|
BCE Fine Needle Aspiration
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$102.19 |
| Max. Negotiated Rate |
$253.05 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$225.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.27
|
| Rate for Payer: Health EOS Commercial |
$215.78
|
| Rate for Payer: HFN Commercial |
$225.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$253.05
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: Preferred Network Access Commercial |
$225.26
|
| Rate for Payer: Quartz Beloit One Network |
$104.33
|
| Rate for Payer: Quartz Commercial |
$135.16
|
| Rate for Payer: The Alliance Commercial |
$118.56
|
| Rate for Payer: United Healthcare Medicaid |
$102.19
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$175.63
|
|
|
BCE Fine Needle Aspiration
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$66.39 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Aetna Managed Medicare |
$66.39
|
| 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 |
$125.67
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$218.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$211.04
|
| Rate for Payer: HFN Commercial |
$218.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.84
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$218.15
|
| Rate for Payer: Quartz Beloit One Network |
$116.19
|
| Rate for Payer: Quartz Commercial |
$154.13
|
| Rate for Payer: Quartz Medicare Advantage |
$142.27
|
| Rate for Payer: The Alliance Commercial |
$118.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$175.63
|
|
|
BCE Fine Needle Aspiration
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 10005 TC
|
| Hospital Charge Code |
5400647
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$116.19 |
| Max. Negotiated Rate |
$218.15 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.67
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$218.15
|
| Rate for Payer: Health EOS Commercial |
$211.04
|
| Rate for Payer: HFN Commercial |
$218.15
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: Preferred Network Access Commercial |
$218.15
|
| Rate for Payer: Quartz Beloit One Network |
$116.19
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$175.63
|
|
|
BCE Fine Needle Aspiration ea additional
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.32 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$62.32
|
| 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 |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.92
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$133.54
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$133.54
|
| Rate for Payer: The Alliance Commercial |
$111.28
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
BCE Fine Needle Aspiration ea additional
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
BCE Fine Needle Aspiration ea additional
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 10006 TC
|
| Hospital Charge Code |
5649626
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$48.55 |
| Max. Negotiated Rate |
$211.43 |
| Rate for Payer: Aetna Commercial |
$211.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$211.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.54
|
| Rate for Payer: Health EOS Commercial |
$202.53
|
| Rate for Payer: HFN Commercial |
$211.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.55
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$211.43
|
| Rate for Payer: Quartz Beloit One Network |
$97.93
|
| Rate for Payer: Quartz Commercial |
$126.86
|
| Rate for Payer: The Alliance Commercial |
$111.28
|
| Rate for Payer: United Healthcare Medicaid |
$48.55
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
BCE Image Guided Fluid Drainage Catheter
|
Facility
|
OP
|
$7,649.00
|
|
|
Service Code
|
CPT 49406 TC
|
| Hospital Charge Code |
5649633
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$7,318.56 |
| Rate for Payer: Aetna Commercial |
$7,159.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,841.27
|
| Rate for Payer: Aetna Managed Medicare |
$2,227.39
|
| 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 |
$4,216.13
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cigna Commercial |
$7,318.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$7,079.91
|
| Rate for Payer: HFN Commercial |
$7,318.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,966.22
|
| Rate for Payer: Multiplan Commercial |
$6,363.97
|
| Rate for Payer: NAPHCARE Commercial |
$4,772.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,318.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,897.93
|
| Rate for Payer: Quartz Commercial |
$5,170.72
|
| Rate for Payer: Quartz Medicare Advantage |
$4,772.98
|
| Rate for Payer: The Alliance Commercial |
$3,977.48
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$4,375.23
|
| Rate for Payer: WPS Commercial |
