|
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
|
|
|
BCE XR Fluoro Guidance Needle Loc Spine
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
5273122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$356.53 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$1,140.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,140.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.00
|
| Rate for Payer: Health EOS Commercial |
$1,092.00
|
| Rate for Payer: HFN Commercial |
$1,140.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$356.53
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.00
|
| Rate for Payer: Quartz Beloit One Network |
$528.00
|
| Rate for Payer: Quartz Commercial |
$684.00
|
| Rate for Payer: The Alliance Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$660.00
|
| Rate for Payer: WPS Commercial |
$888.84
|
|
|
BCE XR Fluoro Guidance Needle Loc Spine
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
5273122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.00
|
| Rate for Payer: Aetna Managed Medicare |
$336.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$780.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$600.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$576.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$671.52
|
| Rate for Payer: Health EOS Commercial |
$1,068.00
|
| Rate for Payer: HFN Commercial |
$1,104.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: NAPHCARE Commercial |
$720.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.00
|
| Rate for Payer: Quartz Beloit One Network |
$588.00
|
| Rate for Payer: Quartz Commercial |
$780.00
|
| Rate for Payer: Quartz Medicare Advantage |
$720.00
|
| Rate for Payer: The Alliance Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$660.00
|
| Rate for Payer: WPS Commercial |
$888.84
|
|
|
BCE XR Fluoro Guidance Needle Loc Spine
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
5273122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$588.00 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$1,080.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,104.00
|
| Rate for Payer: Health EOS Commercial |
$1,068.00
|
| Rate for Payer: HFN Commercial |
$1,104.00
|
| Rate for Payer: Multiplan Commercial |
$960.00
|
| Rate for Payer: NAPHCARE Commercial |
$720.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.00
|
| Rate for Payer: Quartz Beloit One Network |
$588.00
|
| Rate for Payer: Quartz Commercial |
$720.00
|
| Rate for Payer: WEA Trust Commercial |
$660.00
|
| Rate for Payer: WPS Commercial |
$888.84
|
|
|
BCE XR Fluoro Guided Midline
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.79 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Aetna Commercial |
$1,027.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,027.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$541.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.20
|
| Rate for Payer: Health EOS Commercial |
$984.62
|
| Rate for Payer: HFN Commercial |
$1,027.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.79
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.90
|
| Rate for Payer: Quartz Beloit One Network |
$476.08
|
| Rate for Payer: Quartz Commercial |
$616.74
|
| Rate for Payer: The Alliance Commercial |
$541.00
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
BCE XR Fluoro Guided Midline
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$530.18 |
| Max. Negotiated Rate |
$995.44 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.46
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$995.44
|
| Rate for Payer: Health EOS Commercial |
$962.98
|
| Rate for Payer: HFN Commercial |
$995.44
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: NAPHCARE Commercial |
$649.20
|
| Rate for Payer: Preferred Network Access Commercial |
$995.44
|
| Rate for Payer: Quartz Beloit One Network |
$530.18
|
| Rate for Payer: Quartz Commercial |
$649.20
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
BCE XR Fluoro Guided Midline
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,328.00 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Aetna Managed Medicare |
$302.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$703.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$541.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$519.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.46
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$995.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.49
|
| Rate for Payer: Health EOS Commercial |
$962.98
|
| Rate for Payer: HFN Commercial |
$995.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$811.50
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: NAPHCARE Commercial |
$649.20
|
| Rate for Payer: Preferred Network Access Commercial |
$995.44
|
| Rate for Payer: Quartz Beloit One Network |
$530.18
|
| Rate for Payer: Quartz Commercial |
$703.30
|
| Rate for Payer: Quartz Medicare Advantage |
$649.20
|
| Rate for Payer: The Alliance Commercial |
$4,328.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
BCE XR Foot Complete Left
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
CPT 73630 TC,LT
|
| Hospital Charge Code |
3091488
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$236.28 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Aetna Commercial |
$510.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$510.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.20
|
| Rate for Payer: Health EOS Commercial |
$488.67
|
| Rate for Payer: HFN Commercial |
$510.15
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$510.15
|
| Rate for Payer: Quartz Beloit One Network |
$236.28
|
| Rate for Payer: Quartz Commercial |
$306.09
|
| Rate for Payer: The Alliance Commercial |
$268.50
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
BCE XR Foot Complete Left
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 73630 TC,LT
|
| Hospital Charge Code |
3091488
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$494.04 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$322.20
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
BCE XR Foot Complete Left
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 73630 TC,LT
|
| Hospital Charge Code |
3091488
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.36 |
| Max. Negotiated Rate |
$2,148.00 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Aetna Managed Medicare |
$150.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.51
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$349.05
|
| Rate for Payer: Quartz Medicare Advantage |
$322.20
|
| Rate for Payer: The Alliance Commercial |
$2,148.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
BCE XR Forearm 2 Views Right
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
3925428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$502.32 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
BCE XR Forearm 2 Views Right
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
3925428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$152.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.54
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.50
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$354.90
|
| Rate for Payer: Quartz Medicare Advantage |
$327.60
|
| Rate for Payer: The Alliance Commercial |
$2,184.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
BCE XR Forearm 2 Views Right
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
3925428
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.60
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: HFN Commercial |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: The Alliance Commercial |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
BCE XR Hip w or w/o Pelvis 1 view Left
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4598702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
BCE XR Hip w or w/o Pelvis 1 view Left
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4598702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
BCE XR Hip w or w/o Pelvis 1 view Left
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4598702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
BCE XR Hip w or w/o Pelvis 1 view Right
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
4598703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
BCE XR Hip w or w/o Pelvis 1 view Right
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
4598703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
BCE XR Hip w or w/o Pelvis 1 view Right
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
4598703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
4598704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
4598704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.44 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: HFN Commercial |
$713.45
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
4598704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$3,004.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Aetna Managed Medicare |
$210.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.26
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.25
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| Rate for Payer: Quartz Medicare Advantage |
$450.60
|
| Rate for Payer: The Alliance Commercial |
$3,004.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Right
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4598705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Right
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4598705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$3,004.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Aetna Managed Medicare |
$210.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.26
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.25
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| Rate for Payer: Quartz Medicare Advantage |
$450.60
|
| Rate for Payer: The Alliance Commercial |
$3,004.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Right
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4598705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.44 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: HFN Commercial |
$713.45
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
