|
XR Abdomen Series w/ Chest 1 View
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
625630
|
| Min. Negotiated Rate |
$49.03 |
| Max. Negotiated Rate |
$933.66 |
| Rate for Payer: Aetna Commercial |
$933.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.21
|
| Rate for Payer: Aetna Managed Medicare |
$49.03
|
| Rate for Payer: Anthem Medicare Advantage |
$49.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.03
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$933.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$491.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.03
|
| Rate for Payer: Health EOS Commercial |
$894.35
|
| Rate for Payer: HFN Commercial |
$933.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.03
|
| Rate for Payer: Multiplan Commercial |
$786.24
|
| Rate for Payer: NAPHCARE Commercial |
$73.54
|
| Rate for Payer: Preferred Network Access Commercial |
$933.66
|
| Rate for Payer: Quartz Beloit One Network |
$432.43
|
| Rate for Payer: Quartz Commercial |
$560.20
|
| Rate for Payer: Quartz Medicare Advantage |
$49.03
|
| Rate for Payer: The Alliance Commercial |
$186.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.03
|
| Rate for Payer: WEA Trust Commercial |
$540.54
|
| Rate for Payer: WPS Commercial |
$245.13
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.74
|
| Rate for Payer: Anthem Medicare Advantage |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.74
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.74
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.11
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$20.74
|
| Rate for Payer: The Alliance Commercial |
$78.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.74
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$103.69
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$586.87 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.27
|
| Rate for Payer: Aetna Managed Medicare |
$20.74
|
| Rate for Payer: Anthem Medicare Advantage |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.74
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$586.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.74
|
| Rate for Payer: Health EOS Commercial |
$562.16
|
| Rate for Payer: HFN Commercial |
$586.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$494.21
|
| Rate for Payer: NAPHCARE Commercial |
$31.11
|
| Rate for Payer: Preferred Network Access Commercial |
$586.87
|
| Rate for Payer: Quartz Beloit One Network |
$271.81
|
| Rate for Payer: Quartz Commercial |
$352.12
|
| Rate for Payer: Quartz Medicare Advantage |
$20.74
|
| Rate for Payer: The Alliance Commercial |
$78.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.74
|
| Rate for Payer: WEA Trust Commercial |
$339.77
|
| Rate for Payer: WPS Commercial |
$103.69
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.67
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.70 |
| Max. Negotiated Rate |
$568.34 |
| Rate for Payer: Aetna Commercial |
$555.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.41
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$568.34
|
| Rate for Payer: Health EOS Commercial |
$549.81
|
| Rate for Payer: HFN Commercial |
$568.34
|
| Rate for Payer: Multiplan Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$568.34
|
| Rate for Payer: Quartz Beloit One Network |
$302.70
|
| Rate for Payer: Quartz Commercial |
$370.66
|
| Rate for Payer: WEA Trust Commercial |
$339.77
|
| Rate for Payer: WPS Commercial |
$457.56
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$568.34 |
| Rate for Payer: Aetna Commercial |
$555.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.27
|
| Rate for Payer: Aetna Managed Medicare |
$172.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.41
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$568.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$345.71
|
| Rate for Payer: Health EOS Commercial |
$549.81
|
| Rate for Payer: HFN Commercial |
$568.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$463.32
|
| Rate for Payer: Multiplan Commercial |
$494.21
|
| Rate for Payer: NAPHCARE Commercial |
$370.66
|
| Rate for Payer: Preferred Network Access Commercial |
$568.34
|
| Rate for Payer: Quartz Beloit One Network |
$302.70
|
| Rate for Payer: Quartz Commercial |
$401.54
|
| Rate for Payer: Quartz Medicare Advantage |
$370.66
|
| Rate for Payer: The Alliance Commercial |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$339.77
|
| Rate for Payer: WPS Commercial |
$457.56
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$160.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.10
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.00
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$343.20
|
| Rate for Payer: The Alliance Commercial |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.67
|
|
|
XR AC Joints Bilateral w/ wts
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$565.14 |
| Rate for Payer: Aetna Commercial |
$565.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Aetna Managed Medicare |
$20.74
|
| Rate for Payer: Anthem Medicare Advantage |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.74
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$565.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.74
|
| Rate for Payer: Health EOS Commercial |
$541.34
|
| Rate for Payer: HFN Commercial |
$565.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: NAPHCARE Commercial |
$31.11
|
| Rate for Payer: Preferred Network Access Commercial |
$565.14
|
| Rate for Payer: Quartz Beloit One Network |
$261.75
|
| Rate for Payer: Quartz Commercial |
$339.08
|
| Rate for Payer: Quartz Medicare Advantage |
$20.74
|
| Rate for Payer: The Alliance Commercial |
$78.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.74
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$103.69
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$547.29 |
| Rate for Payer: Aetna Commercial |
$535.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Aetna Managed Medicare |
$166.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.29
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$547.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.90
|
| Rate for Payer: Health EOS Commercial |
$529.44
|
| Rate for Payer: HFN Commercial |
$547.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.16
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: NAPHCARE Commercial |
$356.93
|
| Rate for Payer: Preferred Network Access Commercial |
$547.29
|
| Rate for Payer: Quartz Beloit One Network |
$291.49
|
