|
BCE Biopsy Soft Tissue Neck/Thorax
|
Facility
|
IP
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,963.16 |
| Max. Negotiated Rate |
$7,441.03 |
| Rate for Payer: Aetna Commercial |
$7,279.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,955.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,286.68
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,441.03
|
| Rate for Payer: Health EOS Commercial |
$7,198.39
|
| Rate for Payer: HFN Commercial |
$7,441.03
|
| Rate for Payer: Multiplan Commercial |
$6,470.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,441.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,963.16
|
| Rate for Payer: Quartz Commercial |
$4,852.85
|
| Rate for Payer: WEA Trust Commercial |
$4,448.44
|
| Rate for Payer: WPS Commercial |
$5,990.62
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Facility
|
OP
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$7,441.03 |
| Rate for Payer: Aetna Commercial |
$7,279.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,955.75
|
| Rate for Payer: Aetna Managed Medicare |
$2,264.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,286.68
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,441.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$7,198.39
|
| Rate for Payer: HFN Commercial |
$7,441.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,066.06
|
| Rate for Payer: Multiplan Commercial |
$6,470.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,852.85
|
| Rate for Payer: Preferred Network Access Commercial |
$7,441.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,963.16
|
| Rate for Payer: Quartz Commercial |
$5,257.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,852.85
|
| Rate for Payer: The Alliance Commercial |
$4,044.04
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$4,448.44
|
| Rate for Payer: WPS Commercial |
$5,990.62
|
|
|
BCE Biopsy Soft Tissue Neck/Thorax
|
Professional
|
Both
|
$7,777.00
|
|
|
Service Code
|
CPT 21550 TC
|
| Hospital Charge Code |
5446658
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$7,683.68 |
| Rate for Payer: Aetna Commercial |
$7,683.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,955.75
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Cigna Commercial |
$7,683.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,852.85
|
| Rate for Payer: Health EOS Commercial |
$7,360.15
|
| Rate for Payer: HFN Commercial |
$7,683.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$542.38
|
| Rate for Payer: Multiplan Commercial |
$6,470.46
|
| Rate for Payer: Preferred Network Access Commercial |
$7,683.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,558.76
|
| Rate for Payer: Quartz Commercial |
$4,610.21
|
| Rate for Payer: The Alliance Commercial |
$4,044.04
|
| Rate for Payer: United Healthcare Medicaid |
$51.80
|
| Rate for Payer: WEA Trust Commercial |
$4,448.44
|
| Rate for Payer: WPS Commercial |
$5,990.62
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$28.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.10
|
| Rate for Payer: Health EOS Commercial |
$27.45
|
| Rate for Payer: HFN Commercial |
$28.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.54
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$28.65
|
| Rate for Payer: Quartz Beloit One Network |
$13.27
|
| Rate for Payer: Quartz Commercial |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$18.10
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.10
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
BCE Crossmatch IS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$125.49 |
| Rate for Payer: Aetna Commercial |
$92.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$92.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.66
|
| Rate for Payer: Health EOS Commercial |
$88.96
|
| Rate for Payer: HFN Commercial |
$92.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$92.87
|
| Rate for Payer: Quartz Beloit One Network |
$43.01
|
| Rate for Payer: Quartz Commercial |
$55.72
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
BCE Crossmatch IS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$73.32
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
BCE Crossmatch IS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
BCE CTA Abdomen
|
Professional
|
Both
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$219.63 |
| Max. Negotiated Rate |
$6,062.37 |
| Rate for Payer: Aetna Commercial |
$6,062.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,488.04
|
| Rate for Payer: Aetna Managed Medicare |
$219.63
|
| Rate for Payer: Anthem Medicare Advantage |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.63
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$6,062.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,190.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.63
|
| Rate for Payer: Health EOS Commercial |
$5,807.11
|
| Rate for Payer: HFN Commercial |
$6,062.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$850.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$850.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.63
|
| Rate for Payer: Multiplan Commercial |
$5,105.15
|
| Rate for Payer: NAPHCARE Commercial |
$329.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,062.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,807.83
|
| Rate for Payer: Quartz Commercial |
$3,637.42
|
| Rate for Payer: Quartz Medicare Advantage |
$219.63
|
| Rate for Payer: The Alliance Commercial |
$834.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.63
|
| Rate for Payer: WEA Trust Commercial |
$3,509.79
|
| Rate for Payer: WPS Commercial |
$1,098.14
|
|
|
BCE CTA Abdomen
|
Facility
|
OP
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$878.51 |
| Max. Negotiated Rate |
$5,870.92 |
| Rate for Payer: Aetna Commercial |
$5,743.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,488.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,786.80
|
| 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 |
