|
XR Abdomen AP Obliques Cone Views
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
CPT 74019 TC
|
| Hospital Charge Code |
1536805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$523.64 |
| Rate for Payer: Aetna Commercial |
$523.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Aetna Managed Medicare |
$25.06
|
| Rate for Payer: Anthem Medicare Advantage |
$25.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.06
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$523.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.06
|
| Rate for Payer: Health EOS Commercial |
$501.59
|
| Rate for Payer: HFN Commercial |
$523.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.06
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: NAPHCARE Commercial |
$37.60
|
| Rate for Payer: Preferred Network Access Commercial |
$523.64
|
| Rate for Payer: Quartz Beloit One Network |
$242.53
|
| Rate for Payer: Quartz Commercial |
$314.18
|
| Rate for Payer: Quartz Medicare Advantage |
$25.06
|
| Rate for Payer: The Alliance Commercial |
$95.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.06
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: WPS Commercial |
$125.32
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
CPT 74021 TC
|
| Hospital Charge Code |
1536807
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$602.68 |
| Rate for Payer: Aetna Commercial |
$602.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$29.39
|
| Rate for Payer: Anthem Medicare Advantage |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.39
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$602.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$317.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.39
|
| Rate for Payer: Health EOS Commercial |
$577.30
|
| Rate for Payer: HFN Commercial |
$602.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.39
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$44.09
|
| Rate for Payer: Preferred Network Access Commercial |
$602.68
|
| Rate for Payer: Quartz Beloit One Network |
$279.14
|
| Rate for Payer: Quartz Commercial |
$361.61
|
| Rate for Payer: Quartz Medicare Advantage |
$29.39
|
| Rate for Payer: The Alliance Commercial |
$111.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.39
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$146.95
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 74021 TC
|
| Hospital Charge Code |
1536807
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
CPT 74020
|
| Hospital Charge Code |
625618
|
| Min. Negotiated Rate |
$258.54 |
| Max. Negotiated Rate |
$558.22 |
| Rate for Payer: Aetna Commercial |
$558.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$558.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.56
|
| Rate for Payer: Health EOS Commercial |
$534.72
|
| Rate for Payer: HFN Commercial |
$558.22
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$558.22
|
| Rate for Payer: Quartz Beloit One Network |
$258.54
|
| Rate for Payer: Quartz Commercial |
$334.93
|
| Rate for Payer: The Alliance Commercial |
$293.80
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 74021 TC
|
| Hospital Charge Code |
1536807
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.56 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$117.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 74020
|
| Hospital Charge Code |
625618
|
| Min. Negotiated Rate |
$164.53 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$164.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.83
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.70
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$352.56
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$381.94
|
| Rate for Payer: Quartz Medicare Advantage |
$352.56
|
| Rate for Payer: The Alliance Commercial |
$293.80
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 74020
|
| Hospital Charge Code |
625618
|
| Min. Negotiated Rate |
$287.92 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
1536809
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$136.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
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 Abdomen Series w/ Chest 1 View
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
625630
|
| Min. Negotiated Rate |
$481.57 |
| Max. Negotiated Rate |
$904.18 |
| Rate for Payer: Aetna Commercial |
$884.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.88
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$904.18
|
| Rate for Payer: Health EOS Commercial |
$874.69
|
| Rate for Payer: HFN Commercial |
$904.18
|
| Rate for Payer: Multiplan Commercial |
$786.24
|
| Rate for Payer: Preferred Network Access Commercial |
$904.18
|
| Rate for Payer: Quartz Beloit One Network |
$481.57
|
| Rate for Payer: Quartz Commercial |
$589.68
|
| Rate for Payer: WEA Trust Commercial |
$540.54
|
| Rate for Payer: WPS Commercial |
$727.93
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
1536809
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$1,007.76 |
| Rate for Payer: Aetna Commercial |
$1,007.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$34.05
|
| Rate for Payer: Anthem Medicare Advantage |
$34.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.05
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$1,007.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.05
|
| Rate for Payer: Health EOS Commercial |
$965.33
|
| Rate for Payer: HFN Commercial |
$1,007.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.05
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$51.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.75
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| Rate for Payer: Quartz Medicare Advantage |
$34.05
|
| Rate for Payer: The Alliance Commercial |
$129.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.05
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$170.25
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
1536809
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
625630
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$904.18 |
| Rate for Payer: Aetna Commercial |
$884.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$845.21
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$638.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$471.74
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$520.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$904.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$549.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$874.69
|
| Rate for Payer: HFN Commercial |
$904.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$786.24
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$904.18
|
| Rate for Payer: Quartz Beloit One Network |
$481.57
|
| Rate for Payer: Quartz Commercial |
$638.82
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$540.54
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$727.93
|
|
|
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
|
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
|
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
|
$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
|
$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/ + 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/ 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 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
|
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 |
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
|
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
|
|
