|
XR Forearm 2 Views Left
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 73090 LT,TC
|
| Hospital Charge Code |
1537074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Aetna Managed Medicare |
$159.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.77
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.88
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: NAPHCARE Commercial |
$340.70
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$369.10
|
| Rate for Payer: Quartz Medicare Advantage |
$340.70
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
XR Forearm 2 Views Left
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
CPT 73090 LT,TC
|
| Hospital Charge Code |
1537074
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$539.45 |
| Rate for Payer: Aetna Commercial |
$539.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$539.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.70
|
| Rate for Payer: Health EOS Commercial |
$516.73
|
| Rate for Payer: HFN Commercial |
$539.45
|
| 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: Multiplan Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$539.45
|
| Rate for Payer: Quartz Beloit One Network |
$249.85
|
| Rate for Payer: Quartz Commercial |
$323.67
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
XR Forearm 2 Views Left
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630523
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$499.93 |
| Rate for Payer: Aetna Commercial |
$499.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$28.74
|
| Rate for Payer: Anthem Medicare Advantage |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.74
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$499.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.74
|
| Rate for Payer: Health EOS Commercial |
$478.88
|
| Rate for Payer: HFN Commercial |
$499.93
|
| 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 |
$28.74
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$43.10
|
| Rate for Payer: Preferred Network Access Commercial |
$499.93
|
| Rate for Payer: Quartz Beloit One Network |
$231.55
|
| Rate for Payer: Quartz Commercial |
$299.96
|
| Rate for Payer: Quartz Medicare Advantage |
$28.74
|
| Rate for Payer: The Alliance Commercial |
$109.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$143.68
|
|
|
XR Forearm 2 Views Left
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630523
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$315.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
XR Forearm 2 Views Left
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630523
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$342.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.60
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$342.06
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
XR Forearm 2 Views Right
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
2979999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.17 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$153.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.13
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$328.22
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$355.58
|
| Rate for Payer: Quartz Medicare Advantage |
$328.22
|
| Rate for Payer: The Alliance Commercial |
$273.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
XR Forearm 2 Views Right
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
CPT 73090 RT,TC
|
| Hospital Charge Code |
1537076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$539.45 |
| Rate for Payer: Aetna Commercial |
$539.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$539.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.70
|
| Rate for Payer: Health EOS Commercial |
$516.73
|
| Rate for Payer: HFN Commercial |
$539.45
|
| 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: Multiplan Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$539.45
|
| Rate for Payer: Quartz Beloit One Network |
$249.85
|
| Rate for Payer: Quartz Commercial |
$323.67
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
XR Forearm 2 Views Right
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630519
|
| Min. Negotiated Rate |
$28.74 |
| Max. Negotiated Rate |
$499.93 |
| Rate for Payer: Aetna Commercial |
$499.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$28.74
|
| Rate for Payer: Anthem Medicare Advantage |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.74
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$499.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.74
|
| Rate for Payer: Health EOS Commercial |
$478.88
|
| Rate for Payer: HFN Commercial |
$499.93
|
| 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 |
$28.74
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$43.10
|
| Rate for Payer: Preferred Network Access Commercial |
$499.93
|
| Rate for Payer: Quartz Beloit One Network |
$231.55
|
| Rate for Payer: Quartz Commercial |
$299.96
|
| Rate for Payer: Quartz Medicare Advantage |
$28.74
|
| Rate for Payer: The Alliance Commercial |
$109.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$143.68
|
|
|
XR Forearm 2 Views Right
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 73090 RT,TC
|
| Hospital Charge Code |
1537076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.24 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$340.70
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
XR Forearm 2 Views Right
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630519
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$315.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
XR Forearm 2 Views Right
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 73090 RT,TC