$5,892.02
|
|
|
BCE Image Guided Fluid Drainage Catheter
|
Professional
|
Both
|
$7,649.00
|
|
|
Service Code
|
CPT 49406 TC
|
| Hospital Charge Code |
5649633
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$166.29 |
| Max. Negotiated Rate |
$7,557.21 |
| Rate for Payer: Aetna Commercial |
$7,557.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,841.27
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cigna Commercial |
$7,557.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,772.98
|
| Rate for Payer: Health EOS Commercial |
$7,239.01
|
| Rate for Payer: HFN Commercial |
$7,557.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$684.57
|
| Rate for Payer: Multiplan Commercial |
$6,363.97
|
| Rate for Payer: Preferred Network Access Commercial |
$7,557.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,500.18
|
| Rate for Payer: Quartz Commercial |
$4,534.33
|
| Rate for Payer: The Alliance Commercial |
$3,977.48
|
| Rate for Payer: United Healthcare Medicaid |
$166.29
|
| Rate for Payer: WEA Trust Commercial |
$4,375.23
|
| Rate for Payer: WPS Commercial |
$5,892.02
|
|
|
BCE Image Guided Fluid Drainage Catheter
|
Facility
|
IP
|
$7,649.00
|
|
|
Service Code
|
CPT 49406 TC
|
| Hospital Charge Code |
5649633
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$3,897.93 |
| Max. Negotiated Rate |
$7,318.56 |
| Rate for Payer: Aetna Commercial |
$7,159.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,841.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,216.13
|
| Rate for Payer: Cash Price |
$2,294.70
|
| Rate for Payer: Cigna Commercial |
$7,318.56
|
| Rate for Payer: Health EOS Commercial |
$7,079.91
|
| Rate for Payer: HFN Commercial |
$7,318.56
|
| Rate for Payer: Multiplan Commercial |
$6,363.97
|
| Rate for Payer: Preferred Network Access Commercial |
$7,318.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,897.93
|
| Rate for Payer: Quartz Commercial |
$4,772.98
|
| Rate for Payer: WEA Trust Commercial |
$4,375.23
|
| Rate for Payer: WPS Commercial |
$5,892.02
|
|
|
BCE Image Guided Fluid Drainage Cath Perc
|
Facility
|
OP
|
$4,612.00
|
|
|
Service Code
|
CPT 10030 TC
|
| Hospital Charge Code |
5649640
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$4,316.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,124.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,343.01
|
| 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 |
$2,542.13
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$4,412.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$4,268.87
|
| Rate for Payer: HFN Commercial |
$4,412.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,597.36
|
| Rate for Payer: Multiplan Commercial |
$3,837.18
|
| Rate for Payer: NAPHCARE Commercial |
$2,877.89
|
| Rate for Payer: Preferred Network Access Commercial |
$4,412.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,350.28
|
| Rate for Payer: Quartz Commercial |
$3,117.71
|
| Rate for Payer: Quartz Medicare Advantage |
$2,877.89
|
| Rate for Payer: The Alliance Commercial |
$2,398.24
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$2,638.06
|
| Rate for Payer: WPS Commercial |
$3,552.62
|
|
|
BCE Image Guided Fluid Drainage Cath Perc
|
Professional
|
Both
|
$4,612.00
|
|
|
Service Code
|
CPT 10030 TC
|
| Hospital Charge Code |
5649640
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$120.04 |
| Max. Negotiated Rate |
$4,556.66 |
| Rate for Payer: Aetna Commercial |
$4,556.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,124.97
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$4,556.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,877.89
|
| Rate for Payer: Health EOS Commercial |
$4,364.80
|
| Rate for Payer: HFN Commercial |
$4,556.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.57
|
| Rate for Payer: Multiplan Commercial |
$3,837.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,556.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.45
|
| Rate for Payer: Quartz Commercial |
$2,733.99
|
| Rate for Payer: The Alliance Commercial |
$2,398.24
|
| Rate for Payer: United Healthcare Medicaid |
$120.04
|
| Rate for Payer: WEA Trust Commercial |
$2,638.06
|
| Rate for Payer: WPS Commercial |
$3,552.62
|
|
|
BCE Image Guided Fluid Drainage Cath Perc
|
Facility
|
IP
|
$4,612.00
|
|
|
Service Code
|
CPT 10030 TC
|
| Hospital Charge Code |
5649640
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$2,350.28 |
| Max. Negotiated Rate |
$4,412.76 |
| Rate for Payer: Aetna Commercial |
$4,316.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,124.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,542.13
|
| Rate for Payer: Cash Price |
$1,383.60
|
| Rate for Payer: Cigna Commercial |
$4,412.76
|
| Rate for Payer: Health EOS Commercial |
$4,268.87
|
| Rate for Payer: HFN Commercial |
$4,412.76
|
| Rate for Payer: Multiplan Commercial |
