|
BCE VL Vascular Guidance Intraop
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$957.95 |
| Max. Negotiated Rate |
$1,798.60 |
| Rate for Payer: Aetna Commercial |
$1,759.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.15
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: Health EOS Commercial |
$1,739.95
|
| Rate for Payer: HFN Commercial |
$1,798.60
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.60
|
| Rate for Payer: Quartz Beloit One Network |
$957.95
|
| Rate for Payer: Quartz Commercial |
$1,173.00
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
BCE VL Vascular Guidance Intraop
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$1,857.25 |
| Rate for Payer: Aetna Commercial |
$1,857.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,857.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$977.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,173.00
|
| Rate for Payer: Health EOS Commercial |
$1,779.05
|
| Rate for Payer: HFN Commercial |
$1,857.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.56
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,857.25
|
| Rate for Payer: Quartz Beloit One Network |
$860.20
|
| Rate for Payer: Quartz Commercial |
$1,114.35
|
| Rate for Payer: The Alliance Commercial |
$977.50
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
BCE VL Vascular Guidance Intraop
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$547.40 |
| Max. Negotiated Rate |
$7,820.00 |
| Rate for Payer: Aetna Commercial |
$1,759.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,681.30
|
| Rate for Payer: Aetna Managed Medicare |
$547.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,270.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$977.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$938.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.15
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,798.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.02
|
| Rate for Payer: Health EOS Commercial |
$1,739.95
|
| Rate for Payer: HFN Commercial |
$1,798.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.25
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,798.60
|
| Rate for Payer: Quartz Beloit One Network |
$957.95
|
| Rate for Payer: Quartz Commercial |
$1,270.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,173.00
|
| Rate for Payer: The Alliance Commercial |
$7,820.00
|
| Rate for Payer: United Healthcare PPO |
$1,466.25
|
| Rate for Payer: WEA Trust Commercial |
$1,075.25
|
| Rate for Payer: WPS Commercial |
$1,448.07
|
|
|
BCE VL Vasoreactivity Testing
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$553.00 |
| Max. Negotiated Rate |
$7,900.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$553.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,283.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$987.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.21
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,481.25
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,283.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,185.00
|
| Rate for Payer: The Alliance Commercial |
$7,900.00
|
| Rate for Payer: United Healthcare PPO |
$1,481.25
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
BCE VL Vasoreactivity Testing
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$796.26 |
| Max. Negotiated Rate |
$1,876.25 |
| Rate for Payer: Aetna Commercial |
$1,876.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,876.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$987.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.00
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: HFN Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$796.26
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.25
|
| Rate for Payer: Quartz Beloit One Network |
$869.00
|
| Rate for Payer: Quartz Commercial |
$1,125.75
|
| Rate for Payer: The Alliance Commercial |
$987.50
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
BCE VL Vasoreactivity Testing
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$967.75 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,185.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
BCE VL Vein Mapping Bilateral
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,211.77 |
| Max. Negotiated Rate |
$2,275.16 |
| Rate for Payer: Aetna Commercial |
$2,225.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.69
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,275.16
|
| Rate for Payer: Health EOS Commercial |
$2,200.97
|
| Rate for Payer: HFN Commercial |
$2,275.16
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.77
|
| Rate for Payer: Quartz Commercial |
$1,483.80
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
BCE VL Vein Mapping Bilateral
|
Professional
|
Both
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.95 |
| Max. Negotiated Rate |
$2,349.35 |
| Rate for Payer: Aetna Commercial |
$2,349.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,349.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,236.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,483.80
|
| Rate for Payer: Health EOS Commercial |
$2,250.43
|
| Rate for Payer: HFN Commercial |
$2,349.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,349.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.12
|
| Rate for Payer: Quartz Commercial |
$1,409.61
|
| Rate for Payer: The Alliance Commercial |
$1,236.50
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
BCE VL Vein Mapping Bilateral
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$692.44 |
| Max. Negotiated Rate |
$9,892.00 |
| Rate for Payer: Aetna Commercial |
$2,225.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.78
|
| Rate for Payer: Aetna Managed Medicare |
$692.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,607.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,236.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,187.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.69
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,275.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,383.89
|
| Rate for Payer: Health EOS Commercial |
$2,200.97
|
| Rate for Payer: HFN Commercial |
$2,275.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,854.75
|
| Rate for Payer: Multiplan Commercial |
$1,978.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,483.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.77
|
| Rate for Payer: Quartz Commercial |
$1,607.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,483.80
|
| Rate for Payer: The Alliance Commercial |
$9,892.00
|
| Rate for Payer: United Healthcare PPO |
$1,854.75
|
| Rate for Payer: WEA Trust Commercial |
$1,360.15
|
| Rate for Payer: WPS Commercial |
$1,831.75
|
|
|
BCE VL Vein Mapping Unilateral
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$703.15 |
| Max. Negotiated Rate |