$3,382.16
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,870.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,571.15
|
| Rate for Payer: Health EOS Commercial |
$5,679.48
|
| Rate for Payer: HFN Commercial |
$5,870.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,786.08
|
| Rate for Payer: Multiplan Commercial |
$5,105.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,828.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,870.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,126.91
|
| Rate for Payer: Quartz Commercial |
$4,147.94
|
| Rate for Payer: Quartz Medicare Advantage |
$3,828.86
|
| Rate for Payer: The Alliance Commercial |
$878.51
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,509.79
|
| Rate for Payer: WPS Commercial |
$1,537.39
|
|
|
BCE CTA Abdomen
|
Facility
|
IP
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,126.91 |
| Max. Negotiated Rate |
$5,870.92 |
| Rate for Payer: Aetna Commercial |
$5,743.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,488.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,382.16
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,870.92
|
| Rate for Payer: Health EOS Commercial |
$5,679.48
|
| Rate for Payer: HFN Commercial |
$5,870.92
|
| Rate for Payer: Multiplan Commercial |
$5,105.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,870.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,126.91
|
| Rate for Payer: Quartz Commercial |
$3,828.86
|
| Rate for Payer: WEA Trust Commercial |
$3,509.79
|
| Rate for Payer: WPS Commercial |
$4,726.56
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Facility
|
OP
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$782.66 |
| Max. Negotiated Rate |
$4,003.25 |
| Rate for Payer: Aetna Commercial |
$3,916.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,742.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,218.38
|
| 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 |
$2,306.22
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$4,003.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,435.09
|
| Rate for Payer: Health EOS Commercial |
$3,872.71
|
| Rate for Payer: HFN Commercial |
$4,003.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,263.52
|
| Rate for Payer: Multiplan Commercial |
$3,481.09
|
| Rate for Payer: NAPHCARE Commercial |
$2,610.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,003.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,132.17
|
| Rate for Payer: Quartz Commercial |
$2,828.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,610.82
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,393.25
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Professional
|
Both
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.67 |
| Max. Negotiated Rate |
$4,133.79 |
| Rate for Payer: Aetna Commercial |
$4,133.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,742.17
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$4,133.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,175.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$3,959.74
|
| Rate for Payer: HFN Commercial |
$4,133.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$3,481.09
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,133.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,914.60
|
| Rate for Payer: Quartz Commercial |
$2,480.28
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$2,393.25
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Facility
|
IP
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,132.17 |
| Max. Negotiated Rate |
$4,003.25 |
| Rate for Payer: Aetna Commercial |
$3,916.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,742.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,306.22
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$4,003.25
|
| Rate for Payer: Health EOS Commercial |
$3,872.71
|
| Rate for Payer: HFN Commercial |
$4,003.25
|
| Rate for Payer: Multiplan Commercial |
$3,481.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,003.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,132.17
|
| Rate for Payer: Quartz Commercial |
$2,610.82
|
| Rate for Payer: WEA Trust Commercial |
$2,393.25
|
| Rate for Payer: WPS Commercial |
$3,222.94
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Professional
|
Both
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$378.92 |
| Max. Negotiated Rate |
$3,756.38 |
| Rate for Payer: Aetna Commercial |
$3,756.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,400.51
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,756.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$378.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,372.45
|
| Rate for Payer: Health EOS Commercial |
$3,598.21
|
| Rate for Payer: HFN Commercial |
$3,756.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$391.61
|
| Rate for Payer: Multiplan Commercial |
$3,163.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,756.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.80
|
| Rate for Payer: Quartz Commercial |
$2,253.83
|
| Rate for Payer: The Alliance Commercial |
$1,977.04
|
| Rate for Payer: United Healthcare Medicaid |
$378.92
|
| Rate for Payer: WEA Trust Commercial |
$2,174.74
|
| Rate for Payer: WPS Commercial |
$2,928.68
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Facility
|
IP
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,937.50 |
| Max. Negotiated Rate |
$3,637.75 |
| Rate for Payer: Aetna Commercial |
$3,558.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,400.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,095.66
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,637.75
|
| Rate for Payer: Health EOS Commercial |
$3,519.13
|
| Rate for Payer: HFN Commercial |
$3,637.75
|
| Rate for Payer: Multiplan Commercial |
$3,163.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,637.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,937.50
|
| Rate for Payer: Quartz Commercial |
$2,372.45
|
