|
XR Forearm 2 Views Left
|
Professional
|
$546.00
|
|
|
Service Code
|
CPT 73090 LT,TC
|
| Hospital Charge Code |
1537074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.60
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: The Alliance Commercial |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
XR Forearm 2 Views Left
|
Facility
IP
|
$546.00
|
|
|
Service Code
|
CPT 73090 LT,TC
|
| Hospital Charge Code |
1537074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$502.32 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
XR Forearm 2 Views Left
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630523
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$2,182.48 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.88
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| 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 |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| 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 |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| 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 |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$328.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$2,182.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
XR Forearm 2 Views Right
|
Professional
|
$526.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
2979999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$231.44 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna Commercial |
$499.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$499.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.60
|
| Rate for Payer: Health EOS Commercial |
$478.66
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.70
|
| Rate for Payer: Quartz Beloit One Network |
$231.44
|
| Rate for Payer: Quartz Commercial |
$299.82
|
| Rate for Payer: The Alliance Commercial |
$263.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Forearm 2 Views Right
|
Facility
IP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630519
|
| Min. Negotiated Rate |
$247.94 |
| Max. Negotiated Rate |
$465.52 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| Rate for Payer: Health EOS Commercial |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$303.60
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$303.60
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
XR Forearm 2 Views Right
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
2979999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$2,104.00 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$147.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.50
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| Rate for Payer: Quartz Medicare Advantage |
$315.60
|
| Rate for Payer: The Alliance Commercial |
$2,104.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Forearm 2 Views Right
|
Facility
OP
|
$546.00
|
|
|
Service Code
|
CPT 73090 RT,TC
|
| Hospital Charge Code |
1537076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Aetna Managed Medicare |
$152.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$354.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.50
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$354.90
|
| Rate for Payer: Quartz Medicare Advantage |
$327.60
|
| Rate for Payer: The Alliance Commercial |
$2,184.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
XR Forearm 2 Views Right
|
Professional
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630519
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$480.70 |
| Rate for Payer: Aetna Commercial |
$480.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| 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 |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$480.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.17
|
| Rate for Payer: Health EOS Commercial |
$460.46
|
| 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 |
$404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$480.70
|
| Rate for Payer: Quartz Beloit One Network |
$222.64
|
| Rate for Payer: Quartz Commercial |
$288.42
|
| 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 |
$278.30
|
| Rate for Payer: WPS Commercial |
$140.85
|
|
|
XR Forearm 2 Views Right
|
Professional
|
$546.00
|
|
|
Service Code
|
CPT 73090 RT,TC
|
| Hospital Charge Code |
1537076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.60
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: The Alliance Commercial |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
XR Forearm 2 Views Right
|
Facility
OP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630519
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$2,182.48 |
| Rate for Payer: Aetna Commercial |
$455.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.88
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.18
|
| 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 |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$465.52
|
| 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 |
$450.34
|
| Rate for Payer: HFN Commercial |
$465.52
|
| 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 |
$404.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$465.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.94
|
| Rate for Payer: Quartz Commercial |
$328.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$2,182.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$278.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$374.79
|
|
|
XR Forearm 2 Views Right
|
Facility
IP
|
$526.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
2979999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Forearm 2 Views Right
|
Facility
IP
|
$546.00
|
|
|
Service Code
|
CPT 73090 RT,TC
|
| Hospital Charge Code |
1537076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$267.54 |
| Max. Negotiated Rate |
$502.32 |
| Rate for Payer: Aetna Commercial |
$491.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.38
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$502.32
|
| Rate for Payer: Health EOS Commercial |
$485.94
|
| Rate for Payer: HFN Commercial |
$502.32
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: NAPHCARE Commercial |
$327.60
|
| Rate for Payer: Preferred Network Access Commercial |
$502.32
|
| Rate for Payer: Quartz Beloit One Network |
$267.54
|
| Rate for Payer: Quartz Commercial |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.42
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
IP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$591.56 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$385.80
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Professional
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.92 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Aetna Commercial |
$610.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$610.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$385.80
|
| Rate for Payer: Health EOS Commercial |
$585.13
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.85
|
| Rate for Payer: Quartz Beloit One Network |
$282.92
|
| Rate for Payer: Quartz Commercial |
$366.51
|
| Rate for Payer: The Alliance Commercial |
$321.50
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630515
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,950.16 |
| Rate for Payer: Aetna Commercial |
$1,071.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.26
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$774.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.68
