|
XR Femur Right
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Professional
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.16 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Facility
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Femur Right
|
Facility
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Professional
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: The Alliance Commercial |
$267.50
|
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$508.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.00
|
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$508.25
|
| Rate for Payer: Quartz Beloit One Network |
$235.40
|
| Rate for Payer: Quartz Commercial |
$304.95
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Femur Right
|
Professional
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.16 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Finger 2nd Digit Left
|
Professional
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna Commercial |
$379.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$379.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$363.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.05
|
| Rate for Payer: Quartz Beloit One Network |
$175.56
|
| Rate for Payer: Quartz Commercial |
$227.43
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$138.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$182.45
|
|
|
XR Finger 2nd Digit Left
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F1,TC
|
| Hospital Charge Code |
1537028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 2nd Digit Left
|
Professional
|
$431.00
|
|
|
Service Code
|
CPT 73140 F1,TC
|
| Hospital Charge Code |
1537028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.64 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Aetna Commercial |
$409.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$409.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.60
|
| Rate for Payer: Health EOS Commercial |
$392.21
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$409.45
|
| Rate for Payer: Quartz Beloit One Network |
$189.64
|
| Rate for Payer: Quartz Commercial |
$245.67
|
| Rate for Payer: The Alliance Commercial |
$215.50
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 2nd Digit Left
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F1,TC
|
| Hospital Charge Code |
1537028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,724.00 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: The Alliance Commercial |
$1,724.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 2nd Digit Left
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$259.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.52
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| 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 |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| 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 |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$259.35
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$235.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
XR Finger 2nd Digit Left
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
XR Finger 2nd Digit Right
|
Professional
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630647
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna Commercial |
$379.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$379.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$363.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.05
|
| Rate for Payer: Quartz Beloit One Network |
$175.56
|
| Rate for Payer: Quartz Commercial |
$227.43
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$138.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$182.45
|
|
|
XR Finger 2nd Digit Right
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630647
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
XR Finger 2nd Digit Right
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F6,TC
|
| Hospital Charge Code |
1537030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$1,724.00 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$120.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.25
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$258.60
|
| Rate for Payer: The Alliance Commercial |
$1,724.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 2nd Digit Right
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F6,TC
|
| Hospital Charge Code |
1537030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 2nd Digit Right
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630647
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$259.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.52
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| 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 |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| 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 |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$259.35
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$235.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
XR Finger 2nd Digit Right
|
Professional
|
$431.00
|
|
|
Service Code
|
CPT 73140 F6,TC
|
| Hospital Charge Code |
1537030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.64 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Aetna Commercial |
$409.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$409.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.60
|
| Rate for Payer: Health EOS Commercial |
$392.21
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$409.45
|
| Rate for Payer: Quartz Beloit One Network |
$189.64
|
| Rate for Payer: Quartz Commercial |
$245.67
|
| Rate for Payer: The Alliance Commercial |
$215.50
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 3rd Digit Left
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630641
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$259.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.52
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| 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 |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| 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 |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$259.35
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$235.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
XR Finger 3rd Digit Left
|
Professional
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630641
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$379.05 |
| Rate for Payer: Aetna Commercial |
$379.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$379.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$363.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.05
|
| Rate for Payer: Quartz Beloit One Network |
$175.56
|
| Rate for Payer: Quartz Commercial |
$227.43
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$138.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$182.45
|
|
|
XR Finger 3rd Digit Left
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F2,TC
|
| Hospital Charge Code |
1537032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
XR Finger 3rd Digit Left
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630641
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
