|
XR Wrist 2 Views Left
|
Facility
OP
|
$494.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$138.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$321.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$237.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$296.40
|
| Rate for Payer: The Alliance Commercial |
$1,976.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
XR Wrist 2 Views Left
|
Professional
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613632
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna Commercial |
$416.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Aetna Managed Medicare |
$32.68
|
| Rate for Payer: Anthem Medicare Advantage |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.68
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$416.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.68
|
| Rate for Payer: Health EOS Commercial |
$398.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.68
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Preferred Network Access Commercial |
$416.10
|
| Rate for Payer: Quartz Beloit One Network |
$192.72
|
| Rate for Payer: Quartz Commercial |
$249.66
|
| Rate for Payer: Quartz Medicare Advantage |
$32.68
|
| Rate for Payer: The Alliance Commercial |
$124.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.68
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$163.40
|
|
|
XR Wrist 2 Views Left
|
Facility
IP
|
$494.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
XR Wrist 2 Views Right
|
Facility
OP
|
$456.00
|
|
|
Service Code
|
CPT 73100 TC,RT
|
| Hospital Charge Code |
2980001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$1,824.00 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.16
|
| Rate for Payer: Aetna Managed Medicare |
$127.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$419.52
|
| Rate for Payer: Health EOS Commercial |
$405.84
|
| Rate for Payer: HFN Commercial |
$419.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.00
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: NAPHCARE Commercial |
$273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.52
|
| Rate for Payer: Quartz Beloit One Network |
$223.44
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: Quartz Medicare Advantage |
$273.60
|
| Rate for Payer: The Alliance Commercial |
$1,824.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
XR Wrist 2 Views Right
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613634
|
| Min. Negotiated Rate |
$87.32 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.24
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.14
|
| 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 |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$402.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$389.82
|
| Rate for Payer: HFN Commercial |
$402.96
|
| 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 |
$350.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$402.96
|
| Rate for Payer: Quartz Beloit One Network |
$214.62
|
| Rate for Payer: Quartz Commercial |
$284.70
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$87.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$324.43
|
|
|
XR Wrist 2 Views Right
|
Professional
|
$494.00
|
|
|
Service Code
|
CPT 73100 RT,TC
|
| Hospital Charge Code |
1537485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.40
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: The Alliance Commercial |
$247.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
XR Wrist 2 Views Right
|
Professional
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613634
|
| Min. Negotiated Rate |
$32.68 |
| Max. Negotiated Rate |
$416.10 |
| Rate for Payer: Aetna Commercial |
$416.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.68
|
| Rate for Payer: Aetna Managed Medicare |
$32.68
|
| Rate for Payer: Anthem Medicare Advantage |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.68
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$416.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.68
|
| Rate for Payer: Health EOS Commercial |
$398.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.68
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Preferred Network Access Commercial |
$416.10
|
| Rate for Payer: Quartz Beloit One Network |
$192.72
|
| Rate for Payer: Quartz Commercial |
$249.66
|
| Rate for Payer: Quartz Medicare Advantage |
$32.68
|
| Rate for Payer: The Alliance Commercial |
$124.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.68
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$163.40
|
|
|
XR Wrist 2 Views Right
|
Facility
IP
|
$494.00
|
|
|
Service Code
|
CPT 73100 RT,TC
|
| Hospital Charge Code |
1537485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
XR Wrist 2 Views Right
|
Professional
|
$456.00
|
|
|
Service Code
|
CPT 73100 TC,RT
|
| Hospital Charge Code |
2980001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$200.64 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Aetna Commercial |
$433.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.16
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$433.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.60
|
| Rate for Payer: Health EOS Commercial |
$414.96
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Preferred Network Access Commercial |
$433.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.64
|
| Rate for Payer: Quartz Commercial |
$259.92
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
XR Wrist 2 Views Right
|
Facility
IP
|
$456.00
|
|
|
Service Code
|
CPT 73100 TC,RT
|
| Hospital Charge Code |
2980001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$419.52 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.68
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$419.52
|
| Rate for Payer: Health EOS Commercial |
$405.84
|
| Rate for Payer: HFN Commercial |
$419.52
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: NAPHCARE Commercial |
$273.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.52
|
| Rate for Payer: Quartz Beloit One Network |
$223.44
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
XR Wrist 2 Views Right
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613634
|
| Min. Negotiated Rate |
$214.62 |
| Max. Negotiated Rate |
$402.96 |
| Rate for Payer: Aetna Commercial |
$394.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.14
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$402.96
|
| Rate for Payer: Health EOS Commercial |
$389.82
|
| Rate for Payer: HFN Commercial |
$402.96
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: NAPHCARE Commercial |
$262.80
|
| Rate for Payer: Preferred Network Access Commercial |
$402.96
|
| Rate for Payer: Quartz Beloit One Network |
$214.62
|
| Rate for Payer: Quartz Commercial |
$262.80
|
| Rate for Payer: WEA Trust Commercial |
$240.90
|
| Rate for Payer: WPS Commercial |
