|
BCE US Breast Biopsy each additional RT
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 19084 TC,RT
|
| Hospital Charge Code |
4076046
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$431.27 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$431.27
|
| 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 |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,155.18
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$924.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$1,001.16
|
| Rate for Payer: Quartz Medicare Advantage |
$924.14
|
| Rate for Payer: The Alliance Commercial |
$770.12
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
BCE US Pregnancy Transvaginal
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3091485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$1,071.98 |
| Rate for Payer: Aetna Commercial |
$1,071.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.42
|
| Rate for Payer: Aetna Managed Medicare |
$57.01
|
| Rate for Payer: Anthem Medicare Advantage |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.01
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$1,071.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$564.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.01
|
| Rate for Payer: Health EOS Commercial |
$1,026.84
|
| Rate for Payer: HFN Commercial |
$1,071.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.01
|
| Rate for Payer: Multiplan Commercial |
$902.72
|
| Rate for Payer: NAPHCARE Commercial |
$85.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,071.98
|
| Rate for Payer: Quartz Beloit One Network |
$496.50
|
| Rate for Payer: Quartz Commercial |
$643.19
|
| Rate for Payer: Quartz Medicare Advantage |
$57.01
|
| Rate for Payer: The Alliance Commercial |
$216.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.01
|
| Rate for Payer: WEA Trust Commercial |
$620.62
|
| Rate for Payer: WPS Commercial |
$285.06
|
|
|
BCE US Pregnancy Transvaginal
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3091485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$228.05 |
| Max. Negotiated Rate |
$1,038.13 |
| Rate for Payer: Aetna Commercial |
$1,015.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.42
|
| Rate for Payer: Aetna Managed Medicare |
$315.95
|
| 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 |
$598.05
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$1,038.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$631.47
|
| Rate for Payer: Health EOS Commercial |
$1,004.28
|
| Rate for Payer: HFN Commercial |
$1,038.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$846.30
|
| Rate for Payer: Multiplan Commercial |
$902.72
|
| Rate for Payer: NAPHCARE Commercial |
$677.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,038.13
|
| Rate for Payer: Quartz Beloit One Network |
$552.92
|
| Rate for Payer: Quartz Commercial |
$733.46
|
| Rate for Payer: Quartz Medicare Advantage |
$677.04
|
| Rate for Payer: The Alliance Commercial |
$228.05
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$620.62
|
| Rate for Payer: WPS Commercial |
$835.78
|
|
|
BCE US Pregnancy Transvaginal
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
3091485
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$552.92 |
| Max. Negotiated Rate |
$1,038.13 |
| Rate for Payer: Aetna Commercial |
$1,015.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$598.05
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$1,038.13
|
| Rate for Payer: Health EOS Commercial |
$1,004.28
|
| Rate for Payer: HFN Commercial |
$1,038.13
|
| Rate for Payer: Multiplan Commercial |
$902.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,038.13
|
| Rate for Payer: Quartz Beloit One Network |
$552.92
|
| Rate for Payer: Quartz Commercial |
$677.04
|
| Rate for Payer: WEA Trust Commercial |
$620.62
|
| Rate for Payer: WPS Commercial |
$835.78
|
|
|
BCE US Renal
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3091460
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$1,614.39 |
| Rate for Payer: Aetna Commercial |
$1,614.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,614.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$849.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$1,546.42
|
| Rate for Payer: HFN Commercial |
$1,614.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,614.39
|
| Rate for Payer: Quartz Beloit One Network |
$747.72
|
| Rate for Payer: Quartz Commercial |
$968.64
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
BCE US Renal
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3091460
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Aetna Managed Medicare |
$475.82
|
| 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 |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$950.99
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.52
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,019.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,104.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,019.62
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
BCE US Renal
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3091460
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$832.69 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,019.62
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
BCE Venous Draw
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3119360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$44.46 |
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$44.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$42.59
|
| Rate for Payer: HFN Commercial |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$44.46
|
| Rate for Payer: Quartz Beloit One Network |
$20.59
|
| Rate for Payer: Quartz Commercial |
$26.68
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$41.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$42.74
|
|
|
BCE Venous Draw
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3119360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$30.42
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$38.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare PPO |
$35.10
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: Wellcare Medicare |
$9.71
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
BCE Venous Draw
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
3119360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
BCE VL Ankle Pressure Single Level
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114946
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$514.75 |
| Rate for Payer: Aetna Commercial |
