|
BCE XR Calcaneous Left
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 73650 TC,LT
|
| Hospital Charge Code |
3925471
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$1,804.00 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Aetna Managed Medicare |
$126.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.03
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$414.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.38
|
| Rate for Payer: Health EOS Commercial |
$401.39
|
| Rate for Payer: HFN Commercial |
$414.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.25
|
| 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 |
$293.15
|
| Rate for Payer: Quartz Medicare Advantage |
$270.60
|
| Rate for Payer: The Alliance Commercial |
$1,804.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
BCE XR Calcaneous Left
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
CPT 73650 TC,LT
|
| Hospital Charge Code |
3925471
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.44 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$428.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$428.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.60
|
| Rate for Payer: Health EOS Commercial |
$410.41
|
| Rate for Payer: HFN Commercial |
$428.45
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: Preferred Network Access Commercial |
$428.45
|
| Rate for Payer: Quartz Beloit One Network |
$198.44
|
| Rate for Payer: Quartz Commercial |
$257.07
|
| Rate for Payer: The Alliance Commercial |
$225.50
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
BCE XR Change Intra Cath of Renal Pelvis
|
Facility
|
OP
|
$1,655.00
|
|
|
Service Code
|
CPT 75984 TC
|
| Hospital Charge Code |
4213339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$463.40 |
| Max. Negotiated Rate |
$6,620.00 |
| Rate for Payer: Aetna Commercial |
$1,489.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,423.30
|
| Rate for Payer: Aetna Managed Medicare |
$463.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,075.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$827.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$794.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$877.15
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,522.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$926.14
|
| Rate for Payer: Health EOS Commercial |
$1,472.95
|
| Rate for Payer: HFN Commercial |
$1,522.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,241.25
|
| Rate for Payer: Multiplan Commercial |
$1,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$993.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.60
|
| Rate for Payer: Quartz Beloit One Network |
$810.95
|
| Rate for Payer: Quartz Commercial |
$1,075.75
|
| Rate for Payer: Quartz Medicare Advantage |
$993.00
|
| Rate for Payer: The Alliance Commercial |
$6,620.00
|
| Rate for Payer: WEA Trust Commercial |
$910.25
|
| Rate for Payer: WPS Commercial |
$1,225.86
|
|
|
BCE XR Change Intra Cath of Renal Pelvis
|
Facility
|
IP
|
$1,655.00
|
|
|
Service Code
|
CPT 75984 TC
|
| Hospital Charge Code |
4213339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$810.95 |
| Max. Negotiated Rate |
$1,522.60 |
| Rate for Payer: Aetna Commercial |
$1,489.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,423.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$877.15
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,522.60
|
| Rate for Payer: Health EOS Commercial |
$1,472.95
|
| Rate for Payer: HFN Commercial |
$1,522.60
|
| Rate for Payer: Multiplan Commercial |
$1,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$993.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.60
|
| Rate for Payer: Quartz Beloit One Network |
$810.95
|
| Rate for Payer: Quartz Commercial |
$993.00
|
| Rate for Payer: WEA Trust Commercial |
$910.25
|
| Rate for Payer: WPS Commercial |
$1,225.86
|
|
|
BCE XR Change Intra Cath of Renal Pelvis
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
CPT 75984 TC
|
| Hospital Charge Code |
4213339
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.30 |
| Max. Negotiated Rate |
$1,572.25 |
| Rate for Payer: Aetna Commercial |
$1,572.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,423.30
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,572.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$827.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$993.00
|
| Rate for Payer: Health EOS Commercial |
$1,506.05
|
| Rate for Payer: HFN Commercial |
$1,572.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.30
|
| Rate for Payer: Multiplan Commercial |
$1,324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.25
|
| Rate for Payer: Quartz Beloit One Network |
$728.20
|
| Rate for Payer: Quartz Commercial |
$943.35
|
| Rate for Payer: The Alliance Commercial |
$827.50
|
| Rate for Payer: WEA Trust Commercial |
$910.25
|
| Rate for Payer: WPS Commercial |
$1,225.86
|
|
|
BCE XR Chest 1 View Frontal
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3925377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$1,652.00 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$115.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.11
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.75
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$247.80
|
| Rate for Payer: The Alliance Commercial |
$1,652.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
BCE XR Chest 1 View Frontal
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3925377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
BCE XR Chest 1 View Frontal
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
3925377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$392.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$392.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.80
|
| Rate for Payer: Health EOS Commercial |
$375.83
|
| Rate for Payer: HFN Commercial |
$392.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.09
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Preferred Network Access Commercial |
$392.35
|
| Rate for Payer: Quartz Beloit One Network |
$181.72
|
| Rate for Payer: Quartz Commercial |
$235.41
|
| Rate for Payer: The Alliance Commercial |
$206.50
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
BCE XR Chest 2 Views
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
3091462
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
BCE XR Chest 2 Views
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
3091462
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.84 |
| Max. Negotiated Rate |
$1,912.00 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$133.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.50
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| Rate for Payer: Quartz Medicare Advantage |
$286.80
|
| Rate for Payer: The Alliance Commercial |
$1,912.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