| Rate for Payer: WEA Trust Commercial |
$2,174.74
|
| Rate for Payer: WPS Commercial |
$2,928.68
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,107.14 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$3,558.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,400.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,107.14
|
| 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 |
$2,095.66
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,637.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$3,519.13
|
| Rate for Payer: HFN Commercial |
$3,637.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,965.56
|
| Rate for Payer: Multiplan Commercial |
$3,163.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,372.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,637.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,937.50
|
| Rate for Payer: Quartz Commercial |
$2,570.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,372.45
|
| Rate for Payer: The Alliance Commercial |
$1,977.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,174.74
|
| Rate for Payer: WPS Commercial |
$2,928.68
|
|
|
BCE CV Echocardiogram W Contrast Acquisition
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388711
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,761.18 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,156.54
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
BCE CV Echocardiogram W Contrast Acquisition
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388711
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,336.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,797.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,725.24
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,011.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,336.26
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
BCE CV Echo Complete WO Contrast Acqusition
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388647
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,761.18 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,156.54
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
BCE CV Echo Complete WO Contrast Acqusition
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388647
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$575.04 |
| Max. Negotiated Rate |
$3,306.70 |
| Rate for Payer: Aetna Commercial |
$3,234.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,091.05
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,336.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,797.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,725.24
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,904.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,306.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,011.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$3,198.87
|
| Rate for Payer: HFN Commercial |
$3,306.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$2,875.39
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,306.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,761.18
|
| Rate for Payer: Quartz Commercial |
$2,336.26
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: United Healthcare PPO |
$2,695.68
|
| Rate for Payer: WEA Trust Commercial |
$1,976.83
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$2,662.16
|
|
|
BCE CV Echo TEE Adult wo Probe Plcmt Cong Acquisition
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5388648
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$558.23 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Aetna Managed Medicare |
$558.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,295.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$996.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$956.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,115.69
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.26
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,196.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,295.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,196.21
|
| Rate for Payer: The Alliance Commercial |
$996.84
|
| Rate for Payer: United Healthcare PPO |
$1,495.26
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
BCE CV Echo TEE Adult wo Probe Plcmt Cong Acquisition
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5388648
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$976.90 |
| Max. Negotiated Rate |
$1,834.19 |
| Rate for Payer: Aetna Commercial |
$1,794.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,714.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,056.65
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,834.19
|
| Rate for Payer: Health EOS Commercial |
$1,774.38
|
| Rate for Payer: HFN Commercial |
$1,834.19
|
| Rate for Payer: Multiplan Commercial |
$1,594.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,834.19
|
| Rate for Payer: Quartz Beloit One Network |
$976.90
|
| Rate for Payer: Quartz Commercial |
$1,196.21
|
| Rate for Payer: WEA Trust Commercial |
$1,096.52
|
| Rate for Payer: WPS Commercial |
$1,476.67
|
|
|
BCE CV NM Cardiac Blood Pool Gated Single Acqusition
|
Facility
|
IP
|
$5,516.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5386670
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,810.95 |
| Max. Negotiated Rate |
$5,277.71 |
| Rate for Payer: Aetna Commercial |
$5,162.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,933.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.42
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$5,277.71
|
| Rate for Payer: Health EOS Commercial |
$5,105.61
|
| Rate for Payer: HFN Commercial |
$5,277.71
|
| Rate for Payer: Multiplan Commercial |
$4,589.31
|
| Rate for Payer: Preferred Network Access Commercial |
$5,277.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,810.95
|
| Rate for Payer: Quartz Commercial |
$3,441.98
|
| Rate for Payer: WEA Trust Commercial |
$3,155.15
|
| Rate for Payer: WPS Commercial |
$4,248.97
|
|
