|
XR PleurX Placement Lung Left
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
XR PleurX Placement Lung Left
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,223.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.00
|
| Rate for Payer: Health EOS Commercial |
$2,129.40
|
| Rate for Payer: HFN Commercial |
$2,223.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.60
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: The Alliance Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
XR PleurX Placement Lung Right
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$2,275.36 |
| Rate for Payer: Aetna Commercial |
$2,275.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,275.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,197.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,437.07
|
| Rate for Payer: Health EOS Commercial |
$2,179.56
|
| Rate for Payer: HFN Commercial |
$2,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,365.22
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR PleurX Placement Lung Right
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR PleurX Placement Lung Right
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Pleurx Removal
|
Facility
|
OP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$2,205.42 |
| Rate for Payer: Aetna Commercial |
$2,157.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.59
|
| 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 |
$1,270.52
|
| 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 |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,205.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,341.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$2,133.51
|
| Rate for Payer: HFN Commercial |
$2,205.42
|
| 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 |
$1,917.76
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.63
|
| Rate for Payer: Quartz Commercial |
$1,558.18
|
| 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 |
$1,318.46
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,775.54
|
|
|
XR Pleurx Removal
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$2,277.34 |
| Rate for Payer: Aetna Commercial |
$2,277.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.59
|
| 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 |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,277.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,198.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$2,181.45
|
| Rate for Payer: HFN Commercial |
$2,277.34
|
| 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 |
$1,917.76
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.77
|
| Rate for Payer: Quartz Commercial |
$1,366.40
|
| 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 |
$1,318.46
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Pleurx Removal
|
Facility
|
IP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,174.63 |
| Max. Negotiated Rate |
$2,205.42 |
| Rate for Payer: Aetna Commercial |
$2,157.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,270.52
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,205.42
|
| Rate for Payer: Health EOS Commercial |
$2,133.51
|
| Rate for Payer: HFN Commercial |
$2,205.42
|
| Rate for Payer: Multiplan Commercial |
$1,917.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.63
|
| Rate for Payer: Quartz Commercial |
$1,438.32
|
| Rate for Payer: WEA Trust Commercial |
$1,318.46
|
| Rate for Payer: WPS Commercial |
$1,775.54
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$145.31
|
| 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 |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.42
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.22
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$311.38
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$337.32
|
| Rate for Payer: Quartz Medicare Advantage |
$311.38
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$490.24 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.23
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| 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 |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| 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 |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$650.31
|
| 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 |
$550.26
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$950.46 |
| Rate for Payer: Aetna Commercial |
$950.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$950.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$910.44
|
| Rate for Payer: HFN Commercial |
$950.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$950.46
|
| Rate for Payer: Quartz Beloit One Network |
$440.21
|
| Rate for Payer: Quartz Commercial |
$570.27
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.38
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$145.31
|
| 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 |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.42
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.22
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$311.38
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$337.32
|
| Rate for Payer: Quartz Medicare Advantage |
$311.38
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Left
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.38
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Left
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448822
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$474.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$474.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$454.27
|
| Rate for Payer: HFN Commercial |
$474.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$474.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.65
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448822
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
XR Pod Ankle 2 Views Left
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448822
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.62
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| 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 |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| 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 |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$324.48
|
| 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 |
$274.56
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
|
XR Pod Ankle 2 Views Right
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
2587259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$511.78 |
| Rate for Payer: Aetna Commercial |
$511.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$511.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.23
|
| Rate for Payer: Health EOS Commercial |
$490.24
|
| Rate for Payer: HFN Commercial |
$511.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$511.78
|
| Rate for Payer: Quartz Beloit One Network |
$237.04
|
| Rate for Payer: Quartz Commercial |
$307.07
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Pod Ankle 2 Views Right
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448823
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$474.24 |
| Rate for Payer: Aetna Commercial |
$474.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$474.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$454.27
|
| Rate for Payer: HFN Commercial |
$474.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$474.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.65
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
2587259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$150.84
|
| 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 |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.04
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$323.23
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$323.23
|
| Rate for Payer: The Alliance Commercial |
$269.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
XR Pod Ankle 2 Views Right
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,RT
|
| Hospital Charge Code |
2980062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.38
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Pod Ankle 2 Views Right
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448823
|
| Min. Negotiated Rate |
$244.61 |
| Max. Negotiated Rate |
$459.26 |
| Rate for Payer: Aetna Commercial |
$449.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$459.26
|
| Rate for Payer: Health EOS Commercial |
$444.29
|
| Rate for Payer: HFN Commercial |
$459.26
|
| Rate for Payer: Multiplan Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$459.26
|
| Rate for Payer: Quartz Beloit One Network |
$244.61
|
| Rate for Payer: Quartz Commercial |
$299.52
|
| Rate for Payer: WEA Trust Commercial |
$274.56
|
| Rate for Payer: WPS Commercial |
$369.74
|
|
