|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
OP
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Aetna Managed Medicare |
$166.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$386.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.82
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$546.48
|
| Rate for Payer: Health EOS Commercial |
$528.66
|
| Rate for Payer: HFN Commercial |
$546.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.50
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: NAPHCARE Commercial |
$356.40
|
| Rate for Payer: Preferred Network Access Commercial |
$546.48
|
| Rate for Payer: Quartz Beloit One Network |
$291.06
|
| Rate for Payer: Quartz Commercial |
$386.10
|
| Rate for Payer: Quartz Medicare Advantage |
$356.40
|
| Rate for Payer: The Alliance Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Professional
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$522.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$500.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$522.50
|
| Rate for Payer: Quartz Beloit One Network |
$242.00
|
| Rate for Payer: Quartz Commercial |
$313.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$71.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$93.90
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$330.00
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$330.00
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
IP
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.06 |
| Max. Negotiated Rate |
$546.48 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.82
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$546.48
|
| Rate for Payer: Health EOS Commercial |
$528.66
|
| Rate for Payer: HFN Commercial |
$546.48
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: NAPHCARE Commercial |
$356.40
|
| Rate for Payer: Preferred Network Access Commercial |
$546.48
|
| Rate for Payer: Quartz Beloit One Network |
$291.06
|
| Rate for Payer: Quartz Commercial |
$356.40
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Professional
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$564.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$540.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$564.30
|
| Rate for Payer: Quartz Beloit One Network |
$261.36
|
| Rate for Payer: Quartz Commercial |
$338.58
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$71.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$93.90
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
IP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
XR AC Joints Bilateral w/ wts
|
Professional
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$71.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$93.90
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
OP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$160.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$371.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.00
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$343.20
|
| Rate for Payer: The Alliance Commercial |
$2,288.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
OP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$2,288.00 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$160.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$371.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.00
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$343.20
|
| Rate for Payer: The Alliance Commercial |
$2,288.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
XR AC Joints Bilateral w/ wts
|
Professional
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$71.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$93.90
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
IP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
XR Ankle 2 Views Bilateral
|
Professional
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625716
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Aetna Commercial |
$913.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$31.39
|
| Rate for Payer: Anthem Medicare Advantage |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.39
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$913.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$481.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.39
|
| Rate for Payer: Health EOS Commercial |
$875.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$913.90
|
| Rate for Payer: Quartz Beloit One Network |
$423.28
|
| Rate for Payer: Quartz Commercial |
$548.34
|
| Rate for Payer: Quartz Medicare Advantage |
$31.39
|
| Rate for Payer: The Alliance Commercial |
$119.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.39
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$156.95
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
OP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625716
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$224.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Ankle 2 Views Bilateral
|
Professional
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.80
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: The Alliance Commercial |
$259.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
IP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625716
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
XR Ankle 2 Views Left
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625718
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
XR Ankle 2 Views Left
|
Facility
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625718
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$312.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$224.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
XR Ankle 2 Views Left
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536813
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Ankle 2 Views Left
|
Professional
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536813
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.80
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: The Alliance Commercial |
$259.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Ankle 2 Views Left
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536813
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Ankle 2 Views Left
|
Professional
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625718
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$31.39
|
| Rate for Payer: Anthem Medicare Advantage |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.39
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.39
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: Quartz Medicare Advantage |
$31.39
|
| Rate for Payer: The Alliance Commercial |
$119.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.39
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$156.95
|
|
|
XR Ankle 2 Views Right
|
Professional
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625720
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$31.39
|
| Rate for Payer: Anthem Medicare Advantage |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.39
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.39
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: Quartz Medicare Advantage |
$31.39
|
| Rate for Payer: The Alliance Commercial |
$119.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.39
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$156.95
|
|
|
XR Ankle 2 Views Right
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625720
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
