|
XR Elbow Complete Left
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630683
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$545.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$32.74
|
| Rate for Payer: Anthem Medicare Advantage |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.74
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.74
|
| Rate for Payer: Health EOS Commercial |
$522.41
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.74
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$49.11
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$252.60
|
| Rate for Payer: Quartz Commercial |
$327.23
|
| Rate for Payer: Quartz Medicare Advantage |
$32.74
|
| Rate for Payer: The Alliance Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.74
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$163.70
|
|
|
XR Elbow Complete Left
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630683
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$344.45
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
XR Elbow Complete Left
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630683
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.56
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
XR Elbow Complete Left
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Left
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Left
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73080 LT,TC
|
| Hospital Charge Code |
1537004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Right
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 73080 RT,TC
|
| Hospital Charge Code |
1537006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Right
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630679
|
| Min. Negotiated Rate |
$32.74 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$545.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$32.74
|
| Rate for Payer: Anthem Medicare Advantage |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.74
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.74
|
| Rate for Payer: Health EOS Commercial |
$522.41
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.74
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$49.11
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$252.60
|
| Rate for Payer: Quartz Commercial |
$327.23
|
| Rate for Payer: Quartz Medicare Advantage |
$32.74
|
| Rate for Payer: The Alliance Commercial |
$124.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.74
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$163.70
|
|
|
XR Elbow Complete Right
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 73080 RT,TC
|
| Hospital Charge Code |
2979998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Right
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630679
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.56
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
XR Elbow Complete Right
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73080 RT,TC
|
| Hospital Charge Code |
2979998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Right
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73080 RT,TC
|
| Hospital Charge Code |
1537006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.04 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Right
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 73080 RT,TC
|
| Hospital Charge Code |
2979998
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Elbow Complete Right
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630679
|
| Min. Negotiated Rate |
$281.30 |
| Max. Negotiated Rate |
$528.15 |
| Rate for Payer: Aetna Commercial |
$516.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$493.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.26
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$528.15
|
| Rate for Payer: Health EOS Commercial |
$510.93
|
| Rate for Payer: HFN Commercial |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$459.26
|
| Rate for Payer: Preferred Network Access Commercial |
$528.15
|
| Rate for Payer: Quartz Beloit One Network |
$281.30
|
| Rate for Payer: Quartz Commercial |
$344.45
|
| Rate for Payer: WEA Trust Commercial |
$315.74
|
| Rate for Payer: WPS Commercial |
$425.21
|
|
|
XR Elbow Complete Right
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 73080 RT,TC
|
| Hospital Charge Code |
1537006
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Enteroclysis Tube Placement
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2448807
|
| Min. Negotiated Rate |
$521.67 |
| Max. Negotiated Rate |
$1,716.16 |
| Rate for Payer: Aetna Commercial |
$1,716.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.57
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,716.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$903.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.89
|
| Rate for Payer: Health EOS Commercial |
$1,643.90
|
| Rate for Payer: HFN Commercial |
$1,716.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$521.67
|
| Rate for Payer: Multiplan Commercial |
$1,445.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,716.16
|
| Rate for Payer: Quartz Beloit One Network |
$794.85
|
| Rate for Payer: Quartz Commercial |
$1,029.69
|
| Rate for Payer: The Alliance Commercial |
$903.24
|
| Rate for Payer: WEA Trust Commercial |
$993.56
|
| Rate for Payer: WPS Commercial |
$1,338.01
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2448807
|
| Min. Negotiated Rate |
$885.18 |
| Max. Negotiated Rate |
$1,661.96 |
| Rate for Payer: Aetna Commercial |
$1,625.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.43
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,661.96
|
| Rate for Payer: Health EOS Commercial |
$1,607.77
|
| Rate for Payer: HFN Commercial |
$1,661.96
|
| Rate for Payer: Multiplan Commercial |
$1,445.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.96
|
| Rate for Payer: Quartz Beloit One Network |
$885.18
|
| Rate for Payer: Quartz Commercial |
$1,083.89
|
| Rate for Payer: WEA Trust Commercial |
$993.56
|
| Rate for Payer: WPS Commercial |
$1,338.01
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2587223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,727.98 |
| Rate for Payer: Aetna Commercial |
