|
XR Clavicle Left
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$357.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$159.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR Clavicle Left
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536952
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Left
|
Professional
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$522.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$500.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$522.50
|
| Rate for Payer: Quartz Beloit One Network |
$242.00
|
| Rate for Payer: Quartz Commercial |
$313.50
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
XR Clavicle Right
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629754
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$357.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$159.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR Clavicle Right
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 TC,RT
|
| Hospital Charge Code |
2979991
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Right
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629754
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$330.00
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$330.00
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR Clavicle Right
|
Professional
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629754
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$522.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$500.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$522.50
|
| Rate for Payer: Quartz Beloit One Network |
$242.00
|
| Rate for Payer: Quartz Commercial |
$313.50
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
XR Clavicle Right
|
Professional
|
$560.00
|
|
|
Service Code
|
CPT 73000 TC,RT
|
| Hospital Charge Code |
2979991
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.00
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Right
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 RT,TC
|
| Hospital Charge Code |
1536954
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$156.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$364.00
|
| Rate for Payer: Quartz Medicare Advantage |
$336.00
|
| Rate for Payer: The Alliance Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Right
|
Professional
|
$560.00
|
|
|
Service Code
|
CPT 73000 RT,TC
|
| Hospital Charge Code |
1536954
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.00
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Right
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 RT,TC
|
| Hospital Charge Code |
1536954
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Right
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 TC,RT
|
| Hospital Charge Code |
2979991
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$156.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$364.00
|
| Rate for Payer: Quartz Medicare Advantage |
$336.00
|
| Rate for Payer: The Alliance Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Coccyx
|
Professional
|
$580.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
629756
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$31.41
|
| Rate for Payer: Anthem Medicare Advantage |
$31.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.41
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.41
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.41
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: Quartz Medicare Advantage |
$31.41
|
| Rate for Payer: The Alliance Commercial |
$119.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.41
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$157.05
|
|
|
XR Coccyx
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
1536956
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
XR Coccyx
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
629756
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Coccyx
|
Professional
|
$626.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
1536956
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$23.29
|
| Rate for Payer: Anthem Medicare Advantage |
$23.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.29
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.29
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.29
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: Quartz Medicare Advantage |
$23.29
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.29
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$116.45
|
|
|
XR Coccyx
|
Facility
IP
|
$626.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
1536956
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
XR Coccyx
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
629756
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$377.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$278.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$3.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Cystography
|
Professional
|
$977.00
|
|
|
Service Code
|
CPT 74430 TC
|
| Hospital Charge Code |
3072713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$928.15 |
| Rate for Payer: Aetna Commercial |
$928.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Aetna Managed Medicare |
$25.22
|
| Rate for Payer: Anthem Medicare Advantage |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.22
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$928.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$488.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.22
|
| Rate for Payer: Health EOS Commercial |
$889.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.22
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: Preferred Network Access Commercial |
$928.15
|
| Rate for Payer: Quartz Beloit One Network |
$429.88
|
| Rate for Payer: Quartz Commercial |
$556.89
|
| Rate for Payer: Quartz Medicare Advantage |
$25.22
|
| Rate for Payer: The Alliance Commercial |
$95.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.22
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$126.10
|
|
|
XR Cystography
|
Facility
IP
|
$977.00
|
|
|
Service Code
|
CPT 74430 TC
|
| Hospital Charge Code |
3072713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$898.84 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$586.20
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
XR Cystography
|
Facility
OP
|
$977.00
|
|
|
Service Code
|
CPT 74430 TC
|
| Hospital Charge Code |
3072713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.56 |
| Max. Negotiated Rate |
$3,908.00 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Aetna Managed Medicare |
$273.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.75
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$635.05
|
| Rate for Payer: Quartz Medicare Advantage |
$586.20
|
| Rate for Payer: The Alliance Commercial |
$3,908.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
XR Drainage Abscess or Cyst
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Abscess or Cyst
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Abscess or Cyst
|
Facility
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Liver
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536972
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
