|
BCE XR Humerus Right
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 73060 TC,RT
|
| Hospital Charge Code |
3925422
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: HFN Commercial |
$529.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
BCE XR Humerus Right
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 73060 TC,RT
|
| Hospital Charge Code |
3925422
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$512.44 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$362.05
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
BCE XR Humerus Right
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 73060 TC,RT
|
| Hospital Charge Code |
3925422
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$512.44 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$334.20
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
BCE XR Knee 3 Views Left
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
3925460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.41 |
| Max. Negotiated Rate |
$560.28 |
| Rate for Payer: Aetna Commercial |
$548.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$322.77
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$560.28
|
| Rate for Payer: Health EOS Commercial |
$542.01
|
| Rate for Payer: HFN Commercial |
$560.28
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: NAPHCARE Commercial |
$365.40
|
| Rate for Payer: Preferred Network Access Commercial |
$560.28
|
| Rate for Payer: Quartz Beloit One Network |
$298.41
|
| Rate for Payer: Quartz Commercial |
$365.40
|
| Rate for Payer: WEA Trust Commercial |
$334.95
|
| Rate for Payer: WPS Commercial |
$451.09
|
|
|
BCE XR Knee 3 Views Left
|
Professional
|
Both
|
$609.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
3925460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.61 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Aetna Commercial |
$578.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.74
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$578.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$365.40
|
| Rate for Payer: Health EOS Commercial |
$554.19
|
| Rate for Payer: HFN Commercial |
$578.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.61
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: Preferred Network Access Commercial |
$578.55
|
| Rate for Payer: Quartz Beloit One Network |
$267.96
|
| Rate for Payer: Quartz Commercial |
$347.13
|
| Rate for Payer: The Alliance Commercial |
$304.50
|
| Rate for Payer: WEA Trust Commercial |
$334.95
|
| Rate for Payer: WPS Commercial |
$451.09
|
|
|
BCE XR Knee 3 Views Left
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
3925460
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$560.28 |
| Rate for Payer: Aetna Commercial |
$548.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.74
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$322.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$560.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$542.01
|
| Rate for Payer: HFN Commercial |
$560.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$560.28
|
| Rate for Payer: Quartz Beloit One Network |
$298.41
|
| Rate for Payer: Quartz Commercial |
$395.85
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$334.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$451.09
|
|
|
BCE XR Knee 3 Views Right
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
3091484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$560.28 |
| Rate for Payer: Aetna Commercial |
$548.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.74
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$322.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$560.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$542.01
|
| Rate for Payer: HFN Commercial |
$560.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$560.28
|
| Rate for Payer: Quartz Beloit One Network |
$298.41
|
| Rate for Payer: Quartz Commercial |
$395.85
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$334.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$451.09
|
|
|
BCE XR Knee 3 Views Right
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
3091484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.41 |
| Max. Negotiated Rate |
$560.28 |
| Rate for Payer: Aetna Commercial |
$548.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$322.77
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$560.28
|
| Rate for Payer: Health EOS Commercial |
$542.01
|
| Rate for Payer: HFN Commercial |
$560.28
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: NAPHCARE Commercial |
$365.40
|
| Rate for Payer: Preferred Network Access Commercial |
$560.28
|
| Rate for Payer: Quartz Beloit One Network |
$298.41
|
| Rate for Payer: Quartz Commercial |
$365.40
|
| Rate for Payer: WEA Trust Commercial |
$334.95
|
| Rate for Payer: WPS Commercial |
$451.09
|
|
|
BCE XR Knee 3 Views Right
|
Professional
|
Both
|
$609.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
3091484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.61 |
| Max. Negotiated Rate |
$578.55 |
| Rate for Payer: Aetna Commercial |
$578.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$523.74
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$578.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$365.40
|
| Rate for Payer: Health EOS Commercial |
$554.19
|
| Rate for Payer: HFN Commercial |
$578.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.61
