|
XR Shoulder Complete Right
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Complete Right
|
Facility
IP
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Complete Right
|
Professional
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630121
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.35
|
| Rate for Payer: Anthem Medicare Advantage |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.35
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.35
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.35
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$589.95
|
| Rate for Payer: Quartz Beloit One Network |
$273.24
|
| Rate for Payer: Quartz Commercial |
$353.97
|
| Rate for Payer: Quartz Medicare Advantage |
$33.35
|
| Rate for Payer: The Alliance Commercial |
$126.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.35
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$166.75
|
|
|
XR Shoulder Complete Right
|
Professional
|
$671.00
|
|
|
Service Code
|
CPT 73030 TC,RT
|
| Hospital Charge Code |
2979994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Complete Right
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 TC,RT
|
| Hospital Charge Code |
2979994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Complete Right
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630121
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.08
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| 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 |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| 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 |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| 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 |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$403.65
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
XR Shoulder Complete Right
|
Facility
IP
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
630121
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$372.60
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
XR Shoulder Complete Right
|
Professional
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537294
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Complete Right
|
Facility
IP
|
$671.00
|
|
|
Service Code
|
CPT 73030 TC,RT
|
| Hospital Charge Code |
2979994
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Bilat
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Shoulder Intern/Extern Rotation Bilat
|
Professional
|
$646.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$613.70 |
| Rate for Payer: Aetna Commercial |
$613.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$323.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.60
|
| Rate for Payer: Health EOS Commercial |
$587.86
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Preferred Network Access Commercial |
$613.70
|
| Rate for Payer: Quartz Beloit One Network |
$284.24
|
| Rate for Payer: Quartz Commercial |
$368.22
|
| Rate for Payer: The Alliance Commercial |
$323.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Shoulder Intern/Extern Rotation Bilat
|
Facility
IP
|
$1,242.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711792
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$745.20
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
XR Shoulder Intern/Extern Rotation Bilat
|
Professional
|
$1,242.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711792
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$1,179.90 |
| Rate for Payer: Aetna Commercial |
$1,179.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$33.35
|
| Rate for Payer: Anthem Medicare Advantage |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.35
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,179.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$621.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.35
|
| Rate for Payer: Health EOS Commercial |
$1,130.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.35
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.90
|
| Rate for Payer: Quartz Beloit One Network |
$546.48
|
| Rate for Payer: Quartz Commercial |
$707.94
|
| Rate for Payer: Quartz Medicare Advantage |
$33.35
|
| Rate for Payer: The Alliance Commercial |
$126.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.35
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$166.75
|
|
|
XR Shoulder Intern/Extern Rotation Bilat
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537296
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.50
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Shoulder Intern/Extern Rotation Bilat
|
Facility
OP
|
$1,242.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711792
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$807.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$596.16
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| 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 |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| 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 |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| 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 |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$807.30
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
XR Shoulder Intern/Extern Rotation Left
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711793
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.08
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| 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 |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| 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 |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| 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 |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$403.65
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$16.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
XR Shoulder Intern/Extern Rotation Left
|
Professional
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711793
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.35
|
| Rate for Payer: Anthem Medicare Advantage |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.35
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.35
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.35
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$589.95
|
| Rate for Payer: Quartz Beloit One Network |
$273.24
|
| Rate for Payer: Quartz Commercial |
$353.97
|
| Rate for Payer: Quartz Medicare Advantage |
$33.35
|
| Rate for Payer: The Alliance Commercial |
$126.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.35
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$166.75
|
|
|
XR Shoulder Intern/Extern Rotation Left
|
Facility
IP
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711793
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$372.60
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
XR Shoulder Intern/Extern Rotation Left
|
Professional
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Left
|
Facility
IP
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Left
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 LT,TC
|
| Hospital Charge Code |
1537299
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Professional
|
$646.00
|
|
|
Service Code
|
CPT 73030 TC,RT
|
| Hospital Charge Code |
2979995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$613.70 |
| Rate for Payer: Aetna Commercial |
$613.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$323.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.60
|
| Rate for Payer: Health EOS Commercial |
$587.86
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Preferred Network Access Commercial |
$613.70
|
| Rate for Payer: Quartz Beloit One Network |
$284.24
|
| Rate for Payer: Quartz Commercial |
$368.22
|
| Rate for Payer: The Alliance Commercial |
$323.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT 73030 TC,RT
|
| Hospital Charge Code |
2979995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.50
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Professional
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
