|
XR Finger 5th Digit Left
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F4,TC
|
| Hospital Charge Code |
1537040
|
|
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 5th Digit Right
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F9,TC
|
| Hospital Charge Code |
1537042
|
|
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 5th Digit Right
|
Professional
|
$431.00
|
|
|
Service Code
|
CPT 73140 F9,TC
|
| Hospital Charge Code |
1537042
|
|
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 5th Digit Right
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630609
|
| 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 5th Digit Right
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F9,TC
|
| Hospital Charge Code |
1537042
|
|
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 5th Digit Right
|
Professional
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630609
|
| 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 5th Digit Right
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630609
|
| 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 Thumb Left
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 FA,TC
|
| Hospital Charge Code |
1537044
|
|
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 Thumb Left
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 FA,TC
|
| Hospital Charge Code |
1537044
|
|
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 Thumb Left
|
Professional
|
$431.00
|
|
|
Service Code
|
CPT 73140 FA,TC
|
| Hospital Charge Code |
1537044
|
|
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 Thumb Left
|
Professional
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630603
|
| 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 Thumb Left
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630603
|
| 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 Thumb Left
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630603
|
| 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 Thumb Right
|
Facility
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F5,TC
|
| Hospital Charge Code |
1537046
|
|
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 Thumb Right
|
Facility
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630599
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Cash Price |
$119.70
|
| 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: 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 Thumb Right
|
Professional
|
$431.00
|
|
|
Service Code
|
CPT 73140 F5,TC
|
| Hospital Charge Code |
1537046
|
|
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 Thumb Right
|
Professional
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630599
|
| 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 Thumb Right
|
Facility
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F5,TC
|
| Hospital Charge Code |
1537046
|
|
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 Thumb Right
|
Facility
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630599
|
| 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 Fluoro Guidance Needle Loc Spine
|
Facility
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
630591
|
| Min. Negotiated Rate |
$336.28 |
| Max. Negotiated Rate |
$1,104.92 |
| Rate for Payer: Aetna Commercial |
$1,080.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.86
|
| Rate for Payer: Aetna Managed Medicare |
$336.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$780.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$600.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$576.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.53
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cigna Commercial |
$1,104.92
|
| Rate for Payer: Health EOS Commercial |
$1,068.89
|
| Rate for Payer: HFN Commercial |
$1,104.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.75
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: NAPHCARE Commercial |
$720.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.92
|
| Rate for Payer: Quartz Beloit One Network |
$588.49
|
| Rate for Payer: Quartz Commercial |
$780.65
|
| Rate for Payer: Quartz Medicare Advantage |
$720.60
|
| Rate for Payer: The Alliance Commercial |
$905.12
|
| Rate for Payer: WEA Trust Commercial |
$660.55
|
| Rate for Payer: WPS Commercial |
$889.58
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
630591
|
| Min. Negotiated Rate |
$588.49 |
| Max. Negotiated Rate |
$1,104.92 |
| Rate for Payer: Aetna Commercial |
$1,080.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.53
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cigna Commercial |
$1,104.92
|
| Rate for Payer: Health EOS Commercial |
$1,068.89
|
| Rate for Payer: HFN Commercial |
$1,104.92
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: NAPHCARE Commercial |
$720.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.92
|
| Rate for Payer: Quartz Beloit One Network |
$588.49
|
| Rate for Payer: Quartz Commercial |
$720.60
|
| Rate for Payer: WEA Trust Commercial |
$660.55
|
| Rate for Payer: WPS Commercial |
$889.58
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Professional
|
$1,201.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
630591
|
| Min. Negotiated Rate |
$102.31 |
| Max. Negotiated Rate |
$1,140.95 |
| Rate for Payer: Aetna Commercial |
$1,140.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.86
|
| Rate for Payer: Aetna Managed Medicare |
$102.31
|
| Rate for Payer: Anthem Medicare Advantage |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.31
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cigna Commercial |
$1,140.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.31
|
| Rate for Payer: Health EOS Commercial |
$1,092.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$356.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.31
|
| Rate for Payer: Multiplan Commercial |
$960.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.95
|
| Rate for Payer: Quartz Beloit One Network |
$528.44
|
| Rate for Payer: Quartz Commercial |
$684.57
|
| Rate for Payer: Quartz Medicare Advantage |
$102.31
|
| Rate for Payer: The Alliance Commercial |
$388.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.31
|
| Rate for Payer: WEA Trust Commercial |
$660.55
|
| Rate for Payer: WPS Commercial |
$511.55
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
630586
|
| Min. Negotiated Rate |
$293.44 |
| Max. Negotiated Rate |
$2,397.36 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.28
|
| Rate for Payer: Aetna Managed Medicare |
$293.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$524.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$503.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.44
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$964.16
|
| Rate for Payer: Health EOS Commercial |
$932.72
|
| Rate for Payer: HFN Commercial |
$964.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$786.00
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: NAPHCARE Commercial |
$628.80
|
| Rate for Payer: Preferred Network Access Commercial |
$964.16
|
| Rate for Payer: Quartz Beloit One Network |
$513.52
|
| Rate for Payer: Quartz Commercial |
$681.20
|
| Rate for Payer: Quartz Medicare Advantage |
$628.80
|
| Rate for Payer: The Alliance Commercial |
$2,397.36
|
| Rate for Payer: WEA Trust Commercial |
$576.40
|
| Rate for Payer: WPS Commercial |
$776.25
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
1537052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$2,397.36 |
| Rate for Payer: Aetna Commercial |
$1,019.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.38
|
| Rate for Payer: Aetna Managed Medicare |
$317.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$736.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$543.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.49
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,042.36
|
| Rate for Payer: Health EOS Commercial |
$1,008.37
|
| Rate for Payer: HFN Commercial |
$1,042.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$849.75
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: NAPHCARE Commercial |
$679.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,042.36
|
| Rate for Payer: Quartz Beloit One Network |
$555.17
|
| Rate for Payer: Quartz Commercial |
$736.45
|
| Rate for Payer: Quartz Medicare Advantage |
$679.80
|
| Rate for Payer: The Alliance Commercial |
$2,397.36
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$623.15
|
| Rate for Payer: WPS Commercial |
$839.21
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
630586
|
| Min. Negotiated Rate |
$513.52 |
| Max. Negotiated Rate |
$964.16 |
| Rate for Payer: Aetna Commercial |
$943.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.44
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$964.16
|
| Rate for Payer: Health EOS Commercial |
$932.72
|
| Rate for Payer: HFN Commercial |
$964.16
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: NAPHCARE Commercial |
$628.80
|
| Rate for Payer: Preferred Network Access Commercial |
$964.16
|
| Rate for Payer: Quartz Beloit One Network |
$513.52
|
| Rate for Payer: Quartz Commercial |
$628.80
|
| Rate for Payer: WEA Trust Commercial |
$576.40
|
| Rate for Payer: WPS Commercial |
$776.25
|
|