$1,320.20 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.55
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,320.20
|
| Rate for Payer: Health EOS Commercial |
$1,277.15
|
| Rate for Payer: HFN Commercial |
$1,320.20
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.20
|
| Rate for Payer: Quartz Beloit One Network |
$703.15
|
| Rate for Payer: Quartz Commercial |
$861.00
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
BCE VL Vein Mapping Unilateral
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$401.80 |
| Max. Negotiated Rate |
$5,740.00 |
| Rate for Payer: Aetna Commercial |
$1,291.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Aetna Managed Medicare |
$401.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$932.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$717.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$688.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$760.55
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,320.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$803.03
|
| Rate for Payer: Health EOS Commercial |
$1,277.15
|
| Rate for Payer: HFN Commercial |
$1,320.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,076.25
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$861.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,320.20
|
| Rate for Payer: Quartz Beloit One Network |
$703.15
|
| Rate for Payer: Quartz Commercial |
$932.75
|
| Rate for Payer: Quartz Medicare Advantage |
$861.00
|
| Rate for Payer: The Alliance Commercial |
$5,740.00
|
| Rate for Payer: United Healthcare PPO |
$1,076.25
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
BCE VL Vein Mapping Unilateral
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$344.95 |
| Max. Negotiated Rate |
$1,363.25 |
| Rate for Payer: Aetna Commercial |
$1,363.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.10
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,363.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$717.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.00
|
| Rate for Payer: Health EOS Commercial |
$1,305.85
|
| Rate for Payer: HFN Commercial |
$1,363.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$344.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$344.95
|
| Rate for Payer: Multiplan Commercial |
$1,148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.25
|
| Rate for Payer: Quartz Beloit One Network |
$631.40
|
| Rate for Payer: Quartz Commercial |
$817.95
|
| Rate for Payer: The Alliance Commercial |
$717.50
|
| Rate for Payer: WEA Trust Commercial |
$789.25
|
| Rate for Payer: WPS Commercial |
$1,062.90
|
|
|
BCE XR Abdomen AP
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$260.19 |
| Max. Negotiated Rate |
$488.52 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.43
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$488.52
|
| Rate for Payer: Health EOS Commercial |
$472.59
|
| Rate for Payer: HFN Commercial |
$488.52
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: NAPHCARE Commercial |
$318.60
|
| Rate for Payer: Preferred Network Access Commercial |
$488.52
|
| Rate for Payer: Quartz Beloit One Network |
$260.19
|
| Rate for Payer: Quartz Commercial |
$318.60
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
BCE XR Abdomen AP
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$2,124.00 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Aetna Managed Medicare |
$148.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.43
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$488.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.15
|
| Rate for Payer: Health EOS Commercial |
$472.59
|
| Rate for Payer: HFN Commercial |
$488.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.25
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: NAPHCARE Commercial |
$318.60
|
| Rate for Payer: Preferred Network Access Commercial |
$488.52
|
| Rate for Payer: Quartz Beloit One Network |
$260.19
|
| Rate for Payer: Quartz Commercial |
$345.15
|
| Rate for Payer: Quartz Medicare Advantage |
$318.60
|
| Rate for Payer: The Alliance Commercial |
$2,124.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
BCE XR Abdomen AP
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna Commercial |
$504.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$504.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.60
|
| Rate for Payer: Health EOS Commercial |
$483.21
|
| Rate for Payer: HFN Commercial |
$504.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$504.45
|
| Rate for Payer: Quartz Beloit One Network |
$233.64
|
| Rate for Payer: Quartz Commercial |
$302.67
|
| Rate for Payer: The Alliance Commercial |
$265.50
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
BCE XR Ankle 2 Views Left
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE XR Ankle 2 Views Left
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: HFN Commercial |
$474.05
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE XR Ankle 2 Views Left
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
BCE XR Ankle Complete Left
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,LT
|
| Hospital Charge Code |
3091463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Ankle Complete Left
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,LT
|
| Hospital Charge Code |
3091463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: HFN Commercial |
$528.20
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Ankle Complete Left
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,LT
|
| Hospital Charge Code |
3091463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Ankle Complete Right
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,RT
|
| Hospital Charge Code |
3091465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Ankle Complete Right
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,RT
|
| Hospital Charge Code |
3091465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: HFN Commercial |
$528.20
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Ankle Complete Right
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,RT
|
| Hospital Charge Code |
3091465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Calcaneous Left
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 73650 TC,LT
|
| Hospital Charge Code |
3925471
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.99 |
| Max. Negotiated Rate |
$414.92 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.03
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$414.92
|
| Rate for Payer: Health EOS Commercial |
$401.39
|
| Rate for Payer: HFN Commercial |
$414.92
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: NAPHCARE Commercial |
$270.60
|
| Rate for Payer: Preferred Network Access Commercial |
$414.92
|
| Rate for Payer: Quartz Beloit One Network |
$220.99
|
| Rate for Payer: Quartz Commercial |
$270.60
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