$324.43
|
|
|
XR Wrist 2 Views Right
|
Facility
OP
|
$494.00
|
|
|
Service Code
|
CPT 73100 RT,TC
|
| Hospital Charge Code |
1537485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$138.32 |
| Max. Negotiated Rate |
$1,976.00 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$138.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$321.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$237.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$296.40
|
| Rate for Payer: The Alliance Commercial |
$1,976.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.91
|
|
|
XR Wrist Complete Bilateral
|
Facility
OP
|
$959.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611598
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.32
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| 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 |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| 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 |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$623.35
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$887.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
XR Wrist Complete Bilateral
|
Professional
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537487
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.12 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna Commercial |
$496.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$496.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.80
|
| Rate for Payer: Health EOS Commercial |
$475.93
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$496.85
|
| Rate for Payer: Quartz Beloit One Network |
$230.12
|
| Rate for Payer: Quartz Commercial |
$298.11
|
| Rate for Payer: The Alliance Commercial |
$261.50
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Wrist Complete Bilateral
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537487
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Wrist Complete Bilateral
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537487
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Wrist Complete Bilateral
|
Professional
|
$959.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611598
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$911.05 |
| Rate for Payer: Aetna Commercial |
$911.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.74
|
| Rate for Payer: Aetna Managed Medicare |
$39.45
|
| Rate for Payer: Anthem Medicare Advantage |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.45
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$911.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$479.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.45
|
| Rate for Payer: Health EOS Commercial |
$872.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.45
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$911.05
|
| Rate for Payer: Quartz Beloit One Network |
$421.96
|
| Rate for Payer: Quartz Commercial |
$546.63
|
| Rate for Payer: Quartz Medicare Advantage |
$39.45
|
| Rate for Payer: The Alliance Commercial |
$149.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.45
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$197.25
|
|
|
XR Wrist Complete Bilateral
|
Facility
IP
|
$959.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611598
|
| Min. Negotiated Rate |
$469.91 |
| Max. Negotiated Rate |
$882.28 |
| Rate for Payer: Aetna Commercial |
$863.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.27
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$882.28
|
| Rate for Payer: Health EOS Commercial |
$853.51
|
| Rate for Payer: HFN Commercial |
$882.28
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: NAPHCARE Commercial |
$575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$882.28
|
| Rate for Payer: Quartz Beloit One Network |
$469.91
|
| Rate for Payer: Quartz Commercial |
$575.40
|
| Rate for Payer: WEA Trust Commercial |
$527.45
|
| Rate for Payer: WPS Commercial |
$710.33
|
|
|
XR Wrist Complete Left
|
Professional
|
$479.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611596
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna Commercial |
$455.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$39.45
|
| Rate for Payer: Anthem Medicare Advantage |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.45
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$455.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.45
|
| Rate for Payer: Health EOS Commercial |
$435.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.45
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$455.05
|
| Rate for Payer: Quartz Beloit One Network |
$210.76
|
| Rate for Payer: Quartz Commercial |
$273.03
|
| Rate for Payer: Quartz Medicare Advantage |
$39.45
|
| Rate for Payer: The Alliance Commercial |
$149.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.45
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$197.25
|
|
|
XR Wrist Complete Left
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537489
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Wrist Complete Left
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537489
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Wrist Complete Left
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611596
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Wrist Complete Left
|
Professional
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537489
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.12 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna Commercial |
$496.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$496.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.80
|
| Rate for Payer: Health EOS Commercial |
$475.93
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$496.85
|
| Rate for Payer: Quartz Beloit One Network |
$230.12
|
| Rate for Payer: Quartz Commercial |
$298.11
|
| Rate for Payer: The Alliance Commercial |
$261.50
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Wrist Complete Left
|
Facility
OP
|
$479.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611596
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$887.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.92
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| 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 |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| 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 |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$887.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Wrist Complete Right
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 73110 TC,RT
|
| Hospital Charge Code |
2980002
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$2,092.00 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$146.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$313.80
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
