|
XR Lower Extremity Infant Bilateral
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Bilateral
|
Professional
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Left
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630343
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| 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: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| 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 |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| 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 |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| 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 |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| 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 |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$243.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Lower Extremity Infant Left
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630343
|
| 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 Lower Extremity Infant Left
|
Professional
|
$577.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.88 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Aetna Commercial |
$548.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$548.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$288.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.20
|
| Rate for Payer: Health EOS Commercial |
$525.07
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.15
|
| Rate for Payer: Quartz Beloit One Network |
$253.88
|
| Rate for Payer: Quartz Commercial |
$328.89
|
| Rate for Payer: The Alliance Commercial |
$288.50
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Lower Extremity Infant Left
|
Professional
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630343
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$30.42
|
| Rate for Payer: Anthem Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.42
|
| Rate for Payer: Cash Price |
$160.50
|
| 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 |
$30.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.42
|
| 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: Quartz Medicare Advantage |
$30.42
|
| Rate for Payer: The Alliance Commercial |
$115.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.42
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$152.10
|
|
|
XR Lower Extremity Infant Left
|
Facility
IP
|
$577.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.73 |
| Max. Negotiated Rate |
$530.84 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$346.20
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Lower Extremity Infant Left
|
Facility
OP
|
$577.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.56 |
| Max. Negotiated Rate |
$2,308.00 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Aetna Managed Medicare |
$161.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.75
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$375.05
|
| Rate for Payer: Quartz Medicare Advantage |
$346.20
|
| Rate for Payer: The Alliance Commercial |
$2,308.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Lower Extremity Infant Right
|
Facility
IP
|
$556.00
|
|
|
Service Code
|
CPT 73592 TC,RT
|
| Hospital Charge Code |
2980060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Right
|
Facility
IP
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630341
|
| 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 Lower Extremity Infant Right
|
Facility
OP
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630341
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| 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: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| 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 |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| 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 |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| 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 |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| 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 |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$243.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Lower Extremity Infant Right
|
Facility
OP
|
$577.00
|
|
|
Service Code
|
CPT 73592 RT,TC
|
| Hospital Charge Code |
1537176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.56 |
| Max. Negotiated Rate |
$2,308.00 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Aetna Managed Medicare |
$161.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.75
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$375.05
|
| Rate for Payer: Quartz Medicare Advantage |
$346.20
|
| Rate for Payer: The Alliance Commercial |
$2,308.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Lower Extremity Infant Right
|
Professional
|
$556.00
|
|
|
Service Code
|
CPT 73592 TC,RT
|
| Hospital Charge Code |
2980060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Right
|
Professional
|
$577.00
|
|
|
Service Code
|
CPT 73592 RT,TC
|
| Hospital Charge Code |
1537176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.88 |
| Max. Negotiated Rate |
$548.15 |
| Rate for Payer: Aetna Commercial |
$548.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$548.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$288.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.20
|
| Rate for Payer: Health EOS Commercial |
$525.07
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.15
|
| Rate for Payer: Quartz Beloit One Network |
$253.88
|
| Rate for Payer: Quartz Commercial |
$328.89
|
| Rate for Payer: The Alliance Commercial |
$288.50
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Lower Extremity Infant Right
|
Facility
OP
|
$556.00
|
|
|
Service Code
|
CPT 73592 TC,RT
|
| Hospital Charge Code |
2980060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.68 |
| Max. Negotiated Rate |
$2,224.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$155.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$333.60
|
| Rate for Payer: The Alliance Commercial |
$2,224.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Right
|
Facility
IP
|
$577.00
|
|
|
Service Code
|
CPT 73592 RT,TC
|
| Hospital Charge Code |
1537176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$282.73 |
| Max. Negotiated Rate |
$530.84 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$346.20
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Lower Extremity Infant Right
|
Professional
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630341
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$30.42
|
| Rate for Payer: Anthem Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.42
|
| Rate for Payer: Cash Price |
$160.50
|
| 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 |
$30.42
|
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.42
|
| 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: Quartz Medicare Advantage |
$30.42
|
| Rate for Payer: The Alliance Commercial |
$115.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.42
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$152.10
|
|
|
XR Lumbar Puncture
|
Professional
|
$3,235.00
|
|
|
Service Code
|
CPT 62328 TC
|
| Hospital Charge Code |
2587232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,423.40 |
| Max. Negotiated Rate |
$3,073.25 |
| Rate for Payer: Aetna Commercial |
$3,073.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.10
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$3,073.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,617.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,941.00
|
| Rate for Payer: Health EOS Commercial |
$2,943.85
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,073.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.40
|
| Rate for Payer: Quartz Commercial |
$1,843.95
|
| Rate for Payer: The Alliance Commercial |
$1,617.50
|
| Rate for Payer: WEA Trust Commercial |
$1,779.25
|
| Rate for Payer: WPS Commercial |
$2,396.16
|
|
|
XR Lumbar Puncture
|
Facility
IP
|
$3,235.00
|
|
|
Service Code
|
CPT 62328 TC
|
| Hospital Charge Code |
2587232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,585.15 |
| Max. Negotiated Rate |
$2,976.20 |
| Rate for Payer: Aetna Commercial |
$2,911.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.55
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$2,976.20
|
| Rate for Payer: Health EOS Commercial |
$2,879.15
|
| Rate for Payer: HFN Commercial |
$2,976.20
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.15
|
| Rate for Payer: Quartz Commercial |
$1,941.00
|
| Rate for Payer: WEA Trust Commercial |
$1,779.25
|
| Rate for Payer: WPS Commercial |
$2,396.16
|
|
|
XR Lumbar Puncture
|
Facility
OP
|
$3,235.00
|
|
|
Service Code
|
CPT 62328 TC
|
| Hospital Charge Code |
2587232
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,940.00 |
| Rate for Payer: Aetna Commercial |
$2,911.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,782.10
|
| Rate for Payer: Aetna Managed Medicare |
$905.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,617.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,552.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.55
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cash Price |
$970.50
|
| Rate for Payer: Cigna Commercial |
$2,976.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,810.31
|
| Rate for Payer: Health EOS Commercial |
$2,879.15
|
| Rate for Payer: HFN Commercial |
$2,976.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,426.25
|
| Rate for Payer: Multiplan Commercial |
$2,588.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,941.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,976.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,585.15
|
| Rate for Payer: Quartz Commercial |
$2,102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,941.00
|
| Rate for Payer: The Alliance Commercial |
$12,940.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,779.25
|
| Rate for Payer: WPS Commercial |
$2,396.16
|
|
|
XR Major Joint Injection, Asp
|
Facility
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4497806
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$2.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Major Joint Injection, Asp
|
Professional
|
$883.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4497806
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$41.89
|
| Rate for Payer: Anthem Medicare Advantage |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.89
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$441.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.89
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.89
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: Quartz Medicare Advantage |
$41.89
|
| Rate for Payer: The Alliance Commercial |
$178.03
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.89
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$188.50
|
|
|
XR Major Joint Injection, Asp
|
Facility
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
4497806
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Mandible Complete Minimum 4 Views
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
CPT 70110 TC
|
| Hospital Charge Code |
1537178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$103.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$222.60
|
| Rate for Payer: The Alliance Commercial |
$1,484.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