$3,837.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,412.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,350.28
|
| Rate for Payer: Quartz Commercial |
$2,877.89
|
| Rate for Payer: WEA Trust Commercial |
$2,638.06
|
| Rate for Payer: WPS Commercial |
$3,552.62
|
|
|
BCE Inj Knee Arthrogram
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
5577379
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$132.91 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Aetna Managed Medicare |
$283.05
|
| 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 |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.16
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: NAPHCARE Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$657.07
|
| Rate for Payer: Quartz Medicare Advantage |
$606.53
|
| Rate for Payer: The Alliance Commercial |
$132.91
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
BCE Inj Knee Arthrogram
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
5577379
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$495.33 |
| Max. Negotiated Rate |
$930.01 |
| Rate for Payer: Aetna Commercial |
$909.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$535.77
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$930.01
|
| Rate for Payer: Health EOS Commercial |
$899.68
|
| Rate for Payer: HFN Commercial |
$930.01
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$930.01
|
| Rate for Payer: Quartz Beloit One Network |
$495.33
|
| Rate for Payer: Quartz Commercial |
$606.53
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$748.73
|
|
|
BCE Inj Knee Arthrogram
|
Professional
|
Both
|
$972.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
5577379
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$960.34 |
| Rate for Payer: Aetna Commercial |
$960.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$869.36
|
| Rate for Payer: Aetna Managed Medicare |
$33.23
|
| Rate for Payer: Anthem Medicare Advantage |
$33.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.23
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cash Price |
$291.60
|
| Rate for Payer: Cigna Commercial |
$960.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.23
|
| Rate for Payer: Health EOS Commercial |
$919.90
|
| Rate for Payer: HFN Commercial |
$960.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.23
|
| Rate for Payer: Multiplan Commercial |
$808.70
|
| Rate for Payer: NAPHCARE Commercial |
$49.84
|
| Rate for Payer: Preferred Network Access Commercial |
$960.34
|
| Rate for Payer: Quartz Beloit One Network |
$444.79
|
| Rate for Payer: Quartz Commercial |
$576.20
|
| Rate for Payer: Quartz Medicare Advantage |
$33.23
|
| Rate for Payer: The Alliance Commercial |
$141.22
|
| Rate for Payer: United Healthcare Medicaid |
$115.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.23
|
| Rate for Payer: WEA Trust Commercial |
$555.98
|
| Rate for Payer: WPS Commercial |
$149.53
|
|
|
BCE Inj Procedure Retrograde Urethrocystography
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
5506847
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$878.33 |
| Rate for Payer: Aetna Commercial |
$878.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.12
|
| Rate for Payer: Aetna Managed Medicare |
$56.35
|
| Rate for Payer: Anthem Medicare Advantage |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.35
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$878.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.35
|
| Rate for Payer: Health EOS Commercial |
$841.35
|
| Rate for Payer: HFN Commercial |
$878.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$739.65
|
| Rate for Payer: NAPHCARE Commercial |
$84.52
|
| Rate for Payer: Preferred Network Access Commercial |
$878.33
|
| Rate for Payer: Quartz Beloit One Network |
$406.81
|
| Rate for Payer: Quartz Commercial |
$527.00
|
| Rate for Payer: Quartz Medicare Advantage |
$56.35
|
| Rate for Payer: The Alliance Commercial |
$239.48
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.35
|
| Rate for Payer: WEA Trust Commercial |
$508.51
|
| Rate for Payer: WPS Commercial |
$253.56
|
|
|
BCE Inj Procedure Retrograde Urethrocystography
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
5506847
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.39 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$832.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.12
|
| Rate for Payer: Aetna Managed Medicare |
$258.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.02
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$850.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$822.86
|
| Rate for Payer: HFN Commercial |
$850.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.42
|
| Rate for Payer: Multiplan Commercial |
$739.65
|
| Rate for Payer: NAPHCARE Commercial |
$554.74
|
