|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
4598704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.69 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Aetna Managed Medicare |
$218.69
|
| 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 |
$413.95
|
| 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 |
$718.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.08
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.78
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: NAPHCARE Commercial |
$468.62
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$507.68
|
| Rate for Payer: Quartz Medicare Advantage |
$468.62
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| 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 Right
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4598705
|
|
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
|
|
|
BCE XR Hip w or w/o Pelvis 2 or 3 Views Right
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4598705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 Right
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4598705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.69 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Aetna Managed Medicare |
$218.69
|
| 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 |
$413.95
|
| 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 |
$718.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.08
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.78
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: NAPHCARE Commercial |
$468.62
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$507.68
|
| Rate for Payer: Quartz Medicare Advantage |
$468.62
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$112.96 |
| Max. Negotiated Rate |
$550.32 |
| Rate for Payer: Aetna Commercial |
$550.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| 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 |
$550.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.57
|
| Rate for Payer: Health EOS Commercial |
$527.14
|
| Rate for Payer: HFN Commercial |
$550.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: Preferred Network Access Commercial |
$550.32
|
| Rate for Payer: Quartz Beloit One Network |
$254.88
|
| Rate for Payer: Quartz Commercial |
$330.19
|
| Rate for Payer: The Alliance Commercial |
$289.64
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
|
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 |
$283.85 |
| Max. Negotiated Rate |
$532.94 |
| Rate for Payer: Aetna Commercial |
$521.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$532.94
|
| Rate for Payer: Health EOS Commercial |
$515.56
|
| Rate for Payer: HFN Commercial |
$532.94
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: Preferred Network Access Commercial |
$532.94
|
| Rate for Payer: Quartz Beloit One Network |
$283.85
|
| Rate for Payer: Quartz Commercial |
$347.57
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
|
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 |
$162.20 |
| Max. Negotiated Rate |
$532.94 |
| Rate for Payer: Aetna Commercial |
$521.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Aetna Managed Medicare |
$162.20
|
| 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 |
$307.02
|
| 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 |
$532.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.17
|
| Rate for Payer: Health EOS Commercial |
$515.56
|
| Rate for Payer: HFN Commercial |
$532.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.46
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: NAPHCARE Commercial |
$347.57
|
| Rate for Payer: Preferred Network Access Commercial |
$532.94
|
| Rate for Payer: Quartz Beloit One Network |
$283.85
|
| Rate for Payer: Quartz Commercial |
$376.53
|
| Rate for Payer: Quartz Medicare Advantage |
$347.57
|
| Rate for Payer: The Alliance Commercial |
$289.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
|
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 |
$310.35 |
| Max. Negotiated Rate |
$582.69 |
| Rate for Payer: Aetna Commercial |
$570.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$335.68
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$582.69
|
| Rate for Payer: Health EOS Commercial |
$563.69
|
| Rate for Payer: HFN Commercial |
$582.69
|
| Rate for Payer: Multiplan Commercial |
$506.69
|
| Rate for Payer: Preferred Network Access Commercial |
$582.69
|
| Rate for Payer: Quartz Beloit One Network |
$310.35
|
| Rate for Payer: Quartz Commercial |
$380.02
|
| Rate for Payer: WEA Trust Commercial |
$348.35
|
| Rate for Payer: WPS Commercial |
$469.11
|
|
|
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 |
$142.07 |
| Max. Negotiated Rate |
$601.69 |
| Rate for Payer: Aetna Commercial |
$601.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.69
|
| 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 |
$601.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$316.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.02
|
| Rate for Payer: Health EOS Commercial |
$576.36
|
| Rate for Payer: HFN Commercial |
$601.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.07
|
| Rate for Payer: Multiplan Commercial |
$506.69
|
| Rate for Payer: Preferred Network Access Commercial |
$601.69
|
| Rate for Payer: Quartz Beloit One Network |
$278.68
|
| Rate for Payer: Quartz Commercial |
$361.02
|
| Rate for Payer: The Alliance Commercial |
$316.68
|
| Rate for Payer: WEA Trust Commercial |
$348.35
|
| Rate for Payer: WPS Commercial |
$469.11
|
|
|
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 |
$177.34 |
| Max. Negotiated Rate |
$582.69 |
| Rate for Payer: Aetna Commercial |
$570.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.69
|
| Rate for Payer: Aetna Managed Medicare |
$177.34
|
| 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 |
$335.68
|
| 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 |
$582.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.44
|
| Rate for Payer: Health EOS Commercial |
$563.69
|
| Rate for Payer: HFN Commercial |
$582.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.02
|
| Rate for Payer: Multiplan Commercial |
$506.69
|
| Rate for Payer: NAPHCARE Commercial |
$380.02
|
