|
XR Arthrogram Ankle Left
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT 77002 TC,LT
|
| Hospital Charge Code |
3072701
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,631.34 |
| Rate for Payer: Aetna Commercial |
$1,595.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,524.95
|
| Rate for Payer: Aetna Managed Medicare |
$496.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,152.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$886.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$851.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$939.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$1,631.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$992.31
|
| Rate for Payer: Health EOS Commercial |
$1,578.15
|
| Rate for Payer: HFN Commercial |
$1,631.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,329.90
|
| Rate for Payer: Multiplan Commercial |
$1,418.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,063.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,631.34
|
| Rate for Payer: Quartz Beloit One Network |
$868.87
|
| Rate for Payer: Quartz Commercial |
$1,152.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,063.92
|
| Rate for Payer: The Alliance Commercial |
$886.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$975.26
|
| Rate for Payer: WPS Commercial |
$1,313.36
|
|
|
XR Arthrogram Ankle Right
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT 73615 TC,RT
|
| Hospital Charge Code |
3072702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$868.87 |
| Max. Negotiated Rate |
$1,631.34 |
| Rate for Payer: Aetna Commercial |
$1,595.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,524.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$939.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$1,631.34
|
| Rate for Payer: Health EOS Commercial |
$1,578.15
|
| Rate for Payer: HFN Commercial |
$1,631.34
|
| Rate for Payer: Multiplan Commercial |
$1,418.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,631.34
|
| Rate for Payer: Quartz Beloit One Network |
$868.87
|
| Rate for Payer: Quartz Commercial |
$1,063.92
|
| Rate for Payer: WEA Trust Commercial |
$975.26
|
| Rate for Payer: WPS Commercial |
$1,313.36
|
|
|
XR Arthrogram Ankle Right
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
CPT 73615 TC,RT
|
| Hospital Charge Code |
3072702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$484.12 |
| Max. Negotiated Rate |
$1,684.54 |
| Rate for Payer: Aetna Commercial |
$1,684.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,524.95
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$1,684.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$886.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.92
|
| Rate for Payer: Health EOS Commercial |
$1,613.61
|
| Rate for Payer: HFN Commercial |
$1,684.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$484.12
|
| Rate for Payer: Multiplan Commercial |
$1,418.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,684.54
|
| Rate for Payer: Quartz Beloit One Network |
$780.21
|
| Rate for Payer: Quartz Commercial |
$1,010.72
|
| Rate for Payer: The Alliance Commercial |
$886.60
|
| Rate for Payer: WEA Trust Commercial |
$975.26
|
| Rate for Payer: WPS Commercial |
$1,313.36
|
|
|
XR Arthrogram Ankle Right
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT 73615 TC,RT
|
| Hospital Charge Code |
3072702
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,631.34 |
| Rate for Payer: Aetna Commercial |
$1,595.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,524.95
|
| Rate for Payer: Aetna Managed Medicare |
$496.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$939.80
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cigna Commercial |
$1,631.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$992.31
|
| Rate for Payer: Health EOS Commercial |
$1,578.15
|
| Rate for Payer: HFN Commercial |
$1,631.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,329.90
|
| Rate for Payer: Multiplan Commercial |
$1,418.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,063.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,631.34
|
| Rate for Payer: Quartz Beloit One Network |
$868.87
|
| Rate for Payer: Quartz Commercial |
$1,152.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,063.92
|
| Rate for Payer: The Alliance Commercial |
$886.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$975.26
|
| Rate for Payer: WPS Commercial |
$1,313.36
|
|
|
XR Arthrogram Hip Left
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC,LT
|
| Hospital Charge Code |
3072703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$411.36 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.99
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: The Alliance Commercial |
$589.16
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Arthrogram Hip Left
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC,LT
|
| Hospital Charge Code |
3072703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$589.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Arthrogram Hip Left
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC,LT
|
| Hospital Charge Code |
3072703
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Arthrogram Hip Right
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC,RT
|
| Hospital Charge Code |
3072704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$589.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Arthrogram Hip Right
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC,RT
|
| Hospital Charge Code |
3072704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Arthrogram Hip Right
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC,RT
|
| Hospital Charge Code |
3072704
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$411.36 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.99
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: The Alliance Commercial |
$589.16
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Arthrogram Knee Left
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 73580 TC,LT
|
| Hospital Charge Code |
3072705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$916.76
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
XR Arthrogram Knee Left
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 73580 TC,LT
|
| Hospital Charge Code |
3072705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
XR Arthrogram Knee Left
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 73580 TC,LT
|
| Hospital Charge Code |
3072705
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$515.51 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,100.11
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$515.51
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: The Alliance Commercial |
$916.76
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
XR Arthrogram Knee Right
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 73580 TC,RT
|
| Hospital Charge Code |
3072706
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$916.76
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
XR Arthrogram Knee Right
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 73580 TC,RT
|
| Hospital Charge Code |
3072706
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
XR Arthrogram Knee Right
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 73580 TC,RT
|
| Hospital Charge Code |
3072706
