|
XR Wrist 2 Views Left
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.74 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
XR Wrist 2 Views Left
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613632
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$419.08 |
| Rate for Payer: Aetna Commercial |
$409.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.65
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.43
|
| 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 |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$419.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$405.41
|
| Rate for Payer: HFN Commercial |
$419.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$419.08
|
| Rate for Payer: Quartz Beloit One Network |
$223.20
|
| Rate for Payer: Quartz Commercial |
$296.09
|
| 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 |
$250.54
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$337.39
|
|
|
XR Wrist 2 Views Left
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613632
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$419.08 |
| Rate for Payer: Aetna Commercial |
$409.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.43
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$419.08
|
| Rate for Payer: Health EOS Commercial |
$405.41
|
| Rate for Payer: HFN Commercial |
$419.08
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: Preferred Network Access Commercial |
$419.08
|
| Rate for Payer: Quartz Beloit One Network |
$223.20
|
| Rate for Payer: Quartz Commercial |
$273.31
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$337.39
|
|
|
XR Wrist 2 Views Left
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613632
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$432.74 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$432.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$414.52
|
| Rate for Payer: HFN Commercial |
$432.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$432.74
|
| Rate for Payer: Quartz Beloit One Network |
$200.43
|
| Rate for Payer: Quartz Commercial |
$259.65
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
XR Wrist 2 Views Left
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.05 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Aetna Commercial |
$488.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$488.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.26
|
| Rate for Payer: Health EOS Commercial |
$467.52
|
| Rate for Payer: HFN Commercial |
$488.07
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$488.07
|
| Rate for Payer: Quartz Beloit One Network |
$226.05
|
| Rate for Payer: Quartz Commercial |
$292.84
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
XR Wrist 2 Views Right
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
CPT 73100 TC,RT
|
| Hospital Charge Code |
2980001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$450.53 |
| Rate for Payer: Aetna Commercial |
$450.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$450.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.54
|
| Rate for Payer: Health EOS Commercial |
$431.56
|
| Rate for Payer: HFN Commercial |
$450.53
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$450.53
|
| Rate for Payer: Quartz Beloit One Network |
$208.67
|
| Rate for Payer: Quartz Commercial |
$270.32
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
XR Wrist 2 Views Right
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 73100 RT,TC
|
| Hospital Charge Code |
1537485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.85 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Aetna Managed Medicare |
$143.85
|
| 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 |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.51
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.32
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: NAPHCARE Commercial |
$308.26
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$333.94
|
| Rate for Payer: Quartz Medicare Advantage |
$308.26
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
XR Wrist 2 Views Right
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 73100 RT,TC
|
| Hospital Charge Code |
1537485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.74 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
XR Wrist 2 Views Right
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 73100 TC,RT
|
| Hospital Charge Code |
2980001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
XR Wrist 2 Views Right
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 73100 TC,RT
|
| Hospital Charge Code |
2980001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Aetna Managed Medicare |
$132.79
|
| 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 |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.39
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.68
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: NAPHCARE Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: Quartz Medicare Advantage |
$284.54
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
XR Wrist 2 Views Right
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613634
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$419.08 |
| Rate for Payer: Aetna Commercial |
$409.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.43
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$419.08
|
| Rate for Payer: Health EOS Commercial |
$405.41
|
| Rate for Payer: HFN Commercial |
$419.08
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: Preferred Network Access Commercial |
$419.08
|
| Rate for Payer: Quartz Beloit One Network |
$223.20
|
| Rate for Payer: Quartz Commercial |
$273.31
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$337.39
|
|
|
XR Wrist 2 Views Right
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613634
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$432.74 |
| Rate for Payer: Aetna Commercial |
$432.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$432.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$414.52
|
| Rate for Payer: HFN Commercial |
$432.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$432.74
|
| Rate for Payer: Quartz Beloit One Network |
$200.43
|
| Rate for Payer: Quartz Commercial |
$259.65
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$250.54
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
XR Wrist 2 Views Right
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613634
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$419.08 |
| Rate for Payer: Aetna Commercial |
