|
BCE CV NM Cardiac Blood Pool Gated Single Acqusition
|
Facility
|
OP
|
$5,516.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5386670
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| 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: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$5,277.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,210.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$5,105.61
|
| Rate for Payer: HFN Commercial |
$5,277.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$4,589.31
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| 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 |
$3,728.82
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$3,155.15
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$4,248.97
|
|
|
BCE CV VL Arterial Duplex Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5383360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$357.30 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$357.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.06
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$765.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$765.65
|
| Rate for Payer: The Alliance Commercial |
$638.04
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE CV VL Arterial Duplex Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5383360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE CV VL LE PVR Resting Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5388650
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE CV VL LE PVR Resting Acquisition
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5388650
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$829.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$638.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$612.52
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$957.06
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
BCE CV VL LE PVR w Exercise Acquisition
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5388649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$980.47 |
| Max. Negotiated Rate |
$1,840.88 |
| Rate for Payer: Aetna Commercial |
$1,800.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.51
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,840.88
|
| Rate for Payer: Health EOS Commercial |
$1,780.85
|
| Rate for Payer: HFN Commercial |
$1,840.88
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,840.88
|
| Rate for Payer: Quartz Beloit One Network |
$980.47
|
| Rate for Payer: Quartz Commercial |
$1,200.58
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
BCE CV VL LE PVR w Exercise Acquisition
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 93924
|
| Hospital Charge Code |
5388649
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,840.88 |
| Rate for Payer: Aetna Commercial |
$1,800.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.83
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,300.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,000.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$960.46
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,060.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cash Price |
$577.20
|
| Rate for Payer: Cigna Commercial |
$1,840.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,119.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,780.85
|
| Rate for Payer: HFN Commercial |
$1,840.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$1,600.77
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,840.88
|
| Rate for Payer: Quartz Beloit One Network |
$980.47
|
| Rate for Payer: Quartz Commercial |
$1,300.62
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$1,500.72
|
| Rate for Payer: WEA Trust Commercial |
$1,100.53
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,482.06
|
|
|
BCE Cyst Aspiration
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
BCE Cyst Aspiration
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$38.12 |
| Max. Negotiated Rate |
$149.20 |
| Rate for Payer: Aetna Commercial |
$137.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$137.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.74
|
| Rate for Payer: Health EOS Commercial |
$131.55
|
| Rate for Payer: HFN Commercial |
$137.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.20
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$137.33
|
| Rate for Payer: Quartz Beloit One Network |
$63.61
|
| Rate for Payer: Quartz Commercial |
$82.40
|
| Rate for Payer: The Alliance Commercial |
$72.28
|
| Rate for Payer: United Healthcare Medicaid |
$38.12
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
BCE Cyst Aspiration
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 19000 TC
|
| Hospital Charge Code |
5426918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$40.48
|
| 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 |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.42
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$86.74
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$86.74
|
| Rate for Payer: The Alliance Commercial |
$72.28
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
BCE Drug Test Conf 15-21
|
Facility
|
OP
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.69 |
| Max. Negotiated Rate |
$1,571.07 |
| Rate for Payer: Aetna Commercial |
$1,536.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.60
|
| Rate for Payer: Aetna Managed Medicare |
$206.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.69
|
| Rate for Payer: Anthem Medicare Advantage |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$206.69
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,571.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$206.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$206.69
|
| Rate for Payer: Health EOS Commercial |
$1,519.84
|
| Rate for Payer: HFN Commercial |
$1,571.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$206.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$206.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$206.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$206.69
|
| Rate for Payer: Multiplan Commercial |
$1,366.14
|
| Rate for Payer: NAPHCARE Commercial |
$310.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.07
|
| Rate for Payer: Quartz Beloit One Network |
$836.76
|
| Rate for Payer: Quartz Commercial |
$1,109.99
|
| Rate for Payer: Quartz Medicare Advantage |
$206.69
|
| Rate for Payer: The Alliance Commercial |
$826.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.69
|
| Rate for Payer: United Healthcare PPO |
$1,280.76
|
| Rate for Payer: WEA Trust Commercial |
$939.22
|
| Rate for Payer: Wellcare Medicare |
$206.69
|
| Rate for Payer: WPS Commercial |
$1,264.83
|
|
|
BCE Drug Test Conf 15-21
|
Professional
|
Both
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.69 |
| Max. Negotiated Rate |
$1,622.30 |
| Rate for Payer: Aetna Commercial |
