|
XR Elbow 2 Views Bilateral
|
Professional
|
$543.00
|
|
|
Service Code
|
CPT 73070 LT,TC
|
| Hospital Charge Code |
1536996
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.92 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna Commercial |
$515.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$515.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.80
|
| Rate for Payer: Health EOS Commercial |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$515.85
|
| Rate for Payer: Quartz Beloit One Network |
$238.92
|
| Rate for Payer: Quartz Commercial |
$309.51
|
| Rate for Payer: The Alliance Commercial |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Bilateral
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 73070 LT,TC
|
| Hospital Charge Code |
1536996
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Left
|
Professional
|
$503.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630689
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Aetna Commercial |
$477.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$28.17
|
| Rate for Payer: Anthem Medicare Advantage |
$28.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.17
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$477.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.17
|
| Rate for Payer: Health EOS Commercial |
$457.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.17
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.85
|
| Rate for Payer: Quartz Beloit One Network |
$221.32
|
| Rate for Payer: Quartz Commercial |
$286.71
|
| Rate for Payer: Quartz Medicare Advantage |
$28.17
|
| Rate for Payer: The Alliance Commercial |
$107.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.17
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$140.85
|
|
|
XR Elbow 2 Views Left
|
Professional
|
$543.00
|
|
|
Service Code
|
CPT 73070 LT,TC
|
| Hospital Charge Code |
1536998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.92 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna Commercial |
$515.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$515.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.80
|
| Rate for Payer: Health EOS Commercial |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$515.85
|
| Rate for Payer: Quartz Beloit One Network |
$238.92
|
| Rate for Payer: Quartz Commercial |
$309.51
|
| Rate for Payer: The Alliance Commercial |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Left
|
Facility
OP
|
$503.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630689
|
| Min. Negotiated Rate |
$59.88 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| 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 |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| 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 |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| 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 |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$59.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
XR Elbow 2 Views Left
|
Facility
IP
|
$503.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630689
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
XR Elbow 2 Views Left
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 73070 LT,TC
|
| Hospital Charge Code |
1536998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Left
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 73070 LT,TC
|
| Hospital Charge Code |
1536998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Right
|
Facility
OP
|
$503.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630687
|
| Min. Negotiated Rate |
$59.88 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.44
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| 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 |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| 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 |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| 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 |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$326.95
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$59.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
XR Elbow 2 Views Right
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 73070 TC,RT
|
| Hospital Charge Code |
2979997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Right
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 73070 RT,TC
|
| Hospital Charge Code |
1537000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Right
|
Professional
|
$543.00
|
|
|
Service Code
|
CPT 73070 RT,TC
|
| Hospital Charge Code |
1537000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.92 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna Commercial |
$515.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$515.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.80
|
| Rate for Payer: Health EOS Commercial |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$515.85
|
| Rate for Payer: Quartz Beloit One Network |
$238.92
|
| Rate for Payer: Quartz Commercial |
$309.51
|
| Rate for Payer: The Alliance Commercial |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Right
|
Professional
|
$543.00
|
|
|
Service Code
|
CPT 73070 TC,RT
|
| Hospital Charge Code |
2979997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.92 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna Commercial |
$515.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$515.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.80
|
| Rate for Payer: Health EOS Commercial |
$494.13
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$515.85
|
| Rate for Payer: Quartz Beloit One Network |
$238.92
|
| Rate for Payer: Quartz Commercial |
$309.51
|
| Rate for Payer: The Alliance Commercial |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Right
|
Professional
|
$503.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630687
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$477.85 |
| Rate for Payer: Aetna Commercial |
$477.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Aetna Managed Medicare |
$28.17
|
| Rate for Payer: Anthem Medicare Advantage |
$28.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.17
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$477.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.17
|
| Rate for Payer: Health EOS Commercial |
$457.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.17
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.85
|
| Rate for Payer: Quartz Beloit One Network |
$221.32
|
| Rate for Payer: Quartz Commercial |
$286.71
|
| Rate for Payer: Quartz Medicare Advantage |
$28.17
|
| Rate for Payer: The Alliance Commercial |
$107.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.17
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$140.85
|
|
|
XR Elbow 2 Views Right
|
Facility
IP
|
$503.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630687
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$462.76 |
| Rate for Payer: Aetna Commercial |
$452.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.59
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$462.76
|
| Rate for Payer: Health EOS Commercial |
$447.67
|
| Rate for Payer: HFN Commercial |
$462.76
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: NAPHCARE Commercial |
$301.80
|
| Rate for Payer: Preferred Network Access Commercial |
$462.76
|
| Rate for Payer: Quartz Beloit One Network |
$246.47
|
| Rate for Payer: Quartz Commercial |
$301.80
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
|
XR Elbow 2 Views Right
|
Facility
OP
|
$543.00
|
|
|
Service Code
|
CPT 73070 TC,RT
|
| Hospital Charge Code |
2979997
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow 2 Views Right
|
Facility
IP
|
$543.00
|
|
|
Service Code
|
CPT 73070 RT,TC
|
| Hospital Charge Code |
1537000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
XR Elbow Complete Bilateral
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Bilateral
|
Professional
|
$1,104.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630685
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$1,048.80 |
| Rate for Payer: Aetna Commercial |
$1,048.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Aetna Managed Medicare |
$31.41
|
| Rate for Payer: Anthem Medicare Advantage |
$31.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.41
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,048.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.41
|
| Rate for Payer: Health EOS Commercial |
$1,004.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,048.80
|
| Rate for Payer: Quartz Beloit One Network |
$485.76
|
| Rate for Payer: Quartz Commercial |
$629.28
|
| Rate for Payer: Quartz Medicare Advantage |
$31.41
|
| Rate for Payer: The Alliance Commercial |
$119.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.41
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: WPS Commercial |
$157.05
|
|
|
XR Elbow Complete Bilateral
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Bilateral
|
Facility
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630685
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$717.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$552.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.92
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| 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 |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| 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 |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| 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 |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$717.60
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$350.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
XR Elbow Complete Bilateral
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Bilateral
|
Facility
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630685
|
| Min. Negotiated Rate |
$540.96 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: WPS Commercial |
$817.73
|
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$662.40
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
|
|
XR Elbow Complete Left
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Left
|
Professional
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630683
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$31.41
|
| Rate for Payer: Anthem Medicare Advantage |
$31.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.41
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.41
|
| Rate for Payer: Health EOS Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$242.88
|
| Rate for Payer: Quartz Commercial |
$314.64
|
| Rate for Payer: Quartz Medicare Advantage |
$31.41
|
| Rate for Payer: The Alliance Commercial |
$119.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.41
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$157.05
|
|
