|
XR Hip w or w/o Pelvis 1 view Right
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip w or w/o Pelvis 1 view Right
|
Professional
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip w or w/o Pelvis 1 view Right
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Professional
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.44 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$3,004.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Aetna Managed Medicare |
$210.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.25
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| Rate for Payer: Quartz Medicare Advantage |
$450.60
|
| Rate for Payer: The Alliance Commercial |
$3,004.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Humerus Bilateral
|
Professional
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna Commercial |
$978.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$978.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$515.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$937.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: Preferred Network Access Commercial |
$978.50
|
| Rate for Payer: Quartz Beloit One Network |
$453.20
|
| Rate for Payer: Quartz Commercial |
$587.10
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
XR Humerus Bilateral
|
Facility
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| 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 |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$669.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$364.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
XR Humerus Bilateral
|
Facility
IP
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$512.44 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$334.20
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Bilateral
|
Facility
OP
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Aetna Managed Medicare |
$155.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.75
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$362.05
|
| Rate for Payer: Quartz Medicare Advantage |
$334.20
|
| Rate for Payer: The Alliance Commercial |
$2,228.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Bilateral
|
Professional
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.08 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Bilateral
|
Facility
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$618.00
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$618.00
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
XR Humerus Left
|
Professional
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.08 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Left
|
Professional
|
$515.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630429
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Aetna Commercial |
$489.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$468.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Preferred Network Access Commercial |
$489.25
|
| Rate for Payer: Quartz Beloit One Network |
$226.60
|
| Rate for Payer: Quartz Commercial |
$293.55
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
XR Humerus Left
|
Facility
IP
|
$515.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630429
|
| Min. Negotiated Rate |
$252.35 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| Rate for Payer: Health EOS Commercial |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$309.00
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$309.00
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
XR Humerus Left
|
Facility
OP
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Aetna Managed Medicare |
$155.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.75
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$362.05
|
| Rate for Payer: Quartz Medicare Advantage |
$334.20
|
| Rate for Payer: The Alliance Commercial |
$2,228.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Left
|
Facility
IP
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$512.44 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$334.20
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Left
|
Facility
OP
|
$515.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630429
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.20
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| 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 |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| 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 |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| 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 |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$334.75
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$364.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
|
XR Humerus Right
|
Facility
OP
|
$536.00
|
|
|
Service Code
|
CPT 73060 TC,RT
|
| Hospital Charge Code |
2979996
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.08 |
| Max. Negotiated Rate |
$2,144.00 |
| Rate for Payer: Aetna Commercial |
$482.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.96
|
| Rate for Payer: Aetna Managed Medicare |
$150.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$348.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.08
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$493.12
|
| Rate for Payer: Health EOS Commercial |
$477.04
|
| Rate for Payer: HFN Commercial |
$493.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: NAPHCARE Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$493.12
|
| Rate for Payer: Quartz Beloit One Network |
$262.64
|
| Rate for Payer: Quartz Commercial |
$348.40
|
| Rate for Payer: Quartz Medicare Advantage |
$321.60
|
| Rate for Payer: The Alliance Commercial |
$2,144.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$294.80
|
| Rate for Payer: WPS Commercial |
$397.02
|
|
|
XR Humerus Right
|
Facility
OP
|
$557.00
|
|
|
Service Code
|
CPT 73060 RT,TC
|
| Hospital Charge Code |
1537124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Aetna Managed Medicare |
$155.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.75
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$362.05
|
| Rate for Payer: Quartz Medicare Advantage |
$334.20
|
| Rate for Payer: The Alliance Commercial |
$2,228.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Right
|
Facility
IP
|
$536.00
|
|
|
Service Code
|
CPT 73060 TC,RT
|
| Hospital Charge Code |
2979996
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.64 |
| Max. Negotiated Rate |
$493.12 |
| Rate for Payer: Aetna Commercial |
$482.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.08
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$493.12
|
| Rate for Payer: Health EOS Commercial |
$477.04
|
| Rate for Payer: HFN Commercial |
$493.12
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: NAPHCARE Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$493.12
|
| Rate for Payer: Quartz Beloit One Network |
$262.64
|
| Rate for Payer: Quartz Commercial |
$321.60
|
| Rate for Payer: WEA Trust Commercial |
$294.80
|
| Rate for Payer: WPS Commercial |
$397.02
|
|
|
XR Humerus Right
|
Professional
|
$536.00
|
|
|
Service Code
|
CPT 73060 TC,RT
|
| Hospital Charge Code |
2979996
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$235.84 |
| Max. Negotiated Rate |
$509.20 |
| Rate for Payer: Aetna Commercial |
$509.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.96
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cigna Commercial |
$509.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.60
|
| Rate for Payer: Health EOS Commercial |
$487.76
|
| Rate for Payer: Multiplan Commercial |
$428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$509.20
|
| Rate for Payer: Quartz Beloit One Network |
$235.84
|
| Rate for Payer: Quartz Commercial |
$305.52
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: WEA Trust Commercial |
$294.80
|
| Rate for Payer: WPS Commercial |
$397.02
|
|
|
XR Humerus Right
|
Professional
|
$515.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630427
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$489.25 |
| Rate for Payer: Health EOS Commercial |
$468.65
|
| Rate for Payer: Aetna Commercial |
$489.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.90
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$489.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Preferred Network Access Commercial |
$489.25
|
| Rate for Payer: Quartz Beloit One Network |
$226.60
|
| Rate for Payer: Quartz Commercial |
$293.55
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
XR Humerus Right
|
Facility
IP
|
$557.00
|
|
|
Service Code
|
CPT 73060 RT,TC
|
| Hospital Charge Code |
1537124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.93 |
| Max. Negotiated Rate |
$512.44 |
| Rate for Payer: Aetna Commercial |
$501.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.21
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$512.44
|
| Rate for Payer: Health EOS Commercial |
$495.73
|
| Rate for Payer: HFN Commercial |
$512.44
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: NAPHCARE Commercial |
$334.20
|
| Rate for Payer: Preferred Network Access Commercial |
$512.44
|
| Rate for Payer: Quartz Beloit One Network |
$272.93
|
| Rate for Payer: Quartz Commercial |
$334.20
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Right
|
Facility
IP
|
$515.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630427
|
| Min. Negotiated Rate |
$252.35 |
| Max. Negotiated Rate |
$473.80 |
| Rate for Payer: Aetna Commercial |
$463.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.95
|
| Rate for Payer: Cash Price |
$154.50
|
| Rate for Payer: Cigna Commercial |
$473.80
|
| Rate for Payer: Health EOS Commercial |
$458.35
|
| Rate for Payer: HFN Commercial |
$473.80
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: NAPHCARE Commercial |
$309.00
|
| Rate for Payer: Preferred Network Access Commercial |
$473.80
|
| Rate for Payer: Quartz Beloit One Network |
$252.35
|
| Rate for Payer: Quartz Commercial |
$309.00
|
| Rate for Payer: WEA Trust Commercial |
$283.25
|
| Rate for Payer: WPS Commercial |
$381.46
|
|