$1,622.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.60
|
| Rate for Payer: Aetna Managed Medicare |
$206.69
|
| Rate for Payer: Anthem Medicare Advantage |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$206.69
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,622.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$853.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.69
|
| Rate for Payer: Health EOS Commercial |
$1,553.99
|
| Rate for Payer: HFN Commercial |
$1,622.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$729.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$206.69
|
| Rate for Payer: Multiplan Commercial |
$1,366.14
|
| Rate for Payer: NAPHCARE Commercial |
$310.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.30
|
| Rate for Payer: Quartz Beloit One Network |
$751.38
|
| Rate for Payer: Quartz Commercial |
$973.38
|
| Rate for Payer: Quartz Medicare Advantage |
$206.69
|
| Rate for Payer: The Alliance Commercial |
$568.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.69
|
| Rate for Payer: WEA Trust Commercial |
$939.22
|
| Rate for Payer: WPS Commercial |
$361.71
|
|
|
BCE Drug Test Conf 15-21
|
Facility
|
IP
|
$1,642.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$836.76 |
| Max. Negotiated Rate |
$1,571.07 |
| Rate for Payer: Aetna Commercial |
$1,536.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.07
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,571.07
|
| Rate for Payer: Health EOS Commercial |
$1,519.84
|
| Rate for Payer: HFN Commercial |
$1,571.07
|
| Rate for Payer: Multiplan Commercial |
$1,366.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.07
|
| Rate for Payer: Quartz Beloit One Network |
$836.76
|
| Rate for Payer: Quartz Commercial |
$1,024.61
|
| Rate for Payer: WEA Trust Commercial |
$939.22
|
| Rate for Payer: WPS Commercial |
$1,264.83
|
|
|
BCE Drug Test Conf 1-7
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.01 |
| Max. Negotiated Rate |
$476.03 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$119.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.69
|
| Rate for Payer: Anthem Medicare Advantage |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.01
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$119.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$119.01
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$119.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$119.01
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$178.51
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$260.94
|
| Rate for Payer: Quartz Medicare Advantage |
$119.01
|
| Rate for Payer: The Alliance Commercial |
$476.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.01
|
| Rate for Payer: United Healthcare PPO |
$301.08
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: Wellcare Medicare |
$119.01
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
BCE Drug Test Conf 1-7
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$240.86
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
BCE Drug Test Conf 1-7
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.01 |
| Max. Negotiated Rate |
$420.10 |
| Rate for Payer: Aetna Commercial |
$381.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$119.01
|
| Rate for Payer: Anthem Medicare Advantage |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.01
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$381.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.01
|
| Rate for Payer: Health EOS Commercial |
$365.31
|
| Rate for Payer: HFN Commercial |
$381.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.01
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$178.51
|
| Rate for Payer: Preferred Network Access Commercial |
$381.37
|
| Rate for Payer: Quartz Beloit One Network |
$176.63
|
| Rate for Payer: Quartz Commercial |
$228.82
|
| Rate for Payer: Quartz Medicare Advantage |
$119.01
|
| Rate for Payer: The Alliance Commercial |
$327.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.01
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$208.26
|
|
|
BCE Drug Test Conf 22+
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,116.02 |
| Max. Negotiated Rate |
$2,095.39 |
| Rate for Payer: Aetna Commercial |
$2,049.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,958.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.13
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,095.39
|
| Rate for Payer: Health EOS Commercial |
$2,027.06
|
| Rate for Payer: HFN Commercial |
$2,095.39
|
| Rate for Payer: Multiplan Commercial |
$1,822.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,095.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.02
|
| Rate for Payer: Quartz Commercial |
$1,366.56
|
| Rate for Payer: WEA Trust Commercial |
$1,252.68
|
| Rate for Payer: WPS Commercial |
$1,686.96
|
|
|
BCE Drug Test Conf 22+
|
Professional
|
Both
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$2,163.72 |
| Rate for Payer: Aetna Commercial |
$2,163.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,958.74
|
| Rate for Payer: Aetna Managed Medicare |
$256.80
|
| Rate for Payer: Anthem Medicare Advantage |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.80
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,163.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,138.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.80
|
| Rate for Payer: Health EOS Commercial |
$2,072.62
|
| Rate for Payer: HFN Commercial |
$2,163.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$906.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$906.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.80
|
| Rate for Payer: Multiplan Commercial |
$1,822.08
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,163.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.14
|
| Rate for Payer: Quartz Commercial |
$1,298.23
|
| Rate for Payer: Quartz Medicare Advantage |
$256.80
|
| Rate for Payer: The Alliance Commercial |
$706.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.80
|
| Rate for Payer: WEA Trust Commercial |
$1,252.68
|
| Rate for Payer: WPS Commercial |
$449.39
|
|
|
BCE Drug Test Conf 22+
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS G0483
|
| Hospital Charge Code |
5542874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$2,095.39 |
| Rate for Payer: Aetna Commercial |
$2,049.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,958.74
|
| Rate for Payer: Aetna Managed Medicare |
$256.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,480.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,138.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.25
|
| Rate for Payer: Anthem Medicare Advantage |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$256.80
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna Commercial |
$2,095.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$256.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,274.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$256.80
