|
XR Hand 2 Views Bilateral
|
Professional
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.00
|
| Rate for Payer: Aetna Managed Medicare |
$30.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.10
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$665.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$350.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.10
|
| Rate for Payer: Health EOS Commercial |
$637.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$665.00
|
| Rate for Payer: Quartz Beloit One Network |
$308.00
|
| Rate for Payer: Quartz Commercial |
$399.00
|
| Rate for Payer: Quartz Medicare Advantage |
$30.10
|
| Rate for Payer: The Alliance Commercial |
$114.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.10
|
| Rate for Payer: WEA Trust Commercial |
$385.00
|
| Rate for Payer: WPS Commercial |
$150.50
|
|
|
XR Hand 2 Views Bilateral
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: The Alliance Commercial |
$195.50
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Bilateral
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Bilateral
|
Facility
OP
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$630.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.00
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$455.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$350.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.00
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$623.00
|
| Rate for Payer: HFN Commercial |
$644.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$644.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.00
|
| Rate for Payer: Quartz Commercial |
$455.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$7.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$385.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$518.49
|
|
|
XR Hand 2 Views Left
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Left
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$109.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$234.60
|
| Rate for Payer: The Alliance Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Left
|
Facility
IP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
XR Hand 2 Views Left
|
Facility
OP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$7.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
XR Hand 2 Views Left
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: The Alliance Commercial |
$195.50
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Left
|
Professional
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna Commercial |
$331.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$30.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.10
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$331.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.10
|
| Rate for Payer: Health EOS Commercial |
$317.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Preferred Network Access Commercial |
$331.55
|
| Rate for Payer: Quartz Beloit One Network |
$153.56
|
| Rate for Payer: Quartz Commercial |
$198.93
|
| Rate for Payer: Quartz Medicare Advantage |
$30.10
|
| Rate for Payer: The Alliance Commercial |
$114.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.10
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$150.50
|
|
|
XR Hand 2 Views Right
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73120 RT,TC
|
| Hospital Charge Code |
1537094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: The Alliance Commercial |
$195.50
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Right
|
Facility
OP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630489
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$7.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
XR Hand 2 Views Right
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 RT,TC
|
| Hospital Charge Code |
1537094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$109.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$234.60
|
| Rate for Payer: The Alliance Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Right
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73120 TC,RT
|
| Hospital Charge Code |
2980003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.04 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: The Alliance Commercial |
$195.50
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Right
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 TC,RT
|
| Hospital Charge Code |
2980003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Right
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 RT,TC
|
| Hospital Charge Code |
1537094
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Right
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 TC,RT
|
| Hospital Charge Code |
2980003
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$109.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$234.60
|
| Rate for Payer: The Alliance Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Right
|
Professional
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630489
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna Commercial |
$331.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$30.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.10
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$331.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.10
|
| Rate for Payer: Health EOS Commercial |
$317.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Preferred Network Access Commercial |
$331.55
|
| Rate for Payer: Quartz Beloit One Network |
$153.56
|
| Rate for Payer: Quartz Commercial |
$198.93
|
| Rate for Payer: Quartz Medicare Advantage |
$30.10
|
| Rate for Payer: The Alliance Commercial |
$114.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.10
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$150.50
|
|
|
XR Hand 2 Views Right
|
Facility
IP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630489
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
XR Hand Complete Bilateral
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Bilateral
|
Facility
IP
|
$1,022.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630483
|
| Min. Negotiated Rate |
$500.78 |
| Max. Negotiated Rate |
$940.24 |
| Rate for Payer: Aetna Commercial |
$919.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.66
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$940.24
|
| Rate for Payer: Health EOS Commercial |
$909.58
|
| Rate for Payer: HFN Commercial |
$940.24
|
| Rate for Payer: Multiplan Commercial |
$817.60
|
| Rate for Payer: NAPHCARE Commercial |
$613.20
|
| Rate for Payer: Preferred Network Access Commercial |
$940.24
|
| Rate for Payer: Quartz Beloit One Network |
$500.78
|
| Rate for Payer: Quartz Commercial |
$613.20
|
| Rate for Payer: WEA Trust Commercial |
$562.10
|
| Rate for Payer: WPS Commercial |
$757.00
|
|
|
XR Hand Complete Bilateral
|
Professional
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.60
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: The Alliance Commercial |
$275.50
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Bilateral
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537096
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Bilateral
|
Facility
OP
|
$1,022.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630483
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,489.48 |
| Rate for Payer: Aetna Commercial |
$919.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.92
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$664.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$511.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.56
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.66
|
| 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 |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$940.24
|
| 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 |
$909.58
|
| Rate for Payer: HFN Commercial |
$940.24
|
| 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 |
$817.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$940.24
|
| Rate for Payer: Quartz Beloit One Network |
$500.78
|
| Rate for Payer: Quartz Commercial |
$664.30
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,489.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$562.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$757.00
|
|
|
XR Hand Complete Bilateral
|
Professional
|
$1,022.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630483
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$970.90 |
| Rate for Payer: Aetna Commercial |
$970.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.92
|
| Rate for Payer: Aetna Managed Medicare |
$35.59
|
| Rate for Payer: Anthem Medicare Advantage |
$35.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.59
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$970.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$511.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.59
|
| Rate for Payer: Health EOS Commercial |
$930.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$817.60
|
| Rate for Payer: Preferred Network Access Commercial |
$970.90
|
| Rate for Payer: Quartz Beloit One Network |
$449.68
|
| Rate for Payer: Quartz Commercial |
$582.54
|
| Rate for Payer: Quartz Medicare Advantage |
$35.59
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.59
|
| Rate for Payer: WEA Trust Commercial |
$562.10
|
| Rate for Payer: WPS Commercial |
$177.95
|
|