| Rate for Payer: Quartz Commercial |
$386.67
|
| Rate for Payer: Quartz Medicare Advantage |
$356.93
|
| Rate for Payer: The Alliance Commercial |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$440.61
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.49 |
| Max. Negotiated Rate |
$547.29 |
| Rate for Payer: Aetna Commercial |
$535.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.29
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$547.29
|
| Rate for Payer: Health EOS Commercial |
$529.44
|
| Rate for Payer: HFN Commercial |
$547.29
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: Preferred Network Access Commercial |
$547.29
|
| Rate for Payer: Quartz Beloit One Network |
$291.49
|
| Rate for Payer: Quartz Commercial |
$356.93
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$440.61
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.49 |
| Max. Negotiated Rate |
$547.29 |
| Rate for Payer: Aetna Commercial |
$535.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.29
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$547.29
|
| Rate for Payer: Health EOS Commercial |
$529.44
|
| Rate for Payer: HFN Commercial |
$547.29
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: Preferred Network Access Commercial |
$547.29
|
| Rate for Payer: Quartz Beloit One Network |
$291.49
|
| Rate for Payer: Quartz Commercial |
$356.93
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$440.61
|
|
|
XR AC Joints Bilateral w/ wts
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$565.14 |
| Rate for Payer: Aetna Commercial |
$565.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Aetna Managed Medicare |
$20.74
|
| Rate for Payer: Anthem Medicare Advantage |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.74
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$565.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.74
|
| Rate for Payer: Health EOS Commercial |
$541.34
|
| Rate for Payer: HFN Commercial |
$565.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: NAPHCARE Commercial |
$31.11
|
| Rate for Payer: Preferred Network Access Commercial |
$565.14
|
| Rate for Payer: Quartz Beloit One Network |
$261.75
|
| Rate for Payer: Quartz Commercial |
$339.08
|
| Rate for Payer: Quartz Medicare Advantage |
$20.74
|
| Rate for Payer: The Alliance Commercial |
$78.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.74
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$103.69
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$547.29 |
| Rate for Payer: Aetna Commercial |
$535.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$511.60
|
| Rate for Payer: Aetna Managed Medicare |
$166.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.29
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$547.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.90
|
| Rate for Payer: Health EOS Commercial |
$529.44
|
| Rate for Payer: HFN Commercial |
$547.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.16
|
| Rate for Payer: Multiplan Commercial |
$475.90
|
| Rate for Payer: NAPHCARE Commercial |
$356.93
|
| Rate for Payer: Preferred Network Access Commercial |
$547.29
|
| Rate for Payer: Quartz Beloit One Network |
$291.49
|
| Rate for Payer: Quartz Commercial |
$386.67
|
| Rate for Payer: Quartz Medicare Advantage |
$356.93
|
| Rate for Payer: The Alliance Commercial |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$327.18
|
| Rate for Payer: WPS Commercial |
$440.61
|
|
|
XR Ankle 2 Views Bilateral
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$511.78 |
| Rate for Payer: Aetna Commercial |
$511.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$511.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.23
|
| Rate for Payer: Health EOS Commercial |
$490.24
|
| Rate for Payer: HFN Commercial |
$511.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$511.78
|
| Rate for Payer: Quartz Beloit One Network |
$237.04
|
| Rate for Payer: Quartz Commercial |
$307.07
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625716
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.23
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$650.31
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Ankle 2 Views Bilateral
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625716
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$950.46 |
| Rate for Payer: Aetna Commercial |
$950.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$950.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$910.44
|
| Rate for Payer: HFN Commercial |
$950.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$950.46
|
| Rate for Payer: Quartz Beloit One Network |
$440.21
|
| Rate for Payer: Quartz Commercial |
$570.27
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Ankle 2 Views Bilateral
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625716
|
| Min. Negotiated Rate |
$490.24 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
XR Ankle 2 Views Left
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625718
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$474.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$474.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$454.27
|
| Rate for Payer: HFN Commercial |
$474.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$474.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.65
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
XR Ankle 2 Views Left
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625718
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
XR Ankle 2 Views Left
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536813
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Ankle 2 Views Left
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536813
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$511.78 |
| Rate for Payer: Aetna Commercial |
$511.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$511.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.23
|
| Rate for Payer: Health EOS Commercial |
$490.24
|
| Rate for Payer: HFN Commercial |
$511.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$511.78
|
| Rate for Payer: Quartz Beloit One Network |
$237.04
|
| Rate for Payer: Quartz Commercial |
$307.07
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Ankle 2 Views Left
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 73600 LT,TC
|
| Hospital Charge Code |
1536813
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Ankle 2 Views Left
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
625718
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