|
| Rate for Payer: Health EOS Commercial |
$2,027.06
|
| Rate for Payer: HFN Commercial |
$2,095.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$955.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$256.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$256.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$256.80
|
| Rate for Payer: Multiplan Commercial |
$1,822.08
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,095.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.02
|
| Rate for Payer: Quartz Commercial |
$1,480.44
|
| Rate for Payer: Quartz Medicare Advantage |
$256.80
|
| Rate for Payer: The Alliance Commercial |
$1,027.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$256.80
|
| Rate for Payer: United Healthcare PPO |
$1,708.20
|
| Rate for Payer: WEA Trust Commercial |
$1,252.68
|
| Rate for Payer: Wellcare Medicare |
$256.80
|
| Rate for Payer: WPS Commercial |
$1,686.96
|
|
|
BCE Drug Test Conf 8-14
|
Facility
|
OP
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$704.20 |
| Rate for Payer: Aetna Commercial |
$688.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.28
|
| Rate for Payer: Aetna Managed Medicare |
$162.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$497.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$382.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$367.41
|
| Rate for Payer: Anthem Medicare Advantage |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.85
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$704.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$162.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$162.85
|
| Rate for Payer: Health EOS Commercial |
$681.24
|
| Rate for Payer: HFN Commercial |
$704.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$162.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$162.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$162.85
|
| Rate for Payer: Multiplan Commercial |
$612.35
|
| Rate for Payer: NAPHCARE Commercial |
$244.28
|
| Rate for Payer: Preferred Network Access Commercial |
$704.20
|
| Rate for Payer: Quartz Beloit One Network |
$375.07
|
| Rate for Payer: Quartz Commercial |
$497.54
|
| Rate for Payer: Quartz Medicare Advantage |
$162.85
|
| Rate for Payer: The Alliance Commercial |
$651.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.85
|
| Rate for Payer: United Healthcare PPO |
$574.08
|
| Rate for Payer: WEA Trust Commercial |
$420.99
|
| Rate for Payer: Wellcare Medicare |
$162.85
|
| Rate for Payer: WPS Commercial |
$566.94
|
|
|
BCE Drug Test Conf 8-14
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$375.07 |
| Max. Negotiated Rate |
$704.20 |
| Rate for Payer: Aetna Commercial |
$688.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$704.20
|
| Rate for Payer: Health EOS Commercial |
$681.24
|
| Rate for Payer: HFN Commercial |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$612.35
|
| Rate for Payer: Preferred Network Access Commercial |
$704.20
|
| Rate for Payer: Quartz Beloit One Network |
$375.07
|
| Rate for Payer: Quartz Commercial |
$459.26
|
| Rate for Payer: WEA Trust Commercial |
$420.99
|
| Rate for Payer: WPS Commercial |
$566.94
|
|
|
BCE Drug Test Conf 8-14
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS G0481
|
| Hospital Charge Code |
5542872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.85 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$727.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.28
|
| Rate for Payer: Aetna Managed Medicare |
$162.85
|
| Rate for Payer: Anthem Medicare Advantage |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.85
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$382.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.85
|
| Rate for Payer: Health EOS Commercial |
$696.55
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$574.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.85
|
| Rate for Payer: Multiplan Commercial |
$612.35
|
| Rate for Payer: NAPHCARE Commercial |
$244.28
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$336.79
|
| Rate for Payer: Quartz Commercial |
$436.30
|
| Rate for Payer: Quartz Medicare Advantage |
$162.85
|
| Rate for Payer: The Alliance Commercial |
$447.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.85
|
| Rate for Payer: WEA Trust Commercial |
$420.99
|
| Rate for Payer: WPS Commercial |
$284.99
|
|
|
BCE Fiducial Markers
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$808.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,598.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Aetna Managed Medicare |
$808.37
|
| 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 |
$1,530.13
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,656.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$2,569.47
|
| Rate for Payer: HFN Commercial |
$2,656.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,165.28
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,732.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,656.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.65
|
| Rate for Payer: Quartz Commercial |
$1,876.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,732.22
|
| Rate for Payer: The Alliance Commercial |
$1,443.52
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$2,138.35
|
|
|
BCE Fiducial Markers
|
Facility
|
IP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,414.65 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,598.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.13
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,656.08
|
| Rate for Payer: Health EOS Commercial |
$2,569.47
|
| Rate for Payer: HFN Commercial |
$2,656.08
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,656.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.65
|
| Rate for Payer: Quartz Commercial |
$1,732.22
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$2,138.35
|
|
|
BCE Fiducial Markers
|
Professional
|
Both
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5551978
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$439.12 |
| Max. Negotiated Rate |
$2,742.69 |
| Rate for Payer: Aetna Commercial |
$2,742.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,742.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$439.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,732.22
|
| Rate for Payer: Health EOS Commercial |
$2,627.21
|
| Rate for Payer: HFN Commercial |
$2,742.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$643.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.67
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,742.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.30
|
| Rate for Payer: Quartz Commercial |
$1,645.61
|
| Rate for Payer: The Alliance Commercial |
$1,443.52
|
| Rate for Payer: United Healthcare Medicaid |
$439.12
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$2,138.35
|
|
