|
XR Fluoro Guided Midline
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Aetna Managed Medicare |
$315.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$731.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$540.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.72
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.96
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: NAPHCARE Commercial |
$675.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$731.43
|
| Rate for Payer: Quartz Medicare Advantage |
$675.17
|
| Rate for Payer: The Alliance Commercial |
$321.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
|
XR Fluoro Guided Midline
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$551.39 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$675.17
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630583
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,303.17 |
| Rate for Payer: Aetna Commercial |
$1,303.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.71
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,303.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$685.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,248.30
|
| Rate for Payer: HFN Commercial |
$1,303.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$1,097.41
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,303.17
|
| Rate for Payer: Quartz Beloit One Network |
$603.57
|
| Rate for Payer: Quartz Commercial |
$781.90
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$754.47
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630583
|
| Min. Negotiated Rate |
$672.16 |
| Max. Negotiated Rate |
$1,262.02 |
| Rate for Payer: Aetna Commercial |
$1,234.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.03
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,262.02
|
| Rate for Payer: Health EOS Commercial |
$1,220.87
|
| Rate for Payer: HFN Commercial |
$1,262.02
|
| Rate for Payer: Multiplan Commercial |
$1,097.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.02
|
| Rate for Payer: Quartz Beloit One Network |
$672.16
|
| Rate for Payer: Quartz Commercial |
$823.06
|
| Rate for Payer: WEA Trust Commercial |
$754.47
|
| Rate for Payer: WPS Commercial |
$1,016.03
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630583
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,262.02 |
| Rate for Payer: Aetna Commercial |
$1,234.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,179.71
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$891.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$685.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$658.44
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$727.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,262.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$767.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,220.87
|
| Rate for Payer: HFN Commercial |
$1,262.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,097.41
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,262.02
|
| Rate for Payer: Quartz Beloit One Network |
$672.16
|
| Rate for Payer: Quartz Commercial |
$891.64
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$754.47
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,016.03
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,004.39 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,007.76 |
| Rate for Payer: Aetna Commercial |
$1,007.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$1,007.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$965.33
|
| Rate for Payer: HFN Commercial |
$1,007.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.75
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630569
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$969.23 |
| Rate for Payer: Aetna Commercial |
$969.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.41
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$969.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$510.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$928.42
|
| Rate for Payer: HFN Commercial |
$969.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$816.19
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$969.23
|
| Rate for Payer: Quartz Beloit One Network |
$448.91
|
| Rate for Payer: Quartz Commercial |
$581.54
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$561.13
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630569
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,004.39 |
| Rate for Payer: Aetna Commercial |
$918.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.41
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.72
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$938.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$908.01
|
| Rate for Payer: HFN Commercial |
$938.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$816.19
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$938.62
|
| Rate for Payer: Quartz Beloit One Network |
$499.92
|
| Rate for Payer: Quartz Commercial |
$663.16
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$561.13
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$755.66
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630569
|
| Min. Negotiated Rate |
$499.92 |
| Max. Negotiated Rate |
$938.62 |
| Rate for Payer: Aetna Commercial |
$918.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.73
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$938.62
|
| Rate for Payer: Health EOS Commercial |
$908.01
|
| Rate for Payer: HFN Commercial |
$938.62
|
| Rate for Payer: Multiplan Commercial |
$816.19
|
| Rate for Payer: Preferred Network Access Commercial |
$938.62
|
| Rate for Payer: Quartz Beloit One Network |
$499.92
|
| Rate for Payer: Quartz Commercial |
$612.14
|
| Rate for Payer: WEA Trust Commercial |
$561.13
|
| Rate for Payer: WPS Commercial |
$755.66
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$303.26
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Aetna Managed Medicare |
$141.52
|
| 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 |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.85
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.08
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: NAPHCARE Commercial |
$303.26
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$328.54
|
| Rate for Payer: Quartz Medicare Advantage |
$303.26
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$890.19 |
| Rate for Payer: Aetna Commercial |
$890.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$28.40
|
| Rate for Payer: Anthem Medicare Advantage |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.40
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$890.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$468.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.40
|
| Rate for Payer: Health EOS Commercial |
$852.71
|
| Rate for Payer: HFN Commercial |
$890.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| Rate for Payer: Preferred Network Access Commercial |
$890.19
|
| Rate for Payer: Quartz Beloit One Network |
$412.30
|
| Rate for Payer: Quartz Commercial |
$534.11
|
| Rate for Payer: Quartz Medicare Advantage |
$28.40
|
| Rate for Payer: The Alliance Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.40
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$142.01
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| 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 |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| 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 |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| 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 |
$515.37
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$480.17 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.26
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Left
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
XR Foot 2 Views Left
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$303.26
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$28.40
|
| Rate for Payer: Anthem Medicare Advantage |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.40
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$444.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.40
|
| Rate for Payer: Health EOS Commercial |
$425.88
|
| Rate for Payer: HFN Commercial |
$444.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| Rate for Payer: Preferred Network Access Commercial |
$444.60
|
| Rate for Payer: Quartz Beloit One Network |
$205.92
|
| Rate for Payer: Quartz Commercial |
$266.76
|
| Rate for Payer: Quartz Medicare Advantage |
$28.40
|
| Rate for Payer: The Alliance Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.40
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$142.01
|
|
|
XR Foot 2 Views Left
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| 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 |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| 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 |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| 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 |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$480.17 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.26
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