|
| Hospital Charge Code |
1537076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$522.41 |
| Rate for Payer: Aetna Commercial |
$511.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.34
|
| Rate for Payer: Aetna Managed Medicare |
$159.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.96
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cigna Commercial |
$522.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.77
|
| Rate for Payer: Health EOS Commercial |
$505.38
|
| Rate for Payer: HFN Commercial |
$522.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.88
|
| Rate for Payer: Multiplan Commercial |
$454.27
|
| Rate for Payer: NAPHCARE Commercial |
$340.70
|
| Rate for Payer: Preferred Network Access Commercial |
$522.41
|
| Rate for Payer: Quartz Beloit One Network |
$278.24
|
| Rate for Payer: Quartz Commercial |
$369.10
|
| Rate for Payer: Quartz Medicare Advantage |
$340.70
|
| Rate for Payer: The Alliance Commercial |
$283.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.31
|
| Rate for Payer: WPS Commercial |
$420.58
|
|
|
XR Forearm 2 Views Right
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
630519
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$342.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.60
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$342.06
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
XR Forearm 2 Views Right
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
2979999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$519.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$519.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.22
|
| Rate for Payer: Health EOS Commercial |
$497.81
|
| Rate for Payer: HFN Commercial |
$519.69
|
| 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: Multiplan Commercial |
$437.63
|
| Rate for Payer: Preferred Network Access Commercial |
$519.69
|
| Rate for Payer: Quartz Beloit One Network |
$240.70
|
| Rate for Payer: Quartz Commercial |
$311.81
|
| Rate for Payer: The Alliance Commercial |
$273.52
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
XR Forearm 2 Views Right
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 73090 TC,RT
|
| Hospital Charge Code |
2979999
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$328.22
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.67 |
| Max. Negotiated Rate |
$615.22 |
| Rate for Payer: Aetna Commercial |
$601.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.42
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$615.22
|
| Rate for Payer: Health EOS Commercial |
$595.16
|
| Rate for Payer: HFN Commercial |
$615.22
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: Preferred Network Access Commercial |
$615.22
|
| Rate for Payer: Quartz Beloit One Network |
$327.67
|
| Rate for Payer: Quartz Commercial |
$401.23
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
|
OP
|
$1,191.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630515
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,139.55 |
| Rate for Payer: Aetna Commercial |
$1,114.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.23
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$805.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.55
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,139.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$693.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,102.39
|
| Rate for Payer: HFN Commercial |
$1,139.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$990.91
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,139.55
|
| Rate for Payer: Quartz Beloit One Network |
$606.93
|
| Rate for Payer: Quartz Commercial |
$805.12
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$681.25
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$917.43
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
|
IP
|
$1,191.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630515
|
| Min. Negotiated Rate |
$606.93 |
| Max. Negotiated Rate |
$1,139.55 |
| Rate for Payer: Aetna Commercial |
$1,114.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.48
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,139.55
|
| Rate for Payer: Health EOS Commercial |
$1,102.39
|
| Rate for Payer: HFN Commercial |
$1,139.55
|
| Rate for Payer: Multiplan Commercial |
$990.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,139.55
|
| Rate for Payer: Quartz Beloit One Network |
$606.93
|
| Rate for Payer: Quartz Commercial |
$743.18
|
| Rate for Payer: WEA Trust Commercial |
$681.25
|
| Rate for Payer: WPS Commercial |
$917.43
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Professional
|
Both
|
$1,191.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630515
|
| Min. Negotiated Rate |
$32.43 |
| Max. Negotiated Rate |
$1,176.71 |
| Rate for Payer: Aetna Commercial |
$1,176.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,065.23
|
| Rate for Payer: Aetna Managed Medicare |
$32.43
|
| Rate for Payer: Anthem Medicare Advantage |
$32.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.43
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna Commercial |
$1,176.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$619.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.43
|
| Rate for Payer: Health EOS Commercial |
$1,127.16
|
| Rate for Payer: HFN Commercial |
$1,176.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.43
|
| Rate for Payer: Multiplan Commercial |
$990.91
|
| Rate for Payer: NAPHCARE Commercial |
$48.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.71
|
| Rate for Payer: Quartz Beloit One Network |
$545.00
|
| Rate for Payer: Quartz Commercial |
$706.02
|