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.23
|
| 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 |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,095.72
|
| 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 |
$1,059.99
|
| Rate for Payer: HFN Commercial |
$1,095.72
|
| 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 |
$952.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,095.72
|
| Rate for Payer: Quartz Beloit One Network |
$583.59
|
| Rate for Payer: Quartz Commercial |
$774.15
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,950.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$655.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$882.17
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630515
|
| Min. Negotiated Rate |
$583.59 |
| Max. Negotiated Rate |
$1,095.72 |
| Rate for Payer: Aetna Commercial |
$1,071.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.23
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,095.72
|
| Rate for Payer: Health EOS Commercial |
$1,059.99
|
| Rate for Payer: HFN Commercial |
$1,095.72
|
| Rate for Payer: Multiplan Commercial |
$952.80
|
| Rate for Payer: NAPHCARE Commercial |
$714.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,095.72
|
| Rate for Payer: Quartz Beloit One Network |
$583.59
|
| Rate for Payer: Quartz Commercial |
$714.60
|
| Rate for Payer: WEA Trust Commercial |
$655.05
|
| Rate for Payer: WPS Commercial |
$882.17
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Professional
|
$1,191.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630515
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$1,131.45 |
| Rate for Payer: Aetna Commercial |
$1,131.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.26
|
| Rate for Payer: Aetna Managed Medicare |
$31.42
|
| Rate for Payer: Anthem Medicare Advantage |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.42
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,131.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$595.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.42
|
| Rate for Payer: Health EOS Commercial |
$1,083.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.42
|
| Rate for Payer: Multiplan Commercial |
$952.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,131.45
|
| Rate for Payer: Quartz Beloit One Network |
$524.04
|
| Rate for Payer: Quartz Commercial |
$678.87
|
| Rate for Payer: Quartz Medicare Advantage |
$31.42
|
| Rate for Payer: The Alliance Commercial |
$119.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: WEA Trust Commercial |
$655.05
|
| Rate for Payer: WPS Commercial |
$157.10
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
OP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.04 |
| Max. Negotiated Rate |
$2,572.00 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Aetna Managed Medicare |
$180.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.25
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$417.95
|
| Rate for Payer: Quartz Medicare Advantage |
$385.80
|
| Rate for Payer: The Alliance Commercial |
$2,572.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
IP
|
$595.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630511
|
| Min. Negotiated Rate |
$291.55 |
| Max. Negotiated Rate |
$547.40 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.35
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| Rate for Payer: Health EOS Commercial |
$529.55
|
| Rate for Payer: HFN Commercial |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: NAPHCARE Commercial |
$357.00
|
| Rate for Payer: Preferred Network Access Commercial |
$547.40
|
| Rate for Payer: Quartz Beloit One Network |
$291.55
|
| Rate for Payer: Quartz Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$327.25
|
| Rate for Payer: WPS Commercial |
$440.72
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
OP
|
$595.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630511
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,950.16 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.70
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$386.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$285.60
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.35
|
| 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 |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$547.40
|
| 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 |
$529.55
|
| Rate for Payer: HFN Commercial |
$547.40
|
| 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 |
$476.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$547.40
|
| Rate for Payer: Quartz Beloit One Network |
$291.55
|
| Rate for Payer: Quartz Commercial |
$386.75
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,950.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$327.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$440.72
|
|
|
XR Foreign Body Loc Eye Left
|
Professional
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.92 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Aetna Commercial |
$610.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$610.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$385.80
|
| Rate for Payer: Health EOS Commercial |
$585.13
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.85
|
| Rate for Payer: Quartz Beloit One Network |
$282.92
|
| Rate for Payer: Quartz Commercial |
$366.51
|
| Rate for Payer: The Alliance Commercial |
$321.50
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
XR Foreign Body Loc Eye Left
|
Professional
|
$595.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630511
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$565.25 |
| Rate for Payer: Aetna Commercial |
$565.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.42
|
| Rate for Payer: Anthem Medicare Advantage |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.42
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$565.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.42
|
| Rate for Payer: Health EOS Commercial |
$541.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.42
|
| Rate for Payer: Multiplan Commercial |
$476.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.25
|
| Rate for Payer: Quartz Beloit One Network |
$261.80
|
| Rate for Payer: Quartz Commercial |
$339.15
|
| Rate for Payer: Quartz Medicare Advantage |
$31.42
|
| Rate for Payer: The Alliance Commercial |
$119.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.42
|
| Rate for Payer: WEA Trust Commercial |
$327.25
|
| Rate for Payer: WPS Commercial |
$157.10
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
IP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$591.56 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$385.80
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
OP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.04 |
| Max. Negotiated Rate |
$2,572.00 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Aetna Managed Medicare |
$180.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.25
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$417.95
|
| Rate for Payer: Quartz Medicare Advantage |
$385.80
|
| Rate for Payer: The Alliance Commercial |
$2,572.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
XR Foreign Body Loc Eye Right
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 70030 RT,TC
|
| Hospital Charge Code |
1537082
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: The Alliance Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
