|
XR Scapula Right
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630162
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Sella Turcica
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1537282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
XR Sella Turcica
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1537282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| 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: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| 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 |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| 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 |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| 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: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
XR Sella Turcica
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
630156
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$31.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.77
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.77
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.77
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$47.66
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$31.77
|
| Rate for Payer: The Alliance Commercial |
$120.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.77
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$158.86
|
|
|
XR Sella Turcica
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
1537282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$431.76 |
| Rate for Payer: Aetna Commercial |
$431.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$31.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.77
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$431.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.77
|
| Rate for Payer: Health EOS Commercial |
$413.58
|
| Rate for Payer: HFN Commercial |
$431.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.77
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$47.66
|
| Rate for Payer: Preferred Network Access Commercial |
$431.76
|
| Rate for Payer: Quartz Beloit One Network |
$199.97
|
| Rate for Payer: Quartz Commercial |
$259.05
|
| Rate for Payer: Quartz Medicare Advantage |
$31.77
|
| Rate for Payer: The Alliance Commercial |
$120.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.77
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$158.86
|
|
|
XR Sella Turcica
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
630156
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$283.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$209.66
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| 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 |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| 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 |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$283.92
|
| 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 |
$240.24
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
XR Sella Turcica
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
630156
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$262.08
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
XR Shoulder 1 View Bilateral
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
CPT 73020 LT,TC
|
| Hospital Charge Code |
1537284
|
|
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 Bilateral
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630150
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| 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 |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| 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 |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| 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 |
$548.55
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
XR Shoulder 1 View Bilateral
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630150
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
XR Shoulder 1 View Bilateral
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
630150
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$947.49 |
| Rate for Payer: Aetna Commercial |
$947.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| 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 |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$947.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$498.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.39
|
| Rate for Payer: Health EOS Commercial |
$907.60
|
| Rate for Payer: HFN Commercial |
$947.49
|
| 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 |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$32.09
|
| Rate for Payer: Preferred Network Access Commercial |
$947.49
|
| Rate for Payer: Quartz Beloit One Network |
$438.84
|
| Rate for Payer: Quartz Commercial |
$568.50
|
| 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 |
$548.55
|
| Rate for Payer: WPS Commercial |
$106.96
|
|
|
XR Shoulder 1 View Bilateral
|
Facility
|
OP
|
$498.00
|
|
|
Service Code
|
CPT 73020 LT,TC
|
| Hospital Charge Code |
1537284
|
|
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 Bilateral
|
Facility
|
IP
|
$498.00
|
|
|
Service Code
|
CPT 73020 LT,TC
|
| Hospital Charge Code |
1537284
|
|
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 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
|
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
|
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 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
|
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
|
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 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
|
$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 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
|
$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
|
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
|
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
|
|