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: Preferred Network Access Commercial |
$578.55
|
| Rate for Payer: Quartz Beloit One Network |
$267.96
|
| Rate for Payer: Quartz Commercial |
$347.13
|
| Rate for Payer: The Alliance Commercial |
$304.50
|
| Rate for Payer: WEA Trust Commercial |
$334.95
|
| Rate for Payer: WPS Commercial |
$451.09
|
|
|
BCE XR Major Joint Inj, Asp
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
4052762
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$667.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.12
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.16
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$682.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$660.38
|
| Rate for Payer: HFN Commercial |
$682.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$682.64
|
| Rate for Payer: Quartz Beloit One Network |
$363.58
|
| Rate for Payer: Quartz Commercial |
$482.30
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$556.50
|
| Rate for Payer: WEA Trust Commercial |
$408.10
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$549.60
|
|
|
BCE XR Major Joint Inj, Asp
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
4052762
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$704.90 |
| Rate for Payer: Aetna Commercial |
$704.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.12
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$704.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.20
|
| Rate for Payer: Health EOS Commercial |
$675.22
|
| Rate for Payer: HFN Commercial |
$704.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: Preferred Network Access Commercial |
$704.90
|
| Rate for Payer: Quartz Beloit One Network |
$326.48
|
| Rate for Payer: Quartz Commercial |
$422.94
|
| Rate for Payer: The Alliance Commercial |
$371.00
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: WEA Trust Commercial |
$408.10
|
| Rate for Payer: WPS Commercial |
$549.60
|
|
|
BCE XR Major Joint Inj, Asp
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
4052762
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$363.58 |
| Max. Negotiated Rate |
$682.64 |
| Rate for Payer: Aetna Commercial |
$667.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.26
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$682.64
|
| Rate for Payer: Health EOS Commercial |
$660.38
|
| Rate for Payer: HFN Commercial |
$682.64
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: NAPHCARE Commercial |
$445.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.64
|
| Rate for Payer: Quartz Beloit One Network |
$363.58
|
| Rate for Payer: Quartz Commercial |
$445.20
|
| Rate for Payer: WEA Trust Commercial |
$408.10
|
| Rate for Payer: WPS Commercial |
$549.60
|
|
|
BCE XR Nephrostogram
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
4464921
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$689.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$704.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$681.74
|
| Rate for Payer: HFN Commercial |
$704.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$704.72
|
| Rate for Payer: Quartz Beloit One Network |
$375.34
|
| Rate for Payer: Quartz Commercial |
$497.90
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
|
BCE XR Nephrostogram
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
4464921
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$375.34 |
| Max. Negotiated Rate |
$704.72 |
| Rate for Payer: Aetna Commercial |
$689.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$658.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.98
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$704.72
|
| Rate for Payer: Health EOS Commercial |
$681.74
|
| Rate for Payer: HFN Commercial |
$704.72
|
| Rate for Payer: Multiplan Commercial |
$612.80
|
| Rate for Payer: NAPHCARE Commercial |
$459.60
|
| Rate for Payer: Preferred Network Access Commercial |
$704.72
|
| Rate for Payer: Quartz Beloit One Network |
$375.34
|
| Rate for Payer: Quartz Commercial |
$459.60
|
| Rate for Payer: WEA Trust Commercial |
$421.30
|
| Rate for Payer: WPS Commercial |
$567.38
|
|
|
BCE XR Nephrostomy Dilation Bilateral
|
Professional
|
Both
|
$5,405.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
5430695
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$656.93 |
| Max. Negotiated Rate |
$5,134.75 |
| Rate for Payer: Aetna Commercial |
$5,134.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,648.30
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$5,134.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$656.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,243.00
|
| Rate for Payer: Health EOS Commercial |
$4,918.55
|
| Rate for Payer: HFN Commercial |
$5,134.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.26
|
| Rate for Payer: Multiplan Commercial |
$4,324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,134.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,378.20
|
| Rate for Payer: Quartz Commercial |
$3,080.85
|
| Rate for Payer: The Alliance Commercial |
$2,702.50
|
| Rate for Payer: United Healthcare Medicaid |
$656.93
|
| Rate for Payer: WEA Trust Commercial |
$2,972.75
|
| Rate for Payer: WPS Commercial |
$4,003.48
|
|
|
BCE XR Nephrostomy Dilation Bilateral
|
Facility
|
OP
|
$5,405.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
5430695
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$4,864.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,648.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,513.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,702.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,594.40
