|
XR Shoulder 1 View Left
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630146
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.12
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| 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 |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| 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 |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| 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 |
$273.99
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Shoulder 1 View Left
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630146
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$21.39
|
| Rate for Payer: Anthem Medicare Advantage |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.39
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.39
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.39
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$32.09
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: Quartz Medicare Advantage |
$21.39
|
| Rate for Payer: The Alliance Commercial |
$81.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.39
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$106.96
|
|
|
XR Shoulder 1 View Left
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 73020 LT,TC
|
| Hospital Charge Code |
1537286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$435.71 |
| Rate for Payer: Aetna Commercial |
$435.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.43
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$435.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.18
|
| Rate for Payer: Health EOS Commercial |
$417.36
|
| Rate for Payer: HFN Commercial |
$435.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.48
|
| Rate for Payer: Multiplan Commercial |
$366.91
|
| Rate for Payer: Preferred Network Access Commercial |
$435.71
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$261.42
|
| Rate for Payer: The Alliance Commercial |
$229.32
|
| Rate for Payer: WEA Trust Commercial |
$252.25
|
| Rate for Payer: WPS Commercial |
$339.70
|
|
|
XR Shoulder 1 View Left
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630146
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Shoulder 1 View Left
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 73020 LT,TC
|
| Hospital Charge Code |
1537286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.73 |
| Max. Negotiated Rate |
$421.95 |
| Rate for Payer: Aetna Commercial |
$412.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.08
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$421.95
|
| Rate for Payer: Health EOS Commercial |
$408.19
|
| Rate for Payer: HFN Commercial |
$421.95
|
| Rate for Payer: Multiplan Commercial |
$366.91
|
| Rate for Payer: Preferred Network Access Commercial |
$421.95
|
| Rate for Payer: Quartz Beloit One Network |
$224.73
|
| Rate for Payer: Quartz Commercial |
$275.18
|
| Rate for Payer: WEA Trust Commercial |
$252.25
|
| Rate for Payer: WPS Commercial |
$339.70
|
|
|
XR Shoulder 1 View Left
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 73020 LT,TC
|
| Hospital Charge Code |
1537286
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.42 |
| Max. Negotiated Rate |
$421.95 |
| Rate for Payer: Aetna Commercial |
$412.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.43
|
| Rate for Payer: Aetna Managed Medicare |
$128.42
|
| 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 |
$243.08
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$421.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.66
|
| Rate for Payer: Health EOS Commercial |
$408.19
|
| Rate for Payer: HFN Commercial |
$421.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.98
|
| Rate for Payer: Multiplan Commercial |
$366.91
|
| Rate for Payer: NAPHCARE Commercial |
$275.18
|
| Rate for Payer: Preferred Network Access Commercial |
$421.95
|
| Rate for Payer: Quartz Beloit One Network |
$224.73
|
| Rate for Payer: Quartz Commercial |
$298.12
|
| Rate for Payer: Quartz Medicare Advantage |
$275.18
|
| Rate for Payer: The Alliance Commercial |
$229.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$252.25
|
| Rate for Payer: WPS Commercial |
$339.70
|
|
|
XR Shoulder 1 View Right
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630142
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Shoulder 1 View Right
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630142
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$21.39
|
| Rate for Payer: Anthem Medicare Advantage |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.39
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.39
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.39
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$32.09
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: Quartz Medicare Advantage |
$21.39
|
| Rate for Payer: The Alliance Commercial |
$81.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.39
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$106.96
|
|
|
XR Shoulder 1 View Right
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
CPT 73020 TC,RT
|
| Hospital Charge Code |
2979993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$492.02 |
| Rate for Payer: Aetna Commercial |
$492.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.41
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$492.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.75
|
| Rate for Payer: Health EOS Commercial |
$471.31
|
| Rate for Payer: HFN Commercial |
$492.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.48
|
| Rate for Payer: Multiplan Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$492.02
|
| Rate for Payer: Quartz Beloit One Network |
$227.88
|
| Rate for Payer: Quartz Commercial |
$295.21
|
| Rate for Payer: The Alliance Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$284.86
|
| Rate for Payer: WPS Commercial |
$383.61
|
|
|
XR Shoulder 1 View Right
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 73020 RT,TC
|
| Hospital Charge Code |
1537288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$435.71 |
| Rate for Payer: Aetna Commercial |
$435.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.43
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$435.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.18
|
| Rate for Payer: Health EOS Commercial |
$417.36
|
| Rate for Payer: HFN Commercial |
$435.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.48
|
| Rate for Payer: Multiplan Commercial |
$366.91
|
| Rate for Payer: Preferred Network Access Commercial |
$435.71
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$261.42
|
| Rate for Payer: The Alliance Commercial |
$229.32
|
| Rate for Payer: WEA Trust Commercial |
$252.25
|
| Rate for Payer: WPS Commercial |
$339.70
|
|
|
XR Shoulder 1 View Right
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 73020 TC,RT
|
| Hospital Charge Code |
2979993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.78 |
| Max. Negotiated Rate |
$476.49 |
| Rate for Payer: Aetna Commercial |
$466.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.50
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$476.49
|
| Rate for Payer: Health EOS Commercial |
$460.95
|
| Rate for Payer: HFN Commercial |
$476.49
|
| Rate for Payer: Multiplan Commercial |
$414.34
|
| Rate for Payer: Preferred Network Access Commercial |
$476.49
|
| Rate for Payer: Quartz Beloit One Network |
$253.78
|
| Rate for Payer: Quartz Commercial |
$310.75
|
| Rate for Payer: WEA Trust Commercial |
$284.86
|
| Rate for Payer: WPS Commercial |
$383.61
|
|
|
XR Shoulder 1 View Right
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 73020 TC,RT
|
| Hospital Charge Code |
2979993
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.02 |
| Max. Negotiated Rate |
$476.49 |
| Rate for Payer: Aetna Commercial |
$466.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.41
|
| Rate for Payer: Aetna Managed Medicare |
$145.02
|
| 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 |
$274.50
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna Commercial |
$476.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.84
|
| Rate for Payer: Health EOS Commercial |
