|
XR PleurX Placement Lung Right
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR PleurX Placement Lung Right
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,013.32 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,381.80
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: The Alliance Commercial |
$1,151.50
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR PleurX Placement Lung Right
|
Facility
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Pleurx Removal
|
Professional
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$2,189.75 |
| Rate for Payer: Aetna Commercial |
$2,189.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.30
|
| Rate for Payer: Aetna Managed Medicare |
$41.28
|
| Rate for Payer: Anthem Medicare Advantage |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.28
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,189.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,152.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.28
|
| Rate for Payer: Health EOS Commercial |
$2,097.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$1,844.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.20
|
| Rate for Payer: Quartz Commercial |
$1,313.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.28
|
| Rate for Payer: The Alliance Commercial |
$156.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.28
|
| Rate for Payer: WEA Trust Commercial |
$1,267.75
|
| Rate for Payer: WPS Commercial |
$206.40
|
|
|
XR Pleurx Removal
|
Facility
OP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$2,120.60 |
| Rate for Payer: Aetna Commercial |
$2,074.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.30
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.27
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,120.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$2,051.45
|
| Rate for Payer: HFN Commercial |
$2,120.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.45
|
| Rate for Payer: Quartz Commercial |
$1,498.25
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$7.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,267.75
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,707.31
|
|
|
XR Pleurx Removal
|
Facility
IP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,129.45 |
| Max. Negotiated Rate |
$2,120.60 |
| Rate for Payer: Aetna Commercial |
$2,074.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.65
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,120.60
|
| Rate for Payer: Health EOS Commercial |
$2,051.45
|
| Rate for Payer: HFN Commercial |
$2,120.60
|
| Rate for Payer: Multiplan Commercial |
$1,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,383.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.45
|
| Rate for Payer: Quartz Commercial |
$1,383.00
|
| Rate for Payer: WEA Trust Commercial |
$1,267.75
|
| Rate for Payer: WPS Commercial |
$1,707.31
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Professional
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Aetna Commercial |
$913.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$31.39
|
| Rate for Payer: Anthem Medicare Advantage |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.39
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$913.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$481.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.39
|
| Rate for Payer: Health EOS Commercial |
$875.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$913.90
|
| Rate for Payer: Quartz Beloit One Network |
$423.28
|
| Rate for Payer: Quartz Commercial |
$548.34
|
| Rate for Payer: Quartz Medicare Advantage |
$31.39
|
| Rate for Payer: The Alliance Commercial |
$119.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.39
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$156.95
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
OP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| 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 |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| 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 |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| 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 |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$224.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
IP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Professional
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Left
|
Professional
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Left
|
Professional
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448822
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$31.39
|
| Rate for Payer: Anthem Medicare Advantage |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.39
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.39
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.39
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: Quartz Medicare Advantage |
$31.39
|
| Rate for Payer: The Alliance Commercial |
$119.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.39
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$156.95
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448822
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448822
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| 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 |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| 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 |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| 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 |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$312.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$224.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448823
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
2587259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
2587259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| 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 |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,RT
|
| Hospital Charge Code |
2980062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,RT
|
| Hospital Charge Code |
2980062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448823
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| 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 |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| 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 |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| 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 |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$312.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$224.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
XR Pod Ankle 2 Views Right
|
Professional
|
$518.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
2587259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.92 |
| Max. Negotiated Rate |
$492.10 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.80
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: The Alliance Commercial |
$259.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
