|
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
|
|
|
BCE MA Breast Ndl Loc Placement Right ea add
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
CPT 19282 TC,RT
|
| Hospital Charge Code |
4521247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$1,287.36 |
| Rate for Payer: Aetna Commercial |
$1,287.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.40
|
| 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 |
$1,287.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$813.07
|
| Rate for Payer: Health EOS Commercial |
$1,233.16
|
| Rate for Payer: HFN Commercial |
$1,287.36
|
| 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 |
$1,084.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.36
|
| Rate for Payer: Quartz Beloit One Network |
$596.25
|
| Rate for Payer: Quartz Commercial |
$772.42
|
| Rate for Payer: The Alliance Commercial |
$677.56
|
| Rate for Payer: United Healthcare Medicaid |
$38.44
|
| Rate for Payer: WEA Trust Commercial |
$745.32
|
| Rate for Payer: WPS Commercial |
$1,003.70
|
|
|
BCE MA Stereotactic Localization ea additional lesion LT
|
Professional
|
Both
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$66.13 |
| Max. Negotiated Rate |
$2,234.86 |
| Rate for Payer: Aetna Commercial |
$2,234.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,023.13
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,234.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,411.49
|
| Rate for Payer: Health EOS Commercial |
$2,140.76
|
| Rate for Payer: HFN Commercial |
$2,234.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.84
|
| Rate for Payer: Multiplan Commercial |
$1,881.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.09
|
| Rate for Payer: Quartz Commercial |
$1,340.91
|
| Rate for Payer: The Alliance Commercial |
$1,176.24
|
| Rate for Payer: United Healthcare Medicaid |
$66.13
|
| Rate for Payer: WEA Trust Commercial |
$1,293.86
|
| Rate for Payer: WPS Commercial |
$1,742.42
|
|
|
BCE MA Stereotactic Localization ea additional lesion LT
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,152.72 |
| Max. Negotiated Rate |
$2,164.28 |
| Rate for Payer: Aetna Commercial |
$2,117.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,023.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,246.81
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,164.28
|
| Rate for Payer: Health EOS Commercial |
$2,093.71
|
| Rate for Payer: HFN Commercial |
$2,164.28
|
| Rate for Payer: Multiplan Commercial |
$1,881.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,152.72
|
| Rate for Payer: Quartz Commercial |
$1,411.49
|
| Rate for Payer: WEA Trust Commercial |
$1,293.86
|
| Rate for Payer: WPS Commercial |
$1,742.42
|
|
|
BCE MA Stereotactic Localization ea additional lesion LT
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,LT
|
| Hospital Charge Code |
4076048
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$658.69 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,117.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,023.13
|
| Rate for Payer: Aetna Managed Medicare |
$658.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,246.81
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,093.71
|
| Rate for Payer: HFN Commercial |
$2,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,764.36
|
| Rate for Payer: Multiplan Commercial |
$1,881.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,411.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,152.72
|
| Rate for Payer: Quartz Commercial |
$1,529.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,411.49
|
| Rate for Payer: The Alliance Commercial |
$1,176.24
|
| Rate for Payer: United Healthcare PPO |
$1,764.36
|
| Rate for Payer: WEA Trust Commercial |
$1,293.86
|
| Rate for Payer: WPS Commercial |
$1,742.42
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Facility
|
OP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$658.69 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,117.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,023.13
|
| Rate for Payer: Aetna Managed Medicare |
$658.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,529.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,176.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,129.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,246.81
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,164.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,093.71
|
| Rate for Payer: HFN Commercial |
$2,164.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,764.36
|
| Rate for Payer: Multiplan Commercial |
$1,881.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,411.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,152.72
|
| Rate for Payer: Quartz Commercial |
$1,529.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,411.49
|
| Rate for Payer: The Alliance Commercial |
$1,176.24
|
| Rate for Payer: United Healthcare PPO |
$1,764.36
|
| Rate for Payer: WEA Trust Commercial |
$1,293.86
|
| Rate for Payer: WPS Commercial |
$1,742.42
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Facility
|
IP
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$1,152.72 |
| Max. Negotiated Rate |
$2,164.28 |
| Rate for Payer: Aetna Commercial |
$2,117.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,023.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,246.81
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,164.28
|
| Rate for Payer: Health EOS Commercial |
$2,093.71
|
| Rate for Payer: HFN Commercial |
$2,164.28
|
| Rate for Payer: Multiplan Commercial |
$1,881.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,164.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,152.72
|
| Rate for Payer: Quartz Commercial |
$1,411.49
|
| Rate for Payer: WEA Trust Commercial |
$1,293.86
|
| Rate for Payer: WPS Commercial |
$1,742.42
|
|
|
BCE MA Stereotactic Localization ea additional lesion RT
|
Professional
|
Both
|
$2,262.00
|
|
|
Service Code
|
CPT 19082 TC,RT
|
| Hospital Charge Code |
4076049
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$66.13 |
| Max. Negotiated Rate |
$2,234.86 |
| Rate for Payer: Aetna Commercial |
$2,234.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,023.13
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cash Price |
$678.60
|
| Rate for Payer: Cigna Commercial |
$2,234.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,411.49
|
| Rate for Payer: Health EOS Commercial |
