|
BCE XR Ankle Complete Right
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,RT
|
| Hospital Charge Code |
3091465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
BCE XR Ankle Complete Right
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,RT
|
| Hospital Charge Code |
3091465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| 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 |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
BCE XR Ankle Complete Right
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,RT
|
| Hospital Charge Code |
3091465
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$549.33 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| 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 |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.94
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.71
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
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 |
$100.88 |
| Max. Negotiated Rate |
$445.59 |
| Rate for Payer: Aetna Commercial |
$445.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$445.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.42
|
| Rate for Payer: Health EOS Commercial |
$426.83
|
| Rate for Payer: HFN Commercial |
$445.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: Preferred Network Access Commercial |
$445.59
|
| Rate for Payer: Quartz Beloit One Network |
$206.38
|
| Rate for Payer: Quartz Commercial |
$267.35
|
| Rate for Payer: The Alliance Commercial |
$234.52
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
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 |
$131.33 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Aetna Managed Medicare |
$131.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.59
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.48
|
| Rate for Payer: Health EOS Commercial |
$417.45
|
| Rate for Payer: HFN Commercial |
$431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.78
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: NAPHCARE Commercial |
$281.42
|
| Rate for Payer: Preferred Network Access Commercial |
$431.52
|
| Rate for Payer: Quartz Beloit One Network |
$229.83
|
| Rate for Payer: Quartz Commercial |
$304.88
|
| Rate for Payer: Quartz Medicare Advantage |
$281.42
|
| Rate for Payer: The Alliance Commercial |
$234.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
BCE XR Calcaneous Left
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 73650 TC,LT
|
| Hospital Charge Code |
3925471
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.83 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.59
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$431.52
|
| Rate for Payer: Health EOS Commercial |
$417.45
|
| Rate for Payer: HFN Commercial |
$431.52
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: Preferred Network Access Commercial |
$431.52
|
| Rate for Payer: Quartz Beloit One Network |
$229.83
|
| Rate for Payer: Quartz Commercial |
$281.42
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
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 |
$56.35 |
| Max. Negotiated Rate |
$1,635.14 |
| Rate for Payer: Aetna Commercial |
$1,635.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,480.23
|
| Rate for Payer: Aetna Managed Medicare |
$56.35
|
| Rate for Payer: Anthem Medicare Advantage |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.35
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,635.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$860.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.35
|
| Rate for Payer: Health EOS Commercial |
$1,566.29
|
| Rate for Payer: HFN Commercial |
$1,635.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$233.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$1,376.96
|
| Rate for Payer: NAPHCARE Commercial |
$84.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.14
|
| Rate for Payer: Quartz Beloit One Network |
$757.33
|
| Rate for Payer: Quartz Commercial |
$981.08
|
| Rate for Payer: Quartz Medicare Advantage |
$56.35
|
| Rate for Payer: The Alliance Commercial |
$214.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.35
|
| Rate for Payer: WEA Trust Commercial |
$946.66
|
| Rate for Payer: WPS Commercial |
$281.74
|
|
|
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 |
$843.39 |
| Max. Negotiated Rate |
$1,583.50 |
| Rate for Payer: Aetna Commercial |
$1,549.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,480.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$912.24
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,583.50
|
| Rate for Payer: Health EOS Commercial |
$1,531.87
|
| Rate for Payer: HFN Commercial |
$1,583.50
|
| Rate for Payer: Multiplan Commercial |
$1,376.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.50
|
| Rate for Payer: Quartz Beloit One Network |
$843.39
|
| Rate for Payer: Quartz Commercial |
$1,032.72
|
| Rate for Payer: WEA Trust Commercial |
$946.66
|
| Rate for Payer: WPS Commercial |
$1,274.85
|
|
|
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 |
$225.39 |
| Max. Negotiated Rate |
$1,583.50 |
| Rate for Payer: Aetna Commercial |
$1,549.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,480.23
|
| Rate for Payer: Aetna Managed Medicare |
$481.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,118.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$860.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$826.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$912.24
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cash Price |
$496.50
|
| Rate for Payer: Cigna Commercial |
$1,583.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$963.21
|
| Rate for Payer: Health EOS Commercial |
$1,531.87
|
| Rate for Payer: HFN Commercial |
$1,583.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,290.90
|
| Rate for Payer: Multiplan Commercial |
$1,376.96
|
| Rate for Payer: NAPHCARE Commercial |
$1,032.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,583.50
|
| Rate for Payer: Quartz Beloit One Network |
$843.39
|
| Rate for Payer: Quartz Commercial |
