64
|
|
|
BCE Biopsy Pleura, Perc
|
Facility
|
IP
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$553.43 |
| Max. Negotiated Rate |
$1,039.08 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.60
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,039.08
|
| Rate for Payer: Health EOS Commercial |
$1,005.20
|
| Rate for Payer: HFN Commercial |
$1,039.08
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.08
|
| Rate for Payer: Quartz Beloit One Network |
$553.43
|
| Rate for Payer: Quartz Commercial |
$677.66
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BCE Biopsy Pleura, Perc
|
Facility
|
OP
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$316.24 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Aetna Managed Medicare |
$316.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.60
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,039.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,005.20
|
| Rate for Payer: HFN Commercial |
$1,039.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$847.08
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: NAPHCARE Commercial |
$677.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.08
|
| Rate for Payer: Quartz Beloit One Network |
$553.43
|
| Rate for Payer: Quartz Commercial |
$734.14
|
| Rate for Payer: Quartz Medicare Advantage |
$677.66
|
| Rate for Payer: The Alliance Commercial |
$564.72
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BCE Biopsy Pleura, Perc
|
Professional
|
Both
|
$1,086.00
|
|
|
Service Code
|
CPT 32400 TC
|
| Hospital Charge Code |
6242278
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,072.97 |
| Rate for Payer: Aetna Commercial |
$1,072.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$971.32
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna Commercial |
$1,072.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$677.66
|
| Rate for Payer: Health EOS Commercial |
$1,027.79
|
| Rate for Payer: HFN Commercial |
$1,072.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.51
|
| Rate for Payer: Multiplan Commercial |
$903.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.97
|
| Rate for Payer: Quartz Beloit One Network |
$496.95
|
| Rate for Payer: Quartz Commercial |
$643.78
|
| Rate for Payer: The Alliance Commercial |
$564.72
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: WEA Trust Commercial |
$621.19
|
| Rate for Payer: WPS Commercial |
$836.55
|
|
|
BCE Biopsy Salivary Gland
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$861.54 |
| Rate for Payer: Aetna Commercial |
$861.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$861.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$544.13
|
| Rate for Payer: Health EOS Commercial |
$825.26
|
| Rate for Payer: HFN Commercial |
$861.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.18
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: Preferred Network Access Commercial |
$861.54
|
| Rate for Payer: Quartz Beloit One Network |
$399.03
|
| Rate for Payer: Quartz Commercial |
$516.92
|
| Rate for Payer: The Alliance Commercial |
$453.44
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
BCE Biopsy Salivary Gland
|
Facility
|
OP
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$253.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Aetna Managed Medicare |
$253.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$680.16
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: NAPHCARE Commercial |
$544.13
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$589.47
|
| Rate for Payer: Quartz Medicare Advantage |
$544.13
|
| Rate for Payer: The Alliance Commercial |
$453.44
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
BCE Biopsy Salivary Gland
|
Facility
|
IP
|
$872.00
|
|
|
Service Code
|
CPT 42400 TC
|
| Hospital Charge Code |
5400645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$444.37 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$544.13
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
