|
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
|
|
|
BCE XR Femur Left
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
3091472
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| 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 |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.90
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
BCE XR Femur Right
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
3925410
|
|
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
|
|
|
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 |
$123.98 |
| Max. Negotiated Rate |
$647.14 |
| Rate for Payer: Aetna Commercial |
$647.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$647.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$340.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.72
|
| Rate for Payer: Health EOS Commercial |
$619.89
|
| Rate for Payer: HFN Commercial |
$647.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: Preferred Network Access Commercial |
$647.14
|
| Rate for Payer: Quartz Beloit One Network |
$299.73
|
| Rate for Payer: Quartz Commercial |
$388.28
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
BCE XR Femur Right
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
3925410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.74 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$190.74
|
| 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 |
$361.04
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.90
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$408.72
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$408.72
|
| Rate for Payer: The Alliance Commercial |
$340.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
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 |
$611.52 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$1,123.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,073.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.44
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,148.16
|
| Rate for Payer: Health EOS Commercial |
$1,110.72
|
| Rate for Payer: HFN Commercial |
$1,148.16
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,148.16
|
| Rate for Payer: Quartz Beloit One Network |
$611.52
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: WEA Trust Commercial |
$686.40
|
| Rate for Payer: WPS Commercial |
$924.36
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$1,123.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,073.28
|
| Rate for Payer: Aetna Managed Medicare |
$349.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$811.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$624.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$599.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.44
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,148.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$698.40
|
| Rate for Payer: Health EOS Commercial |
$1,110.72
|
| Rate for Payer: HFN Commercial |
$1,148.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$936.00
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: NAPHCARE Commercial |
$748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,148.16
|
| Rate for Payer: Quartz Beloit One Network |
$611.52
|
| Rate for Payer: Quartz Commercial |
$811.20
|
| Rate for Payer: Quartz Medicare Advantage |
$748.80
|
| Rate for Payer: The Alliance Commercial |
$415.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$686.40
|
| Rate for Payer: WPS Commercial |
$924.36
|
|
|
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 |
$103.90 |
| Max. Negotiated Rate |
$1,185.60 |
| Rate for Payer: Aetna Commercial |
$1,185.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,073.28
|
| Rate for Payer: Aetna Managed Medicare |
$103.90
|
| Rate for Payer: Anthem Medicare Advantage |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.90
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,185.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$624.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.90
|
| Rate for Payer: Health EOS Commercial |
$1,135.68
|
| Rate for Payer: HFN Commercial |
$1,185.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.90
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: NAPHCARE Commercial |
$155.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,185.60
|
| Rate for Payer: Quartz Beloit One Network |
$549.12
|
| Rate for Payer: Quartz Commercial |
$711.36
|
| Rate for Payer: Quartz Medicare Advantage |
$103.90
|
| Rate for Payer: The Alliance Commercial |
$394.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.90
|
| Rate for Payer: WEA Trust Commercial |
$686.40
|
| Rate for Payer: WPS Commercial |
$519.48
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Aetna Managed Medicare |
$315.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$731.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$540.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.72
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.96
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: NAPHCARE Commercial |
$675.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$731.43
|
| Rate for Payer: Quartz Medicare Advantage |
$675.17
|
| Rate for Payer: The Alliance Commercial |
$321.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
|
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 |
$551.39 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$675.17
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
|
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 |
$80.31 |
| Max. Negotiated Rate |
$1,069.02 |
| Rate for Payer: Aetna Commercial |
$1,069.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Aetna Managed Medicare |
$80.31
|
| Rate for Payer: Anthem Medicare Advantage |
$80.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.31
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,069.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$562.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.31
|
| Rate for Payer: Health EOS Commercial |
$1,024.00
|
| Rate for Payer: HFN Commercial |
$1,069.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.31
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: NAPHCARE Commercial |
$120.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.02
|
| Rate for Payer: Quartz Beloit One Network |
$495.12
|
| Rate for Payer: Quartz Commercial |
$641.41
|
| Rate for Payer: Quartz Medicare Advantage |
$80.31
|
| Rate for Payer: The Alliance Commercial |
$305.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.31
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$401.54
|
|
|
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 |
$273.66 |
| Max. Negotiated Rate |
$513.80 |
| Rate for Payer: Aetna Commercial |
$502.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.99
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$513.80
|
| Rate for Payer: Health EOS Commercial |
$497.05
|
| Rate for Payer: HFN Commercial |
$513.80
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: Preferred Network Access Commercial |
$513.80
|
| Rate for Payer: Quartz Beloit One Network |
$273.66
|
| Rate for Payer: Quartz Commercial |
$335.09
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
|
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 |
$156.37 |
| Max. Negotiated Rate |
$513.80 |
| Rate for Payer: Aetna Commercial |
$502.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Aetna Managed Medicare |
$156.37
|
| 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 |
$295.99
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$513.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.53
|
| Rate for Payer: Health EOS Commercial |
$497.05
|
| Rate for Payer: HFN Commercial |
$513.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.86
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: NAPHCARE Commercial |
$335.09
|
| Rate for Payer: Preferred Network Access Commercial |
$513.80
|
| Rate for Payer: Quartz Beloit One Network |
$273.66
|
| Rate for Payer: Quartz Commercial |
$363.01
|
| Rate for Payer: Quartz Medicare Advantage |
$335.09
|
| Rate for Payer: The Alliance Commercial |
$279.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
|
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 |
$120.27 |
| Max. Negotiated Rate |
$530.56 |
| Rate for Payer: Aetna Commercial |
$530.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$530.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.09
|
| Rate for Payer: Health EOS Commercial |
$508.22
|
| Rate for Payer: HFN Commercial |
$530.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.27
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: Preferred Network Access Commercial |
$530.56
|
| Rate for Payer: Quartz Beloit One Network |
$245.73
|
| Rate for Payer: Quartz Commercial |
$318.33
|
| Rate for Payer: The Alliance Commercial |
$279.24
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
|
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 |
$102.10 |
| Max. Negotiated Rate |
$539.45 |
| Rate for Payer: Aetna Commercial |
$539.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$539.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.70
|
| Rate for Payer: Health EOS Commercial |
$516.73
|
| Rate for Payer: HFN Commercial |
$539.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.10
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$539.45
|
| Rate for Payer: Quartz Beloit One Network |
$249.85
|
| Rate for Payer: Quartz Commercial |
$323.67
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
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 |
$159.00 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Aetna Managed Medicare |
$159.00
|
| 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 |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.77
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.88
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: NAPHCARE Commercial |
$340.70
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$369.10
|
| Rate for Payer: Quartz Medicare Advantage |
$340.70
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
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 |
$278.24 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$340.70
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
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 |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$71.34 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| 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 |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$112.11 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.88
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$71.34 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| 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 |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$112.11 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.88
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$164.10 |
| Max. Negotiated Rate |
$741.99 |
| Rate for Payer: Aetna Commercial |
$741.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$741.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.62
|
| Rate for Payer: Health EOS Commercial |
$710.75
|
| Rate for Payer: HFN Commercial |
$741.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.10
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$741.99
|
| Rate for Payer: Quartz Beloit One Network |
$343.66
|
| Rate for Payer: Quartz Commercial |
$445.19
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$382.71 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$718.56
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$468.62
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