$1,118.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,032.72
|
| Rate for Payer: The Alliance Commercial |
$225.39
|
| Rate for Payer: WEA Trust Commercial |
$946.66
|
| Rate for Payer: WPS Commercial |
$1,274.85
|
|
|
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 |
$66.98 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$120.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.37
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.14
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$257.71
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$257.71
|
| Rate for Payer: The Alliance Commercial |
$66.98
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
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 |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
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 |
$16.74 |
| Max. Negotiated Rate |
$408.04 |
| Rate for Payer: Aetna Commercial |
$408.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$16.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.74
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$408.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.74
|
| Rate for Payer: Health EOS Commercial |
$390.86
|
| Rate for Payer: HFN Commercial |
$408.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$408.04
|
| Rate for Payer: Quartz Beloit One Network |
$188.99
|
| Rate for Payer: Quartz Commercial |
$244.83
|
| Rate for Payer: Quartz Medicare Advantage |
$16.74
|
| Rate for Payer: The Alliance Commercial |
$63.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.74
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$83.72
|
|
|
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 |
$22.73 |
| Max. Negotiated Rate |
$472.26 |
| Rate for Payer: Aetna Commercial |
$472.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.73
|
| Rate for Payer: Anthem Medicare Advantage |
$22.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.73
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$472.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.73
|
| Rate for Payer: Health EOS Commercial |
$452.38
|
| Rate for Payer: HFN Commercial |
$472.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.73
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$34.10
|
| Rate for Payer: Preferred Network Access Commercial |
$472.26
|
| Rate for Payer: Quartz Beloit One Network |
$218.73
|
| Rate for Payer: Quartz Commercial |
$283.36
|
| Rate for Payer: Quartz Medicare Advantage |
$22.73
|
| Rate for Payer: The Alliance Commercial |
$86.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.73
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$113.67
|
|
|
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 |
$243.59 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$298.27
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
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 |
$90.94 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$139.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.20
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.84
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$298.27
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$298.27
|
| Rate for Payer: The Alliance Commercial |
$90.94
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
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 |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
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 |
$113.04 |
| Max. Negotiated Rate |
$567.11 |
| Rate for Payer: Aetna Commercial |
$567.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$567.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.18
|
| Rate for Payer: Health EOS Commercial |
$543.23
|
| Rate for Payer: HFN Commercial |
$567.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$567.11
|
| Rate for Payer: Quartz Beloit One Network |
$262.66
|
| Rate for Payer: Quartz Commercial |
$340.27
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
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 |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
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 |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
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 |
$126.67 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$271.44
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$271.44
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
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 |
$103.30 |
| Max. Negotiated Rate |
$429.78 |
| Rate for Payer: Aetna Commercial |
$429.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$429.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.44
|
| Rate for Payer: Health EOS Commercial |
$411.68
|
| Rate for Payer: HFN Commercial |
$429.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$429.78
|
| Rate for Payer: Quartz Beloit One Network |
$199.06
|
| Rate for Payer: Quartz Commercial |
$257.87
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
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 |
$103.30 |
| Max. Negotiated Rate |
$429.78 |
| Rate for Payer: Aetna Commercial |
$429.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$429.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.44
|
| Rate for Payer: Health EOS Commercial |
$411.68
|
| Rate for Payer: HFN Commercial |
$429.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$429.78
|
| Rate for Payer: Quartz Beloit One Network |
$199.06
|
| Rate for Payer: Quartz Commercial |
$257.87
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
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 |
$126.67 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$271.44
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$271.44
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
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 |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
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 |
$333.79 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$408.72
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
