|
XR Hand Complete Left
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Left
|
Professional
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.60
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: The Alliance Commercial |
$275.50
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Left
|
Professional
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630479
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$485.45 |
| Rate for Payer: Aetna Commercial |
$485.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$35.59
|
| Rate for Payer: Anthem Medicare Advantage |
$35.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.59
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$485.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.59
|
| Rate for Payer: Health EOS Commercial |
$465.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: Preferred Network Access Commercial |
$485.45
|
| Rate for Payer: Quartz Beloit One Network |
$224.84
|
| Rate for Payer: Quartz Commercial |
$291.27
|
| Rate for Payer: Quartz Medicare Advantage |
$35.59
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.59
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$177.95
|
|
|
XR Hand Complete Left
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Left
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630479
|
| Min. Negotiated Rate |
$250.39 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$306.60
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
XR Hand Complete Left
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630479
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,489.48 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$332.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.28
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| 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 |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| 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 |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| 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 |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$332.15
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,489.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
XR Hand Complete Right
|
Facility
IP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$250.39 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$306.60
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
XR Hand Complete Right
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Right
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 TC,RT
|
| Hospital Charge Code |
2980004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Right
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 TC,RT
|
| Hospital Charge Code |
2980004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Right
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Right
|
Professional
|
$551.00
|
|
|
Service Code
|
CPT 73130 TC,RT
|
| Hospital Charge Code |
2980004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.60
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: The Alliance Commercial |
$275.50
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Right
|
Professional
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.60
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: The Alliance Commercial |
$275.50
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
XR Hand Complete Right
|
Facility
OP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,489.48 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$332.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.28
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| 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 |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| 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 |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| 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 |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$332.15
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,489.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
XR Hand Complete Right
|
Professional
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$35.59 |
| Max. Negotiated Rate |
$485.45 |
| Rate for Payer: Aetna Commercial |
$485.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$35.59
|
| Rate for Payer: Anthem Medicare Advantage |
$35.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.59
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$485.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.59
|
| Rate for Payer: Health EOS Commercial |
$465.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: Preferred Network Access Commercial |
$485.45
|
| Rate for Payer: Quartz Beloit One Network |
$224.84
|
| Rate for Payer: Quartz Commercial |
$291.27
|
| Rate for Payer: Quartz Medicare Advantage |
$35.59
|
| Rate for Payer: The Alliance Commercial |
$135.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.59
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$177.95
|
|
|
XR Hip 1 View Left
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip 1 View Left
|
Professional
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip 1 View Left
|
Facility
OP
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$121.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$326.25
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$261.00
|
| Rate for Payer: The Alliance Commercial |
$1,740.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
XR Hip 1 View Left
|
Facility
IP
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
XR Hip 1 View Left
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip 1 View Left
|
Professional
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna Commercial |
$413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.00
|
| Rate for Payer: Health EOS Commercial |
$395.85
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.25
|
| Rate for Payer: Quartz Beloit One Network |
$191.40
|
| Rate for Payer: Quartz Commercial |
$247.95
|
| Rate for Payer: The Alliance Commercial |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
XR Hip 1 View Right
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip 1 View Right
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip 1 View Right
|
Professional
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip Bilateral w/Pelvis
|
Facility
OP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.24 |
| Max. Negotiated Rate |
$3,032.00 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$212.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.50
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$492.70
|
| Rate for Payer: Quartz Medicare Advantage |
$454.80
|
| Rate for Payer: The Alliance Commercial |
$3,032.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
