|
XR Sternoclavicular Joint(s)
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$358.80
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$510.60 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.30
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$360.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$277.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$510.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$493.95
|
| Rate for Payer: HFN Commercial |
$510.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$510.60
|
| Rate for Payer: Quartz Beloit One Network |
$271.95
|
| Rate for Payer: Quartz Commercial |
$360.75
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$305.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$411.09
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$271.95 |
| Max. Negotiated Rate |
$510.60 |
| Rate for Payer: Aetna Commercial |
$499.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.15
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$510.60
|
| Rate for Payer: Health EOS Commercial |
$493.95
|
| Rate for Payer: HFN Commercial |
$510.60
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: NAPHCARE Commercial |
$333.00
|
| Rate for Payer: Preferred Network Access Commercial |
$510.60
|
| Rate for Payer: Quartz Beloit One Network |
$271.95
|
| Rate for Payer: Quartz Commercial |
$333.00
|
| Rate for Payer: WEA Trust Commercial |
$305.25
|
| Rate for Payer: WPS Commercial |
$411.09
|
|
|
XR Sternoclavicular Joint(s)
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.64 |
| Max. Negotiated Rate |
$568.10 |
| Rate for Payer: Aetna Commercial |
$568.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$568.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$299.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$544.18
|
| Rate for Payer: HFN Commercial |
$568.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.64
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Preferred Network Access Commercial |
$568.10
|
| Rate for Payer: Quartz Beloit One Network |
$263.12
|
| Rate for Payer: Quartz Commercial |
$340.86
|
| Rate for Payer: The Alliance Commercial |
$299.00
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.94
|
|
|
XR Sternoclavicular Joint(s)
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$140.39 |
| Max. Negotiated Rate |
$527.25 |
| Rate for Payer: Aetna Commercial |
$527.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$477.30
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$527.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$277.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.00
|
| Rate for Payer: Health EOS Commercial |
$505.05
|
| Rate for Payer: HFN Commercial |
$527.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.39
|
| Rate for Payer: Multiplan Commercial |
$444.00
|
| Rate for Payer: Preferred Network Access Commercial |
$527.25
|
| Rate for Payer: Quartz Beloit One Network |
$244.20
|
| Rate for Payer: Quartz Commercial |
$316.35
|
| Rate for Payer: The Alliance Commercial |
$277.50
|
| Rate for Payer: WEA Trust Commercial |
$305.25
|
| Rate for Payer: WPS Commercial |
$411.09
|
|
|
XR Sternum Minimum 2 Views
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.45 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Aetna Commercial |
$472.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$472.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.20
|
| Rate for Payer: Health EOS Commercial |
$452.27
|
| Rate for Payer: HFN Commercial |
$472.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.45
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$472.15
|
| Rate for Payer: Quartz Beloit One Network |
$218.68
|
| Rate for Payer: Quartz Commercial |
$283.29
|
| Rate for Payer: The Alliance Commercial |
$248.50
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$220.80
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$299.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Sternum Minimum 2 Views
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$113.56 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna Commercial |
$437.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.00
|
| Rate for Payer: Health EOS Commercial |
$418.60
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.56
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Beloit One Network |
$202.40
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: The Alliance Commercial |
$230.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$414.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.80
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$423.20
|
| Rate for Payer: Health EOS Commercial |
$409.40
|
| Rate for Payer: HFN Commercial |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$368.00
|
| Rate for Payer: NAPHCARE Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$423.20
|
| Rate for Payer: Quartz Beloit One Network |
$225.40
|
| Rate for Payer: Quartz Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$253.00
|
| Rate for Payer: WPS Commercial |
$340.72
|
|
|
XR Swallow Function w/Video Pediatric
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$542.43 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.71
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,018.44
|
| Rate for Payer: Health EOS Commercial |
$985.23
|
| Rate for Payer: HFN Commercial |
$1,018.44
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: NAPHCARE Commercial |
$664.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.44
|
| Rate for Payer: Quartz Beloit One Network |
$542.43
|
| Rate for Payer: Quartz Commercial |
$664.20
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
XR Swallow Function w/Video Pediatric
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,018.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$985.23
|
| Rate for Payer: HFN Commercial |
$1,018.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.44
|
| Rate for Payer: Quartz Beloit One Network |
$542.43
|
| Rate for Payer: Quartz Commercial |
$719.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
XR Swallow Function w/Video Pediatric
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$364.68 |
| Max. Negotiated Rate |
$1,051.65 |
| Rate for Payer: Aetna Commercial |
$1,051.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,051.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$553.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.20