$2,140.76
|
| Rate for Payer: HFN Commercial |
$2,234.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.84
|
| Rate for Payer: Multiplan Commercial |
$1,881.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,234.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.09
|
| Rate for Payer: Quartz Commercial |
$1,340.91
|
| Rate for Payer: The Alliance Commercial |
$1,176.24
|
| Rate for Payer: United Healthcare Medicaid |
$66.13
|
| Rate for Payer: WEA Trust Commercial |
$1,293.86
|
| Rate for Payer: WPS Commercial |
$1,742.42
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
BCE Microalbumin/Creatine Ratio Urine
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3705509
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
BCE Midline Catheter
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.06 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$64.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$137.28
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$148.72
|
| Rate for Payer: Quartz Medicare Advantage |
$137.28
|
| Rate for Payer: The Alliance Commercial |
$114.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
BCE Midline Catheter
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$137.28
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
BCE Midline Catheter
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5442654
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.28
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: The Alliance Commercial |
$114.40
|
| Rate for Payer: United Healthcare Medicaid |
$10.51
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$121.68
|
| Rate for Payer: Anthem Medicare Advantage |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.68
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.68
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$493.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$182.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: Quartz Medicare Advantage |
$121.68
|
| Rate for Payer: The Alliance Commercial |
$462.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$608.40
|
|
|
BCE MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
4075959
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$486.72 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$486.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$851.76
|
|
|
BCE Muscle Biopsy
|
Professional
|
Both
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$1,050.24 |
| Rate for Payer: Aetna Commercial |
$1,050.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$950.75
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$1,050.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$663.31
|
| Rate for Payer: Health EOS Commercial |
$1,006.02
|
| Rate for Payer: HFN Commercial |
$1,050.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.23
|
| Rate for Payer: Multiplan Commercial |
$884.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,050.24
|
| Rate for Payer: Quartz Beloit One Network |
$486.43
|
| Rate for Payer: Quartz Commercial |
$630.15
|
| Rate for Payer: The Alliance Commercial |
$552.76
|
| Rate for Payer: United Healthcare Medicaid |
$136.69
|
| Rate for Payer: WEA Trust Commercial |
$608.04
|
| Rate for Payer: WPS Commercial |
$818.83
|
|
|
BCE Muscle Biopsy
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$541.70 |
| Max. Negotiated Rate |
$1,017.08 |
| Rate for Payer: Aetna Commercial |
$994.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$950.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.93
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$1,017.08
|
| Rate for Payer: Health EOS Commercial |
$983.91
|
| Rate for Payer: HFN Commercial |
$1,017.08
|
| Rate for Payer: Multiplan Commercial |
$884.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.08
|
| Rate for Payer: Quartz Beloit One Network |
$541.70
|
| Rate for Payer: Quartz Commercial |
$663.31
|
| Rate for Payer: WEA Trust Commercial |
$608.04
|
| Rate for Payer: WPS Commercial |
$818.83
|
|
|
BCE Muscle Biopsy
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 20206 TC
|
| Hospital Charge Code |
5418645
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$309.55 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$994.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$950.75
|
| Rate for Payer: Aetna Managed Medicare |
$309.55
|
| 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 |
$585.93
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cash Price |
$318.90
|
| Rate for Payer: Cigna Commercial |
$1,017.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$983.91
|
| Rate for Payer: HFN Commercial |
$1,017.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.14
|
| Rate for Payer: Multiplan Commercial |
$884.42
|
| Rate for Payer: NAPHCARE Commercial |
$663.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.08
|
| Rate for Payer: Quartz Beloit One Network |
$541.70
|
| Rate for Payer: Quartz Commercial |
$718.59
|
| Rate for Payer: Quartz Medicare Advantage |
$663.31
|
| Rate for Payer: The Alliance Commercial |
$552.76
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$608.04
|
| Rate for Payer: WPS Commercial |
$818.83
|
|
|
BCE Nephrostomy Tube
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BCE Nephrostomy Tube
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BCE Nephrostomy Tube
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
CPT 74475
|
| Hospital Charge Code |
4422646
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$460.35 |
| Max. Negotiated Rate |
$993.93 |
| Rate for Payer: Aetna Commercial |
$993.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$993.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$523.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$627.74
|
| Rate for Payer: Health EOS Commercial |
$952.08
|
| Rate for Payer: HFN Commercial |
$993.93
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$993.93
|
| Rate for Payer: Quartz Beloit One Network |
$460.35
|
| Rate for Payer: Quartz Commercial |
$596.36
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
BCE NG Tube Placement
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.84 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.38
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: United Healthcare Medicaid |
$25.84
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
BCE NG Tube Placement
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