$409.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$391.75
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$296.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.65
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$241.43
|
| 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 |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna Commercial |
$419.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$405.41
|
| Rate for Payer: HFN Commercial |
$419.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$364.42
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$419.08
|
| Rate for Payer: Quartz Beloit One Network |
$223.20
|
| Rate for Payer: Quartz Commercial |
$296.09
|
| 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 |
$250.54
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$337.39
|
|
|
XR Wrist 2 Views Right
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 73100 RT,TC
|
| Hospital Charge Code |
1537485
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.05 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Aetna Commercial |
$488.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$488.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.26
|
| Rate for Payer: Health EOS Commercial |
$467.52
|
| Rate for Payer: HFN Commercial |
$488.07
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$488.07
|
| Rate for Payer: Quartz Beloit One Network |
$226.05
|
| Rate for Payer: Quartz Commercial |
$292.84
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
XR Wrist Complete Bilateral
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611598
|
| 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 Wrist Complete Bilateral
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611598
|
| 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 Wrist Complete Bilateral
|
Professional
|
Both
|
$959.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611598
|
| Min. Negotiated Rate |
$42.39 |
| 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 |
$42.39
|
| Rate for Payer: Anthem Medicare Advantage |
$42.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.39
|
| 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 |
$42.39
|
| Rate for Payer: Health EOS Commercial |
$907.60
|
| Rate for Payer: HFN Commercial |
$947.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.39
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$63.59
|
| 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 |
$42.39
|
| Rate for Payer: The Alliance Commercial |
$161.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.39
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$211.95
|
|
|
XR Wrist Complete Bilateral
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537487
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.32 |
| Max. Negotiated Rate |
$516.72 |
| Rate for Payer: Aetna Commercial |
$516.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$516.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.35
|
| Rate for Payer: Health EOS Commercial |
$494.97
|
| Rate for Payer: HFN Commercial |
$516.72
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$516.72
|
| Rate for Payer: Quartz Beloit One Network |
$239.32
|
| Rate for Payer: Quartz Commercial |
$310.03
|
| Rate for Payer: The Alliance Commercial |
$271.96
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Wrist Complete Bilateral
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537487
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$152.30
|
| 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 |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.39
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.94
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$326.35
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$353.55
|
| Rate for Payer: Quartz Medicare Advantage |
$326.35
|
| Rate for Payer: The Alliance Commercial |
$271.96
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Wrist Complete Bilateral
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537487
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$326.35
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Wrist Complete Left
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537489
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$152.30
|
| 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 |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.39
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.94
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$326.35
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$353.55
|
| Rate for Payer: Quartz Medicare Advantage |
$326.35
|
| Rate for Payer: The Alliance Commercial |
$271.96
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Wrist Complete Left
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537489
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$326.35
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Wrist Complete Left
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 73110 LT,TC
|
| Hospital Charge Code |
1537489
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.32 |
| Max. Negotiated Rate |
$516.72 |
| Rate for Payer: Aetna Commercial |
$516.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$516.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.35
|
| Rate for Payer: Health EOS Commercial |
$494.97
|
| Rate for Payer: HFN Commercial |
$516.72
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$516.72
|
| Rate for Payer: Quartz Beloit One Network |
$239.32
|
| Rate for Payer: Quartz Commercial |
$310.03
|
| Rate for Payer: The Alliance Commercial |
$271.96
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Wrist Complete Left
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611596
|
| Min. Negotiated Rate |
$42.39 |
| 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 |
$42.39
|
| Rate for Payer: Anthem Medicare Advantage |
$42.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.39
|
| 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 |
$42.39
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.39
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$63.59
|
| 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 |
$42.39
|
| Rate for Payer: The Alliance Commercial |
$161.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.39
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$211.95
|
|
|
XR Wrist Complete Left
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
611596
|
| 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
|
|