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,864.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$4,972.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$4,810.45
|
| Rate for Payer: HFN Commercial |
$4,972.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$4,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,972.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,648.45
|
| Rate for Payer: Quartz Commercial |
$3,513.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,972.75
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$4,003.48
|
|
|
BCE XR Nephrostomy Dilation Bilateral
|
Facility
|
IP
|
$5,405.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
5430695
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,648.45 |
| Max. Negotiated Rate |
$4,972.60 |
| Rate for Payer: Aetna Commercial |
$4,864.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,648.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,864.65
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$4,972.60
|
| Rate for Payer: Health EOS Commercial |
$4,810.45
|
| Rate for Payer: HFN Commercial |
$4,972.60
|
| Rate for Payer: Multiplan Commercial |
$4,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,243.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,972.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,648.45
|
| Rate for Payer: Quartz Commercial |
$3,243.00
|
| Rate for Payer: WEA Trust Commercial |
$2,972.75
|
| Rate for Payer: WPS Commercial |
$4,003.48
|
|
|
BCE XR Neph Tube Exchange Percutaneous
|
Professional
|
Both
|
$3,505.00
|
|
|
Service Code
|
CPT 50435 TC
|
| Hospital Charge Code |
4616667
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.91 |
| Max. Negotiated Rate |
$3,329.75 |
| Rate for Payer: Aetna Commercial |
$3,329.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,329.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,103.00
|
| Rate for Payer: Health EOS Commercial |
$3,189.55
|
| Rate for Payer: HFN Commercial |
$3,329.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$332.91
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,329.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,542.20
|
| Rate for Payer: Quartz Commercial |
$1,997.85
|
| Rate for Payer: The Alliance Commercial |
$1,752.50
|
| Rate for Payer: United Healthcare Medicaid |
$367.08
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
BCE XR Neph Tube Exchange Percutaneous
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435 TC
|
| Hospital Charge Code |
4616667
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,717.45 |
| Max. Negotiated Rate |
$3,224.60 |
| Rate for Payer: Aetna Commercial |
$3,154.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.65
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,224.60
|
| Rate for Payer: Health EOS Commercial |
$3,119.45
|
| Rate for Payer: HFN Commercial |
$3,224.60
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,103.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,224.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,717.45
|
| Rate for Payer: Quartz Commercial |
$2,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
BCE XR Neph Tube Exchange Percutaneous
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435 TC
|
| Hospital Charge Code |
4616667
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$3,154.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,278.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,752.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,682.40
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,224.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$3,119.45
|
| Rate for Payer: HFN Commercial |
$3,224.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,224.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,717.45
|
| Rate for Payer: Quartz Commercial |
$2,278.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
BCE XR Pelvis 1 or 2 Views
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
3925398
|
|
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 Pelvis 1 or 2 Views
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
3925398
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.18 |
| 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: 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: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| 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 Pelvis 1 or 2 Views
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
3925398
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| 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 |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
BCE XR Ribs w/PA Chest Left
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 71101 TC,LT
|
| Hospital Charge Code |
5280646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$385.63 |
| Max. Negotiated Rate |
$724.04 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$472.20
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$472.20
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
|
BCE XR Ribs w/PA Chest Left
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 71101 TC,LT
|
| Hospital Charge Code |
5280646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$724.04 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$511.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