$514.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$514.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$493.07
|
| Rate for Payer: HFN Commercial |
$514.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$514.75
|
| Rate for Payer: Quartz Beloit One Network |
$238.41
|
| Rate for Payer: Quartz Commercial |
$308.85
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
|
BCE VL Ankle Pressure Single Level
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114946
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$151.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.22
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.38
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$325.10
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$352.20
|
| Rate for Payer: Quartz Medicare Advantage |
$325.10
|
| Rate for Payer: The Alliance Commercial |
$283.05
|
| Rate for Payer: United Healthcare PPO |
$406.38
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
BCE VL Ankle Pressure Single Level
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114946
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$325.10
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
BCE VL Carotid Duplex Bilateral
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
3114947
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$912.69 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,117.58
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
BCE VL Carotid Duplex Bilateral
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
3114947
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$521.54 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Aetna Managed Medicare |
$521.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,210.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$931.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$894.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.36
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,396.98
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,210.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,117.58
|
| Rate for Payer: The Alliance Commercial |
$601.62
|
| Rate for Payer: United Healthcare PPO |
$1,396.98
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
BCE VL Carotid Duplex Bilateral
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
3114947
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.02 |
| Max. Negotiated Rate |
$1,769.51 |
| Rate for Payer: Aetna Commercial |
$1,769.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Aetna Managed Medicare |
$150.40
|
| Rate for Payer: Anthem Medicare Advantage |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.40
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,769.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.40
|
| Rate for Payer: Health EOS Commercial |
$1,695.00
|
| Rate for Payer: HFN Commercial |
$1,769.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.40
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: NAPHCARE Commercial |
$225.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,769.51
|
| Rate for Payer: Quartz Beloit One Network |
$819.56
|
| Rate for Payer: Quartz Commercial |
$1,061.70
|
| Rate for Payer: Quartz Medicare Advantage |
$150.40
|
| Rate for Payer: The Alliance Commercial |
$376.01
|
| Rate for Payer: United Healthcare Medicaid |
$142.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.40
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$601.62
|
|
|
BCE VL Carotid Duplex Left or Limited
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5266753
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
BCE VL Carotid Duplex Left or Limited
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5266753
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.51 |
| Max. Negotiated Rate |
$730.13 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
BCE VL Carotid Duplex Left or Limited
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5266753
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$576.42
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
BCE VL Carotid Duplex Right or Limited
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5266752
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.51 |
| Max. Negotiated Rate |
$730.13 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.84
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$134.51
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
BCE VL Carotid Duplex Right or Limited
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5266752
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.10
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$576.42
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
BCE VL Carotid Duplex Right or Limited
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5266752
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
BCE VL Duplex Arterial/Venous Visceral
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
3114948
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
BCE VL Duplex Arterial/Venous Visceral
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
3114948
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.41 |
| Max. Negotiated Rate |
$1,520.53 |
| Rate for Payer: Aetna Commercial |
$1,520.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$204.42
|
| Rate for Payer: Anthem Medicare Advantage |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.42
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,520.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.42
|
| Rate for Payer: Health EOS Commercial |
$1,456.51
|
| Rate for Payer: HFN Commercial |
$1,520.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$306.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,520.53
|
| Rate for Payer: Quartz Beloit One Network |
$704.25
|
| Rate for Payer: Quartz Commercial |
$912.32
|
| Rate for Payer: Quartz Medicare Advantage |
$204.42
|
| Rate for Payer: The Alliance Commercial |
$511.06
|
| Rate for Payer: United Healthcare Medicaid |
$142.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.42
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$817.69
|
|
|
BCE VL Duplex Arterial/Venous Visceral
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
3114948
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$448.16 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,040.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$800.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$817.69
|
| Rate for Payer: United Healthcare PPO |
$1,200.42
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