BCE XR Chest 2 Views
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
3091462
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$454.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.80
|
| Rate for Payer: Health EOS Commercial |
$434.98
|
| Rate for Payer: HFN Commercial |
$454.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.95
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.10
|
| Rate for Payer: Quartz Beloit One Network |
$210.32
|
| Rate for Payer: Quartz Commercial |
$272.46
|
| Rate for Payer: The Alliance Commercial |
$239.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
BCE XR Elbow Complete Right
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 73080 TC,RT
|
| Hospital Charge Code |
3091469
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$2,296.00 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Aetna Managed Medicare |
$160.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.21
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.50
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$373.10
|
| Rate for Payer: Quartz Medicare Advantage |
$344.40
|
| Rate for Payer: The Alliance Commercial |
$2,296.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
BCE XR Elbow Complete Right
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 73080 TC,RT
|
| Hospital Charge Code |
3091469
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.26 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Aetna Commercial |
$516.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.22
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$528.08
|
| Rate for Payer: Health EOS Commercial |
$510.86
|
| Rate for Payer: HFN Commercial |
$528.08
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$528.08
|
| Rate for Payer: Quartz Beloit One Network |
$281.26
|
| Rate for Payer: Quartz Commercial |
$344.40
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
BCE XR Elbow Complete Right
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
CPT 73080 TC,RT
|
| Hospital Charge Code |
3091469
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$545.30 |
| Rate for Payer: Aetna Commercial |
$545.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.64
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$545.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.40
|
| Rate for Payer: Health EOS Commercial |
$522.34
|
| Rate for Payer: HFN Commercial |
$545.30
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$545.30
|
| Rate for Payer: Quartz Beloit One Network |
$252.56
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: The Alliance Commercial |
$287.00
|
| Rate for Payer: WEA Trust Commercial |
$315.70
|
| Rate for Payer: WPS Commercial |
$425.16
|
|
|
BCE XR Femur 1 View Left
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4598706
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$121.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$261.00
|
| Rate for Payer: The Alliance Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BCE XR Femur 1 View Left
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4598706
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna Commercial |
$413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.00
|
| Rate for Payer: Health EOS Commercial |
$395.85
|
| Rate for Payer: HFN Commercial |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.25
|
| Rate for Payer: Quartz Beloit One Network |
$191.40
|
| Rate for Payer: Quartz Commercial |
$247.95
|
| Rate for Payer: The Alliance Commercial |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BCE XR Femur 1 View Left
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4598706
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BCE XR Femur 1 View Rt
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4598707
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna Commercial |
$413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.00
|
| Rate for Payer: Health EOS Commercial |
$395.85
|
| Rate for Payer: HFN Commercial |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.25
|
| Rate for Payer: Quartz Beloit One Network |
$191.40
|
| Rate for Payer: Quartz Commercial |
$247.95
|
| Rate for Payer: The Alliance Commercial |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BCE XR Femur 1 View Rt
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4598707
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$121.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$261.00
|
| Rate for Payer: The Alliance Commercial |
$1,740.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BCE XR Femur 1 View Rt
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4598707
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
BCE XR Femur Left
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
3091472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.20 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Aetna Commercial |
$622.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$622.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.00
|
| Rate for Payer: Health EOS Commercial |
$596.05
|
| Rate for Payer: HFN Commercial |
$622.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Preferred Network Access Commercial |
$622.25
|
| Rate for Payer: Quartz Beloit One Network |
$288.20
|
| Rate for Payer: Quartz Commercial |
$373.35
|
| Rate for Payer: The Alliance Commercial |
$327.50
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
BCE XR Femur Left
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
3091472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.00
|
| Rate for Payer: The Alliance Commercial |
$2,620.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
BCE XR Femur Left
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
3091472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
BCE XR Femur Right
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
3925410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,620.00 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$183.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$393.00
|
| Rate for Payer: The Alliance Commercial |
$2,620.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
BCE XR Femur Right
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
3925410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.20 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Aetna Commercial |
$622.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$622.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.00
|
| Rate for Payer: Health EOS Commercial |
$596.05
|
| Rate for Payer: HFN Commercial |
$622.25
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Preferred Network Access Commercial |
$622.25
|
| Rate for Payer: Quartz Beloit One Network |
$288.20
|
| Rate for Payer: Quartz Commercial |
$373.35
|
| Rate for Payer: The Alliance Commercial |
$327.50
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