| Rate for Payer: Quartz Medicare Advantage |
$32.43
|
| Rate for Payer: The Alliance Commercial |
$123.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.43
|
| Rate for Payer: WEA Trust Commercial |
$681.25
|
| Rate for Payer: WPS Commercial |
$162.14
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$635.28 |
| Rate for Payer: Aetna Commercial |
$635.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$635.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.23
|
| Rate for Payer: Health EOS Commercial |
$608.54
|
| Rate for Payer: HFN Commercial |
$635.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: Preferred Network Access Commercial |
$635.28
|
| Rate for Payer: Quartz Beloit One Network |
$294.24
|
| Rate for Payer: Quartz Commercial |
$381.17
|
| Rate for Payer: The Alliance Commercial |
$334.36
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
XR Foreign Body Loc Eye Bilateral
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537078
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.24 |
| Max. Negotiated Rate |
$615.22 |
| Rate for Payer: Aetna Commercial |
$601.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Aetna Managed Medicare |
$187.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.42
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$615.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.23
|
| Rate for Payer: Health EOS Commercial |
$595.16
|
| Rate for Payer: HFN Commercial |
$615.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.54
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: NAPHCARE Commercial |
$401.23
|
| Rate for Payer: Preferred Network Access Commercial |
$615.22
|
| Rate for Payer: Quartz Beloit One Network |
$327.67
|
| Rate for Payer: Quartz Commercial |
$434.67
|
| Rate for Payer: Quartz Medicare Advantage |
$401.23
|
| Rate for Payer: The Alliance Commercial |
$334.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.67 |
| Max. Negotiated Rate |
$615.22 |
| Rate for Payer: Aetna Commercial |
$601.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.42
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$615.22
|
| Rate for Payer: Health EOS Commercial |
$595.16
|
| Rate for Payer: HFN Commercial |
$615.22
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: Preferred Network Access Commercial |
$615.22
|
| Rate for Payer: Quartz Beloit One Network |
$327.67
|
| Rate for Payer: Quartz Commercial |
$401.23
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.24 |
| Max. Negotiated Rate |
$615.22 |
| Rate for Payer: Aetna Commercial |
$601.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Aetna Managed Medicare |
$187.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.42
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$615.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.23
|
| Rate for Payer: Health EOS Commercial |
$595.16
|
| Rate for Payer: HFN Commercial |
$615.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.54
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: NAPHCARE Commercial |
$401.23
|
| Rate for Payer: Preferred Network Access Commercial |
$615.22
|
| Rate for Payer: Quartz Beloit One Network |
$327.67
|
| Rate for Payer: Quartz Commercial |
$434.67
|
| Rate for Payer: Quartz Medicare Advantage |
$401.23
|
| Rate for Payer: The Alliance Commercial |
$334.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
XR Foreign Body Loc Eye Left
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
CPT 70030 LT,TC
|
| Hospital Charge Code |
1537080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$635.28 |
| Rate for Payer: Aetna Commercial |
$635.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$635.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.23
|
| Rate for Payer: Health EOS Commercial |
$608.54
|
| Rate for Payer: HFN Commercial |
$635.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: Preferred Network Access Commercial |
$635.28
|
| Rate for Payer: Quartz Beloit One Network |
$294.24
|
| Rate for Payer: Quartz Commercial |
$381.17
|
| Rate for Payer: The Alliance Commercial |
$334.36
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
|
OP
|
$595.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630511
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$569.30 |
| Rate for Payer: Aetna Commercial |
$556.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.17
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.02
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$569.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$550.73
|
| Rate for Payer: HFN Commercial |
$569.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$495.04
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$569.30
|
| Rate for Payer: Quartz Beloit One Network |
$303.21
|
| Rate for Payer: Quartz Commercial |
$402.22
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$340.34
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$458.33
|
|
|
XR Foreign Body Loc Eye Left
|
Facility
|
IP
|
$595.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
630511
|
| Min. Negotiated Rate |
$303.21 |
| Max. Negotiated Rate |
$569.30 |
| Rate for Payer: Aetna Commercial |
$556.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.96
|
| Rate for Payer: Cash Price |
$178.50
|
| Rate for Payer: Cigna Commercial |
$569.30
|
| Rate for Payer: Health EOS Commercial |
$550.73
|
| Rate for Payer: HFN Commercial |
$569.30
|
| Rate for Payer: Multiplan Commercial |
$495.04
|
| Rate for Payer: Preferred Network Access Commercial |
$569.30
|
| Rate for Payer: Quartz Beloit One Network |
$303.21
|
| Rate for Payer: Quartz Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$340.34
|
| Rate for Payer: WPS Commercial |
$458.33
|
|