| Rate for Payer: Preferred Network Access Commercial |
$582.69
|
| Rate for Payer: Quartz Beloit One Network |
$310.35
|
| Rate for Payer: Quartz Commercial |
$411.68
|
| Rate for Payer: Quartz Medicare Advantage |
$380.02
|
| Rate for Payer: The Alliance Commercial |
$316.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$348.35
|
| Rate for Payer: WPS Commercial |
$469.11
|
|
|
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 |
$177.34 |
| Max. Negotiated Rate |
$582.69 |
| Rate for Payer: Aetna Commercial |
$570.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.69
|
| Rate for Payer: Aetna Managed Medicare |
$177.34
|
| 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 |
$335.68
|
| 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 |
$582.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.44
|
| Rate for Payer: Health EOS Commercial |
$563.69
|
| Rate for Payer: HFN Commercial |
$582.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.02
|
| Rate for Payer: Multiplan Commercial |
$506.69
|
| Rate for Payer: NAPHCARE Commercial |
$380.02
|
| Rate for Payer: Preferred Network Access Commercial |
$582.69
|
| Rate for Payer: Quartz Beloit One Network |
$310.35
|
| Rate for Payer: Quartz Commercial |
$411.68
|
| Rate for Payer: Quartz Medicare Advantage |
$380.02
|
| Rate for Payer: The Alliance Commercial |
$316.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$348.35
|
| Rate for Payer: WPS Commercial |
$469.11
|
|
|
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 |
$142.07 |
| Max. Negotiated Rate |
$601.69 |
| Rate for Payer: Aetna Commercial |
$601.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.69
|
| 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 |
$601.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$316.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$380.02
|
| Rate for Payer: Health EOS Commercial |
$576.36
|
| Rate for Payer: HFN Commercial |
$601.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.07
|
| Rate for Payer: Multiplan Commercial |
$506.69
|
| Rate for Payer: Preferred Network Access Commercial |
$601.69
|
| Rate for Payer: Quartz Beloit One Network |
$278.68
|
| Rate for Payer: Quartz Commercial |
$361.02
|
| Rate for Payer: The Alliance Commercial |
$316.68
|
| Rate for Payer: WEA Trust Commercial |
$348.35
|
| Rate for Payer: WPS Commercial |
$469.11
|
|
|
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 |
$310.35 |
| Max. Negotiated Rate |
$582.69 |
| Rate for Payer: Aetna Commercial |
$570.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$544.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$335.68
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna Commercial |
$582.69
|
| Rate for Payer: Health EOS Commercial |
$563.69
|
| Rate for Payer: HFN Commercial |
$582.69
|
| Rate for Payer: Multiplan Commercial |
$506.69
|
| Rate for Payer: Preferred Network Access Commercial |
$582.69
|
| Rate for Payer: Quartz Beloit One Network |
$310.35
|
| Rate for Payer: Quartz Commercial |
$380.02
|
| Rate for Payer: WEA Trust Commercial |
$348.35
|
| Rate for Payer: WPS Commercial |
$469.11
|
|
|
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 |
$378.12 |
| Max. Negotiated Rate |
$709.95 |
| Rate for Payer: Aetna Commercial |
$694.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$408.99
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$709.95
|
| Rate for Payer: Health EOS Commercial |
$686.80
|
| Rate for Payer: HFN Commercial |
$709.95
|
| Rate for Payer: Multiplan Commercial |
$617.34
|
| Rate for Payer: Preferred Network Access Commercial |
$709.95
|
| Rate for Payer: Quartz Beloit One Network |
$378.12
|
| Rate for Payer: Quartz Commercial |
$463.01
|
| Rate for Payer: WEA Trust Commercial |
$424.42
|
| Rate for Payer: WPS Commercial |
$571.56
|
|
|
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 |
$67.24 |
| Max. Negotiated Rate |
$733.10 |
| Rate for Payer: Aetna Commercial |
$733.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.64
|
| 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 |
$733.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.01
|
| Rate for Payer: Health EOS Commercial |
$702.23
|
| Rate for Payer: HFN Commercial |
$733.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$617.34
|
| Rate for Payer: Preferred Network Access Commercial |
$733.10
|
| Rate for Payer: Quartz Beloit One Network |
$339.54
|
| Rate for Payer: Quartz Commercial |
$439.86
|
| Rate for Payer: The Alliance Commercial |
$385.84
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$424.42
|
| Rate for Payer: WPS Commercial |
$571.56
|
|
|
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 |
$216.07 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$694.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.64
|
| Rate for Payer: Aetna Managed Medicare |
$216.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$501.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$385.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$370.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$408.99
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$709.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$686.80
|
| Rate for Payer: HFN Commercial |
$709.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$578.76
|
| Rate for Payer: Multiplan Commercial |
$617.34
|
| Rate for Payer: NAPHCARE Commercial |
$463.01
|
| Rate for Payer: Preferred Network Access Commercial |
$709.95
|
| Rate for Payer: Quartz Beloit One Network |
$378.12
|
| Rate for Payer: Quartz Commercial |
$501.59
|
| Rate for Payer: Quartz Medicare Advantage |
$463.01
|
| Rate for Payer: The Alliance Commercial |
$385.84
|
| Rate for Payer: United Healthcare PPO |
$578.76
|
| Rate for Payer: WEA Trust Commercial |
$424.42
|
| Rate for Payer: WPS Commercial |
$571.56
|
|
|
BCE XR Nephrostogram
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
4464921
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$390.35 |
| Max. Negotiated Rate |
$732.91 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$477.98
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
BCE XR Nephrostogram
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
4464921
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$1,482.47 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Aetna Managed Medicare |
