|
XR Facial Bones < 3 Views
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.74 |
| Max. Negotiated Rate |
$530.56 |
| Rate for Payer: Aetna Commercial |
$530.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.74
|
| Rate for Payer: Anthem Medicare Advantage |
$21.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.74
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$530.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.74
|
| Rate for Payer: Health EOS Commercial |
$508.22
|
| Rate for Payer: HFN Commercial |
$530.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.74
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: NAPHCARE Commercial |
$32.60
|
| Rate for Payer: Preferred Network Access Commercial |
$530.56
|
| Rate for Payer: Quartz Beloit One Network |
$245.73
|
| Rate for Payer: Quartz Commercial |
$318.33
|
| Rate for Payer: Quartz Medicare Advantage |
$21.74
|
| Rate for Payer: The Alliance Commercial |
$82.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.74
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$108.68
|
|
|
XR Facial Bones Minimum 3 Views
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
630663
|
| Min. Negotiated Rate |
$46.50 |
| Max. Negotiated Rate |
$688.64 |
| Rate for Payer: Aetna Commercial |
$688.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Aetna Managed Medicare |
$46.50
|
| Rate for Payer: Anthem Medicare Advantage |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.50
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$688.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$362.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.50
|
| Rate for Payer: Health EOS Commercial |
$659.64
|
| Rate for Payer: HFN Commercial |
$688.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: NAPHCARE Commercial |
$69.75
|
| Rate for Payer: Preferred Network Access Commercial |
$688.64
|
| Rate for Payer: Quartz Beloit One Network |
$318.95
|
| Rate for Payer: Quartz Commercial |
$413.18
|
| Rate for Payer: Quartz Medicare Advantage |
$46.50
|
| Rate for Payer: The Alliance Commercial |
$176.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.50
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: WPS Commercial |
$232.49
|
|
|
XR Facial Bones Minimum 3 Views
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$743.96 |
| Rate for Payer: Aetna Commercial |
$743.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| 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 |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$743.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.05
|
| Rate for Payer: Health EOS Commercial |
$712.64
|
| Rate for Payer: HFN Commercial |
$743.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.05
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: NAPHCARE Commercial |
$51.07
|
| Rate for Payer: Preferred Network Access Commercial |
$743.96
|
| Rate for Payer: Quartz Beloit One Network |
$344.57
|
| Rate for Payer: Quartz Commercial |
$446.38
|
| 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 |
$430.72
|
| Rate for Payer: WPS Commercial |
$170.25
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
630663
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$666.89 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.94
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| 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 |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| 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 |
$579.90
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$471.17
|
| 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 |
$398.68
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
630663
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$666.89 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$434.93
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.73 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$469.87
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.20 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Aetna Managed Medicare |
$219.27
|
| 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 |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.25
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.34
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: NAPHCARE Commercial |
$469.87
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$509.03
|
| Rate for Payer: Quartz Medicare Advantage |
$469.87
|
| Rate for Payer: The Alliance Commercial |
$136.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
XR Femur 1 View 73551
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
4605843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$145.34 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$29.07
|
| Rate for Payer: Anthem Medicare Advantage |
$29.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.07
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.07
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.07
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$43.60
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$29.07
|
| Rate for Payer: The Alliance Commercial |
$110.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$145.34
|
|
|
XR Femur 1 View 7355126
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 73551 26
|
| Hospital Charge Code |
4605844
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$52.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$8.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.00
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.00
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.00
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$8.00
|
| Rate for Payer: The Alliance Commercial |
$30.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$39.99
|
|
|
XR Femur 1 View Left
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4590783
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.62 |
| Max. Negotiated Rate |
$432.47 |
| Rate for Payer: Aetna Commercial |
$423.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Aetna Managed Medicare |
$131.62
|
| 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 |
$249.14
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$432.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.06
|
| Rate for Payer: Health EOS Commercial |
$418.37
|
| Rate for Payer: HFN Commercial |
$432.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$352.56
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: NAPHCARE Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$432.47
|
| Rate for Payer: Quartz Beloit One Network |
$230.34
|
| Rate for Payer: Quartz Commercial |
$305.55
|
| Rate for Payer: Quartz Medicare Advantage |
$282.05
|
| Rate for Payer: The Alliance Commercial |
$235.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
|
XR Femur 1 View Left
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4590783
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$446.58 |
| Rate for Payer: Aetna Commercial |
$446.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$446.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.05
|
| Rate for Payer: Health EOS Commercial |
$427.77
|
| Rate for Payer: HFN Commercial |
$446.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: Preferred Network Access Commercial |
$446.58
|
| Rate for Payer: Quartz Beloit One Network |
$206.84
|
| Rate for Payer: Quartz Commercial |
$267.95
|
| Rate for Payer: The Alliance Commercial |
$235.04
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
|
XR Femur 1 View Left
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4590783
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$432.47 |
| Rate for Payer: Aetna Commercial |
$423.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.14
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$432.47
|
| Rate for Payer: Health EOS Commercial |
$418.37
|
| Rate for Payer: HFN Commercial |
$432.47
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: Preferred Network Access Commercial |
$432.47
|
| Rate for Payer: Quartz Beloit One Network |
$230.34
|
| Rate for Payer: Quartz Commercial |
$282.05
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
|
XR Femur 1 View Rt
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$429.78 |
| Rate for Payer: Aetna Commercial |
$429.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$429.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.44
|
| Rate for Payer: Health EOS Commercial |
$411.68
|
| Rate for Payer: HFN Commercial |
$429.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$429.78
|
| Rate for Payer: Quartz Beloit One Network |
$199.06
|
| Rate for Payer: Quartz Commercial |
$257.87
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Femur 1 View Rt
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| 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 |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$271.44
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$271.44
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Femur 1 View Rt
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Femur Bilateral
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Bilateral
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$311.29 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$311.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$722.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$555.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$533.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.16
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$833.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$667.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$722.64
|
| Rate for Payer: Quartz Medicare Advantage |
$667.06
|
| Rate for Payer: The Alliance Commercial |
$555.88
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
XR Femur Bilateral
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Bilateral
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$489.17 |
| Max. Negotiated Rate |
$1,056.17 |
| Rate for Payer: Aetna Commercial |
$1,056.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,056.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$555.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.06
|
| Rate for Payer: Health EOS Commercial |
$1,011.70
|
| Rate for Payer: HFN Commercial |
$1,056.17
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.17
|
| Rate for Payer: Quartz Beloit One Network |
$489.17
|
| Rate for Payer: Quartz Commercial |
$633.70
|
| Rate for Payer: The Alliance Commercial |
$555.88
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
XR Femur Bilateral
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$544.76 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$667.06
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
XR Femur Bilateral
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Left
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Left
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$622.44 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$35.42
|
| Rate for Payer: Anthem Medicare Advantage |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.42
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$622.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.42
|
| Rate for Payer: Health EOS Commercial |
$596.23
|
| Rate for Payer: HFN Commercial |
$622.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.42
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$53.13
|
| Rate for Payer: Preferred Network Access Commercial |
$622.44
|
| Rate for Payer: Quartz Beloit One Network |
$288.29
|
| Rate for Payer: Quartz Commercial |
$373.46
|
| Rate for Payer: Quartz Medicare Advantage |
$35.42
|
| Rate for Payer: The Alliance Commercial |
$134.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.42
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$177.11
|
|
|
XR Femur Left
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Left
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.50
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| 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 |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| 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 |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$425.88
|
| 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 |
$360.36
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
