|
X-RAY C-Spine Flex and Ext 7205226
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 72052 26
|
| Hospital Charge Code |
3236215
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$54.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$71.40
|
|
|
X-RAY C-Spine Min 4 Views 72050
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
3236225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.61 |
| Max. Negotiated Rate |
$273.05 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$54.61
|
| Rate for Payer: Anthem Medicare Advantage |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.61
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.61
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.61
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$81.92
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$54.61
|
| Rate for Payer: The Alliance Commercial |
$207.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.61
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$273.05
|
|
|
X-RAY C-Spine Min 4 Views 7205026
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 72050 26
|
| Hospital Charge Code |
3236226
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$134.37 |
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$12.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.91
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.91
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.91
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$19.36
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12.91
|
| Rate for Payer: The Alliance Commercial |
$49.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.91
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$64.53
|
|
|
X-RAY Elbow 2 View 73070
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
3209482
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$145.34 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| 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 |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.07
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.07
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$43.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| 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 |
$29.74
|
| Rate for Payer: WPS Commercial |
$145.34
|
|
|
X-RAY Elbow 2 View 7307026
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 73070 26
|
| Hospital Charge Code |
3209487
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$104.73 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| 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 |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$104.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.00
|
| Rate for Payer: Health EOS Commercial |
$100.32
|
| Rate for Payer: HFN Commercial |
$104.73
|
| 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 |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.73
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$62.84
|
| 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 |
$60.63
|
| Rate for Payer: WPS Commercial |
$39.99
|
|
|
X-RAY Elbow Complete 73080
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
3209493
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$163.70 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$32.74
|
| Rate for Payer: Anthem Medicare Advantage |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.74
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.74
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.74
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$49.11
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: Quartz Medicare Advantage |
$32.74
|
| Rate for Payer: The Alliance Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.74
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$163.70
|
|
|
X-RAY Elbow Complete 7308026
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 73080 26
|
| Hospital Charge Code |
3209498
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$41.70
|
|
|
X-ray Exam of Acromio-Clavicular Joints 73050
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
3206230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$150.49 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$30.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.10
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.10
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$45.15
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$30.10
|
| Rate for Payer: The Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.10
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$150.49
|
|
|
X-RAY EXAM OF ACROMIO-CLAVICULAR JOINTS 7305026
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 73050 26
|
| Hospital Charge Code |
3015284
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$9.35
|
| Rate for Payer: Anthem Medicare Advantage |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.35
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.35
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$14.02
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$9.35
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.35
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$46.75
|
|
|
X-ray Exam of Ankle Complete 7361026
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 73610 26
|
| Hospital Charge Code |
3171531
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$41.70
|
|
|
X-RAY Exam of Clavicle 73000
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
3206259
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$165.31 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$33.06
|
| Rate for Payer: Anthem Medicare Advantage |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.06
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.06
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.06
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$49.59
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$125.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.06
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$165.31
|
|
|
X-RAY Exam of Clavicle 7300026
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 73000 26
|
| Hospital Charge Code |
3206264
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| 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 |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.00
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| 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 |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$12.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| 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 |
$47.48
|
| Rate for Payer: WPS Commercial |
$39.99
|
|
|
X-ray Exam of Foot Complete 73630
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
3171492
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$168.69 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$33.74
|
| Rate for Payer: Anthem Medicare Advantage |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.74
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.74
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$50.61
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: Quartz Medicare Advantage |
$33.74
|
| Rate for Payer: The Alliance Commercial |
$128.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.74
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$168.69
|
|
|
X-ray Exam of Foot Complete 7363026
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 73630 26
|
| Hospital Charge Code |
3171497
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$156.10 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$8.01
|
| Rate for Payer: Anthem Medicare Advantage |
$8.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.01
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.01
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.01
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$12.01
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: Quartz Medicare Advantage |
$8.01
|
| Rate for Payer: The Alliance Commercial |
$30.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.01
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$40.04
|
|
|
X-ray Exam of Foot Complete 736302650
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 73630 26,50
|
| Hospital Charge Code |
5578004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.18
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.27
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
X-ray Exam of Hand Min Three 73130
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
3171543
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$188.66 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$69.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$66.25
|
| Rate for Payer: HFN Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.16
|
| Rate for Payer: Quartz Beloit One Network |
$32.03
|
| Rate for Payer: Quartz Commercial |
$41.50
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$143.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$188.66
|
|
|
X-ray Exam of Hand Min Three 7313026
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 73130 26
|
| Hospital Charge Code |
3171548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$104.73 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$8.67
|
| Rate for Payer: Anthem Medicare Advantage |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.67
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$104.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.67
|
| Rate for Payer: Health EOS Commercial |
$100.32
|
| Rate for Payer: HFN Commercial |
$104.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$13.01
|
| Rate for Payer: Preferred Network Access Commercial |
$104.73
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$62.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8.67
|
| Rate for Payer: The Alliance Commercial |
$32.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.67
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$43.37
|
|
|
X-RAY Exam of Heel 7365026
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 73650 26
|
| Hospital Charge Code |
3206253
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.66
|
| Rate for Payer: Anthem Medicare Advantage |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.66
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.66
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.66
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$11.50
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7.66
|
| Rate for Payer: The Alliance Commercial |
$29.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.66
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$38.32
|
|
|
X-ray Exam of Knee, 3 View 73562
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
3171475
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.69 |
| Max. Negotiated Rate |
$210.39 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$42.08
|
| Rate for Payer: Anthem Medicare Advantage |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.08
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.08
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.08
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$63.12
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$42.08
|
| Rate for Payer: The Alliance Commercial |
$159.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.08
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$210.39
|
|
|
X-ray Exam of Knee, 3 View 7356226
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 73562 26
|
| Hospital Charge Code |
3171480
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$9.35
|
| Rate for Payer: Anthem Medicare Advantage |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.35
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.35
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$14.02
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$9.35
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.35
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$46.75
|
|
|
X-Ray Exam of Lower Spine 7211426
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 72114 26
|
| Hospital Charge Code |
3451597
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$54.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$71.40
|
|
|
X-ray Exam of Shoulder Complete 73030
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
3171509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$177.11 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| 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 |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$69.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.42
|
| Rate for Payer: Health EOS Commercial |
$66.25
|
| Rate for Payer: HFN Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.42
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$53.13
|
| Rate for Payer: Preferred Network Access Commercial |
$69.16
|
| Rate for Payer: Quartz Beloit One Network |
$32.03
|
| Rate for Payer: Quartz Commercial |
$41.50
|
| 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 |
$40.04
|
| Rate for Payer: WPS Commercial |
$177.11
|
|
|
X-ray Exam of Shoulder Min 7303026
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 73030 26
|
| Hospital Charge Code |
3171514
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$9.02
|
| Rate for Payer: Anthem Medicare Advantage |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.02
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.02
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$13.53
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$9.02
|
| Rate for Payer: The Alliance Commercial |
$34.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$45.08
|
|
|
X-Ray Exam of Sinuses Waters View Only 70210
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
3811616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$32.07
|
| Rate for Payer: Anthem Medicare Advantage |
$32.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.07
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.07
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.07
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$48.11
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$32.07
|
| Rate for Payer: The Alliance Commercial |
$121.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.07
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$160.37
|
|
|
X-RAY Exam of Sinuses Waters View Only 7021026
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 70210 26
|
| Hospital Charge Code |
3814462
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$41.70
|
|