$223.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| 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 |
$732.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.81
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.48
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: NAPHCARE Commercial |
$477.98
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$517.82
|
| Rate for Payer: Quartz Medicare Advantage |
$477.98
|
| Rate for Payer: The Alliance Commercial |
$438.38
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$5,171.50 |
| Rate for Payer: Aetna Commercial |
$5,059.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,573.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,653.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,810.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,698.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,979.24
|
| 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 |
$5,171.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$5,002.87
|
| Rate for Payer: HFN Commercial |
$5,171.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,215.90
|
| Rate for Payer: Multiplan Commercial |
$4,496.96
|
| Rate for Payer: NAPHCARE Commercial |
$3,372.72
|
| Rate for Payer: Preferred Network Access Commercial |
$5,171.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,754.39
|
| Rate for Payer: Quartz Commercial |
$3,653.78
|
| Rate for Payer: Quartz Medicare Advantage |
$3,372.72
|
| Rate for Payer: The Alliance Commercial |
$2,810.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,091.66
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
|
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 |
$2,754.39 |
| Max. Negotiated Rate |
$5,171.50 |
| Rate for Payer: Aetna Commercial |
$5,059.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,979.24
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$5,171.50
|
| Rate for Payer: Health EOS Commercial |
$5,002.87
|
| Rate for Payer: HFN Commercial |
$5,171.50
|
| Rate for Payer: Multiplan Commercial |
$4,496.96
|
| Rate for Payer: Preferred Network Access Commercial |
$5,171.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,754.39
|
| Rate for Payer: Quartz Commercial |
$3,372.72
|
| Rate for Payer: WEA Trust Commercial |
$3,091.66
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
|
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 |
$683.21 |
| Max. Negotiated Rate |
$5,340.14 |
| Rate for Payer: Aetna Commercial |
$5,340.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.23
|
| 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 |
$5,340.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,372.72
|
| Rate for Payer: Health EOS Commercial |
$5,115.29
|
| Rate for Payer: HFN Commercial |
$5,340.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$4,496.96
|
| Rate for Payer: Preferred Network Access Commercial |
$5,340.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,473.33
|
| Rate for Payer: Quartz Commercial |
$3,204.08
|
| Rate for Payer: The Alliance Commercial |
$2,810.60
|
| Rate for Payer: United Healthcare Medicaid |
$683.21
|
| Rate for Payer: WEA Trust Commercial |
$3,091.66
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$3,280.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,134.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,020.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,369.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,822.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,749.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.96
|
| 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 |
$3,353.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$3,244.23
|
| Rate for Payer: HFN Commercial |
$3,353.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,733.90
|
| Rate for Payer: Multiplan Commercial |
$2,916.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,187.12
|
| Rate for Payer: Preferred Network Access Commercial |
$3,353.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,786.15
|
| Rate for Payer: Quartz Commercial |
$2,369.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,187.12
|
| Rate for Payer: The Alliance Commercial |
$1,822.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,004.86
|
| Rate for Payer: WPS Commercial |
$2,699.90
|
|
|
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 |
$346.23 |
| Max. Negotiated Rate |
$3,462.94 |
| Rate for Payer: Aetna Commercial |
$3,462.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,134.87
|
| 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 |
$3,462.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$381.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,187.12
|
| Rate for Payer: Health EOS Commercial |
$3,317.13
|
| Rate for Payer: HFN Commercial |
$3,462.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$346.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$346.23
|
| Rate for Payer: Multiplan Commercial |
$2,916.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,462.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,603.89
|
| Rate for Payer: Quartz Commercial |
$2,077.76
|
| Rate for Payer: The Alliance Commercial |
$1,822.60
|
| Rate for Payer: United Healthcare Medicaid |
$381.76
|
| Rate for Payer: WEA Trust Commercial |
$2,004.86
|
| Rate for Payer: WPS Commercial |
$2,699.90
|
|
|
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 |
$1,786.15 |
| Max. Negotiated Rate |
$3,353.58 |
| Rate for Payer: Aetna Commercial |
$3,280.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,134.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.96
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,353.58
|
| Rate for Payer: Health EOS Commercial |
$3,244.23
|
| Rate for Payer: HFN Commercial |
$3,353.58
|
| Rate for Payer: Multiplan Commercial |
$2,916.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,353.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,786.15
|
| Rate for Payer: Quartz Commercial |
$2,187.12
|
| Rate for Payer: WEA Trust Commercial |
$2,004.86
|
| Rate for Payer: WPS Commercial |
$2,699.90
|
|
|
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 |
$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
|
|