$1,690.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.29
|
| Rate for Payer: Aetna Managed Medicare |
$525.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$939.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.47
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$1,727.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,051.09
|
| Rate for Payer: Health EOS Commercial |
$1,671.63
|
| Rate for Payer: HFN Commercial |
$1,727.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,408.68
|
| Rate for Payer: Multiplan Commercial |
$1,502.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.98
|
| Rate for Payer: Quartz Beloit One Network |
$920.34
|
| Rate for Payer: Quartz Commercial |
$1,220.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.94
|
| Rate for Payer: The Alliance Commercial |
$939.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,033.03
|
| Rate for Payer: WPS Commercial |
$1,391.16
|
|
|
XR Enteroclysis Tube Placement
|
Professional
|
Both
|
$1,806.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2587223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$521.67 |
| Max. Negotiated Rate |
$1,784.33 |
| Rate for Payer: Aetna Commercial |
$1,784.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.29
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$1,784.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$939.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,126.94
|
| Rate for Payer: Health EOS Commercial |
$1,709.20
|
| Rate for Payer: HFN Commercial |
$1,784.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$521.67
|
| Rate for Payer: Multiplan Commercial |
$1,502.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,784.33
|
| Rate for Payer: Quartz Beloit One Network |
$826.43
|
| Rate for Payer: Quartz Commercial |
$1,070.60
|
| Rate for Payer: The Alliance Commercial |
$939.12
|
| Rate for Payer: WEA Trust Commercial |
$1,033.03
|
| Rate for Payer: WPS Commercial |
$1,391.16
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2587223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$920.34 |
| Max. Negotiated Rate |
$1,727.98 |
| Rate for Payer: Aetna Commercial |
$1,690.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,615.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$995.47
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$1,727.98
|
| Rate for Payer: Health EOS Commercial |
$1,671.63
|
| Rate for Payer: HFN Commercial |
$1,727.98
|
| Rate for Payer: Multiplan Commercial |
$1,502.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.98
|
| Rate for Payer: Quartz Beloit One Network |
$920.34
|
| Rate for Payer: Quartz Commercial |
$1,126.94
|
| Rate for Payer: WEA Trust Commercial |
$1,033.03
|
| Rate for Payer: WPS Commercial |
$1,391.16
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2448807
|
| Min. Negotiated Rate |
$505.81 |
| Max. Negotiated Rate |
$1,661.96 |
| Rate for Payer: Aetna Commercial |
$1,625.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.57
|
| Rate for Payer: Aetna Managed Medicare |
$505.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.43
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,661.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.93
|
| Rate for Payer: Health EOS Commercial |
$1,607.77
|
| Rate for Payer: HFN Commercial |
$1,661.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.86
|
| Rate for Payer: Multiplan Commercial |
$1,445.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.96
|
| Rate for Payer: Quartz Beloit One Network |
$885.18
|
| Rate for Payer: Quartz Commercial |
$1,174.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.89
|
| Rate for Payer: The Alliance Commercial |
$903.24
|
| Rate for Payer: WEA Trust Commercial |
$993.56
|
| Rate for Payer: WPS Commercial |
$1,338.01
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2587217
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,279.10 |
| Max. Negotiated Rate |
$2,401.57 |
| Rate for Payer: Aetna Commercial |
$2,349.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,383.51
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$2,401.57
|
| Rate for Payer: Health EOS Commercial |
$2,323.26
|
| Rate for Payer: HFN Commercial |
$2,401.57
|
| Rate for Payer: Multiplan Commercial |
$2,088.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,401.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.10
|
| Rate for Payer: Quartz Commercial |
$1,566.24
|
| Rate for Payer: WEA Trust Commercial |
$1,435.72
|
| Rate for Payer: WPS Commercial |
$1,933.45
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2448809
|
| Min. Negotiated Rate |
$1,184.31 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,450.18
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Professional
|
Both
|
$2,510.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2587217
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$596.87 |
| Max. Negotiated Rate |
$2,479.88 |
| Rate for Payer: Aetna Commercial |
$2,479.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.94
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$2,479.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,305.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,566.24
|
| Rate for Payer: Health EOS Commercial |
$2,375.46
|
| Rate for Payer: HFN Commercial |
$2,479.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$596.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$596.87
|
| Rate for Payer: Multiplan Commercial |
$2,088.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.58
|
| Rate for Payer: Quartz Commercial |
$1,487.93
|
| Rate for Payer: The Alliance Commercial |
$1,305.20
|
| Rate for Payer: WEA Trust Commercial |
$1,435.72
|
| Rate for Payer: WPS Commercial |
$1,933.45
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2448809
|
| Min. Negotiated Rate |
$676.75 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Aetna Managed Medicare |
$676.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,352.57
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.72
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,571.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,450.18
|
| Rate for Payer: The Alliance Commercial |
$1,208.48
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