| Rate for Payer: Preferred Network Access Commercial |
$850.60
|
| Rate for Payer: Quartz Beloit One Network |
$453.03
|
| Rate for Payer: Quartz Commercial |
$600.96
|
| Rate for Payer: Quartz Medicare Advantage |
$554.74
|
| Rate for Payer: The Alliance Commercial |
$225.39
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$508.51
|
| Rate for Payer: WPS Commercial |
$684.80
|
|
|
BCE Inj Procedure Retrograde Urethrocystography
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
5506847
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$453.03 |
| Max. Negotiated Rate |
$850.60 |
| Rate for Payer: Aetna Commercial |
$832.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.02
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$850.60
|
| Rate for Payer: Health EOS Commercial |
$822.86
|
| Rate for Payer: HFN Commercial |
$850.60
|
| Rate for Payer: Multiplan Commercial |
$739.65
|
| Rate for Payer: Preferred Network Access Commercial |
$850.60
|
| Rate for Payer: Quartz Beloit One Network |
$453.03
|
| Rate for Payer: Quartz Commercial |
$554.74
|
| Rate for Payer: WEA Trust Commercial |
$508.51
|
| Rate for Payer: WPS Commercial |
$684.80
|
|
|
B Cell
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4524628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$172.65 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$154.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$172.65
|
|
|
B Cell
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4524628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
B Cell
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
4524628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.14
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$156.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$39.24
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
BCE MA Breast Ndl Loc Placement Left ea add
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 19282 TC,LT
|
| Hospital Charge Code |
4521246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$783.12
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
BCE MA Breast Ndl Loc Placement Left ea add
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
CPT 19282 TC,LT
|
| Hospital Charge Code |
4521246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$1,239.94 |
| Rate for Payer: Aetna Commercial |
$1,239.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,239.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.12
|
| Rate for Payer: Health EOS Commercial |
$1,187.73
|
| Rate for Payer: HFN Commercial |
$1,239.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$174.97
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,239.94
|
| Rate for Payer: Quartz Beloit One Network |
$574.29
|
| Rate for Payer: Quartz Commercial |
$743.96
|
| Rate for Payer: The Alliance Commercial |
$652.60
|
| Rate for Payer: United Healthcare Medicaid |
$38.44
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
BCE MA Breast Ndl Loc Placement Left ea add
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 19282 TC,LT
|
| Hospital Charge Code |
4521246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Aetna Managed Medicare |
$365.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$652.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$626.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.90
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$783.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$848.38
|
| Rate for Payer: Quartz Medicare Advantage |
$783.12
|
| Rate for Payer: The Alliance Commercial |
$652.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
BCE MA Breast Ndl Loc Placement Right ea add
|
Facility
|
OP
|
$1,303.00
|
|
|
Service Code
|
CPT 19282 TC,RT
|
| Hospital Charge Code |
4521247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,219.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| Rate for Payer: Aetna Managed Medicare |
$379.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$880.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$677.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$650.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.21
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cash Price |
$390.90
|
| Rate for Payer: Cigna Commercial |
$1,246.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,206.06
|
| Rate for Payer: HFN Commercial |
$1,246.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.34
|
| Rate for Payer: Multiplan Commercial |
$1,084.10
|
| Rate for Payer: NAPHCARE Commercial |
$813.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.71
|
| Rate for Payer: Quartz Beloit One Network |
$664.01
|
| Rate for Payer: Quartz Commercial |
$880.83
|
| Rate for Payer: Quartz Medicare Advantage |
$813.07
|
| Rate for Payer: The Alliance Commercial |
$677.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