$460.95
|
| Rate for Payer: HFN Commercial |
$476.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.44
|
| Rate for Payer: Multiplan Commercial |
$414.34
|
| Rate for Payer: NAPHCARE Commercial |
$310.75
|
| Rate for Payer: Preferred Network Access Commercial |
$476.49
|
| Rate for Payer: Quartz Beloit One Network |
$253.78
|
| Rate for Payer: Quartz Commercial |
$336.65
|
| Rate for Payer: Quartz Medicare Advantage |
$310.75
|
| Rate for Payer: The Alliance Commercial |
$258.96
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$284.86
|
| Rate for Payer: WPS Commercial |
$383.61
|
|
|
XR Shoulder 1 View Right
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 73020 RT,TC
|
| Hospital Charge Code |
1537288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.73 |
| Max. Negotiated Rate |
$421.95 |
| Rate for Payer: Aetna Commercial |
$412.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.08
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$421.95
|
| Rate for Payer: Health EOS Commercial |
$408.19
|
| Rate for Payer: HFN Commercial |
$421.95
|
| Rate for Payer: Multiplan Commercial |
$366.91
|
| Rate for Payer: Preferred Network Access Commercial |
$421.95
|
| Rate for Payer: Quartz Beloit One Network |
$224.73
|
| Rate for Payer: Quartz Commercial |
$275.18
|
| Rate for Payer: WEA Trust Commercial |
$252.25
|
| Rate for Payer: WPS Commercial |
$339.70
|
|
|
XR Shoulder 1 View Right
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630142
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.12
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| 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 |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| 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 |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| 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 |
$273.99
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Shoulder 1 View Right
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 73020 RT,TC
|
| Hospital Charge Code |
1537288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.42 |
| Max. Negotiated Rate |
$421.95 |
| Rate for Payer: Aetna Commercial |
$412.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$394.43
|
| Rate for Payer: Aetna Managed Medicare |
$128.42
|
| 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 |
$243.08
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$421.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.66
|
| Rate for Payer: Health EOS Commercial |
$408.19
|
| Rate for Payer: HFN Commercial |
$421.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.98
|
| Rate for Payer: Multiplan Commercial |
$366.91
|
| Rate for Payer: NAPHCARE Commercial |
$275.18
|
| Rate for Payer: Preferred Network Access Commercial |
$421.95
|
| Rate for Payer: Quartz Beloit One Network |
$224.73
|
| Rate for Payer: Quartz Commercial |
$298.12
|
| Rate for Payer: Quartz Medicare Advantage |
$275.18
|
| Rate for Payer: The Alliance Commercial |
$229.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$252.25
|
| Rate for Payer: WPS Commercial |
$339.70
|
|
|
XR Shoulder Complete Bilateral
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537290
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.94 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$418.70
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
XR Shoulder Complete Bilateral
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630130
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| 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 |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| 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 |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| 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 |
$710.42
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
XR Shoulder Complete Bilateral
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630130
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$1,227.10 |
| Rate for Payer: Aetna Commercial |
$1,227.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$35.42
|
| Rate for Payer: Anthem Medicare Advantage |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.42
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,227.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.42
|
| Rate for Payer: Health EOS Commercial |
$1,175.43
|
| Rate for Payer: HFN Commercial |
$1,227.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.42
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$53.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.10
|
| Rate for Payer: Quartz Beloit One Network |
$568.34
|
| Rate for Payer: Quartz Commercial |
$736.26
|
| Rate for Payer: Quartz Medicare Advantage |
$35.42
|
| Rate for Payer: The Alliance Commercial |
$134.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.42
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$177.11
|
|
|
XR Shoulder Complete Bilateral
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630130
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
XR Shoulder Complete Bilateral
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537290
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$662.95 |
| Rate for Payer: Aetna Commercial |
$662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$348.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.70
|
| Rate for Payer: Health EOS Commercial |
$635.03
|
| Rate for Payer: HFN Commercial |
$662.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.34
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$662.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.05
|
| Rate for Payer: Quartz Commercial |
$397.77
|
| Rate for Payer: The Alliance Commercial |
$348.92
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
XR Shoulder Complete Bilateral
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537290
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.40 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Aetna Managed Medicare |
$195.40
|
| 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 |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.52
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.38
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$453.60
|
| Rate for Payer: Quartz Medicare Advantage |
$418.70
|
| Rate for Payer: The Alliance Commercial |
$348.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
XR Shoulder Complete Left
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537292
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.94 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$418.70
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
XR Shoulder Complete Left
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630126
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.00
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| 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 |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| 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 |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$419.80
|
| 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 |
$355.21
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
XR Shoulder Complete Left
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630126
|
| Min. Negotiated Rate |
$316.46 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| Rate for Payer: Health EOS Commercial |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$387.50
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
XR Shoulder Complete Left
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537292
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.40 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Aetna Managed Medicare |
$195.40
|
| 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 |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.52
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.38
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$453.60
|
| Rate for Payer: Quartz Medicare Advantage |
$418.70
|
| Rate for Payer: The Alliance Commercial |
$348.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