|
| Rate for Payer: Health EOS Commercial |
$1,007.37
|
| Rate for Payer: HFN Commercial |
$1,051.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$364.68
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.65
|
| Rate for Payer: Quartz Beloit One Network |
$487.08
|
| Rate for Payer: Quartz Commercial |
$630.99
|
| Rate for Payer: The Alliance Commercial |
$553.50
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
XR Swallowing Function w/ Video
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$436.48 |
| Max. Negotiated Rate |
$942.40 |
| Rate for Payer: Aetna Commercial |
$942.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$942.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$496.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.20
|
| Rate for Payer: Health EOS Commercial |
$902.72
|
| Rate for Payer: HFN Commercial |
$942.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$453.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$453.46
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Preferred Network Access Commercial |
$942.40
|
| Rate for Payer: Quartz Beloit One Network |
$436.48
|
| Rate for Payer: Quartz Commercial |
$565.44
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
1537377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,018.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$985.23
|
| Rate for Payer: HFN Commercial |
$1,018.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.44
|
| Rate for Payer: Quartz Beloit One Network |
$542.43
|
| Rate for Payer: Quartz Commercial |
$719.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$912.64 |
| Rate for Payer: Aetna Commercial |
$892.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.16
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$912.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$882.88
|
| Rate for Payer: HFN Commercial |
$912.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$912.64
|
| Rate for Payer: Quartz Beloit One Network |
$486.08
|
| Rate for Payer: Quartz Commercial |
$644.80
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
1537377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$542.43 |
| Max. Negotiated Rate |
$1,018.44 |
| Rate for Payer: Aetna Commercial |
$996.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.71
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,018.44
|
| Rate for Payer: Health EOS Commercial |
$985.23
|
| Rate for Payer: HFN Commercial |
$1,018.44
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: NAPHCARE Commercial |
$664.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.44
|
| Rate for Payer: Quartz Beloit One Network |
$542.43
|
| Rate for Payer: Quartz Commercial |
$664.20
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
XR Swallowing Function w/ Video
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
1537377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$453.46 |
| Max. Negotiated Rate |
$1,051.65 |
| Rate for Payer: Aetna Commercial |
$1,051.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.02
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,051.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$553.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.20
|
| Rate for Payer: Health EOS Commercial |
$1,007.37
|
| Rate for Payer: HFN Commercial |
$1,051.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$453.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$453.46
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.65
|
| Rate for Payer: Quartz Beloit One Network |
$487.08
|
| Rate for Payer: Quartz Commercial |
$630.99
|
| Rate for Payer: The Alliance Commercial |
$553.50
|
| Rate for Payer: WEA Trust Commercial |
$608.85
|
| Rate for Payer: WPS Commercial |
$819.95
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$486.08 |
| Max. Negotiated Rate |
$912.64 |
| Rate for Payer: Aetna Commercial |
$892.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$853.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.76
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$912.64
|
| Rate for Payer: Health EOS Commercial |
$882.88
|
| Rate for Payer: HFN Commercial |
$912.64
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: NAPHCARE Commercial |
$595.20
|
| Rate for Payer: Preferred Network Access Commercial |
$912.64
|
| Rate for Payer: Quartz Beloit One Network |
$486.08
|
| Rate for Payer: Quartz Commercial |
$595.20
|
| Rate for Payer: WEA Trust Commercial |
$545.60
|
| Rate for Payer: WPS Commercial |
$734.77
|
|
|
XR Tibia/Fibula Bilateral
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629946
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,066.85 |
| Rate for Payer: Aetna Commercial |
$1,066.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$965.78
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,066.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$561.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$673.80
|
| Rate for Payer: Health EOS Commercial |
$1,021.93
|
| Rate for Payer: HFN Commercial |
$1,066.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$898.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.85
|
| Rate for Payer: Quartz Beloit One Network |
$494.12
|
| Rate for Payer: Quartz Commercial |
$640.11
|
| Rate for Payer: The Alliance Commercial |
$561.50
|
| Rate for Payer: WEA Trust Commercial |
$617.65
|
| Rate for Payer: WPS Commercial |
$831.81
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Bilateral
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: HFN Commercial |
$575.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629946
|
| Min. Negotiated Rate |
$550.27 |
| Max. Negotiated Rate |
$1,033.16 |
| Rate for Payer: Aetna Commercial |
$1,010.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$965.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.19
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,033.16
|
| Rate for Payer: Health EOS Commercial |
$999.47
|
| Rate for Payer: HFN Commercial |
$1,033.16
|
| Rate for Payer: Multiplan Commercial |
$898.40
|
| Rate for Payer: NAPHCARE Commercial |
$673.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,033.16
|
| Rate for Payer: Quartz Beloit One Network |
$550.27
|
| Rate for Payer: Quartz Commercial |
$673.80
|
| Rate for Payer: WEA Trust Commercial |
$617.65
|
| Rate for Payer: WPS Commercial |
$831.81
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