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$515.51 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,100.11
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$515.51
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: The Alliance Commercial |
$916.76
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
X-ray Ankle 2 Views 73600
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
3206235
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$50.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$48.27
|
| Rate for Payer: HFN Commercial |
$50.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$50.39
|
| Rate for Payer: Quartz Beloit One Network |
$23.34
|
| Rate for Payer: Quartz Commercial |
$30.23
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
X-ray Ankle 2 Views 7360026
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 73600 26
|
| Hospital Charge Code |
3206241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| 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 |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.00
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| 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 |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| 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 |
$48.05
|
| Rate for Payer: WPS Commercial |
$39.99
|
|
|
X-Ray Aorta, Leg Arteries 7563026
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
CPT 75630 26
|
| Hospital Charge Code |
3549522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.95 |
| Max. Negotiated Rate |
$869.44 |
| Rate for Payer: Aetna Commercial |
$869.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.07
|
| Rate for Payer: Aetna Managed Medicare |
$88.95
|
| Rate for Payer: Anthem Medicare Advantage |
$88.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.95
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cigna Commercial |
$869.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$457.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.95
|
| Rate for Payer: Health EOS Commercial |
$832.83
|
| Rate for Payer: HFN Commercial |
$869.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$332.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.95
|
| Rate for Payer: Multiplan Commercial |
$732.16
|
| Rate for Payer: NAPHCARE Commercial |
$133.43
|
| Rate for Payer: Preferred Network Access Commercial |
$869.44
|
| Rate for Payer: Quartz Beloit One Network |
$402.69
|
| Rate for Payer: Quartz Commercial |
$521.66
|
| Rate for Payer: Quartz Medicare Advantage |
$88.95
|
| Rate for Payer: The Alliance Commercial |
$338.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.95
|
| Rate for Payer: WEA Trust Commercial |
$503.36
|
| Rate for Payer: WPS Commercial |
$444.76
|
|
|
XRAY Chest 2 Views 71046
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
5340631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$32.80
|
| Rate for Payer: Anthem Medicare Advantage |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.80
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: Quartz Medicare Advantage |
$32.80
|
| Rate for Payer: The Alliance Commercial |
$124.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.80
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$164.01
|
|
|
XRAY Chest 2 Views 7104626
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 71046 26
|
| Hospital Charge Code |
5340632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$10.07
|
| Rate for Payer: Anthem Medicare Advantage |
$10.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.07
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.07
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$15.10
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: Quartz Medicare Advantage |
$10.07
|
| Rate for Payer: The Alliance Commercial |
$38.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.07
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$50.34
|
|
|
X-ray, chest; single view
|
Facility
|
OP
|
$366.33
|
|
|
Service Code
|
CPT 71045
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$366.33 |
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| 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: NAPHCARE Commercial |
$137.37
|
| 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: Wellcare Medicare |
$91.58
|
|
|
X-RAY C-Spine 2-3 Views 72040
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
3236203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$202.54 |
| Rate for Payer: Aetna Commercial |
$202.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$39.46
|
| Rate for Payer: Anthem Medicare Advantage |
$39.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.46
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$202.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.46
|
| Rate for Payer: Health EOS Commercial |
$194.01
|
| Rate for Payer: HFN Commercial |
$202.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.46
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$59.19
|
| Rate for Payer: Preferred Network Access Commercial |
$202.54
|
| Rate for Payer: Quartz Beloit One Network |
$93.81
|
| Rate for Payer: Quartz Commercial |
$121.52
|
| Rate for Payer: Quartz Medicare Advantage |
$39.46
|
| Rate for Payer: The Alliance Commercial |
$149.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.46
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$197.29
|
|
|
X-RAY C-Spine 2-3 Views 7204026
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 72040 26
|
| Hospital Charge Code |
3236204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$202.54 |
| Rate for Payer: Aetna Commercial |
$202.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$10.40
|
| Rate for Payer: Anthem Medicare Advantage |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.40
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$202.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.40
|
| Rate for Payer: Health EOS Commercial |
$194.01
|
| Rate for Payer: HFN Commercial |
$202.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$202.54
|
| Rate for Payer: Quartz Beloit One Network |
$93.81
|
| Rate for Payer: Quartz Commercial |
$121.52
|
| Rate for Payer: Quartz Medicare Advantage |
$10.40
|
| Rate for Payer: The Alliance Commercial |
$39.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$52.00
|
|
|
X-RAY C-Spine Flex and Ext 72052
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
3236214
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$311.53 |
| Rate for Payer: Aetna Commercial |
$158.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$62.31
|
| Rate for Payer: Anthem Medicare Advantage |
$62.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.31
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$158.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.31
|
| Rate for Payer: Health EOS Commercial |
$151.42
|
| Rate for Payer: HFN Commercial |
$158.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$218.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.31
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$93.46
|
| Rate for Payer: Preferred Network Access Commercial |
$158.08
|
| Rate for Payer: Quartz Beloit One Network |
$73.22
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: Quartz Medicare Advantage |
$62.31
|
| Rate for Payer: The Alliance Commercial |
$236.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.31
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$311.53
|
|
