|
XR Femur Left
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Left
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$393.12
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
XR Femur Right
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Femur Right
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Femur Right
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$244.82 |
| Max. Negotiated Rate |
$528.58 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.84
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Finger 2nd Digit Left
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$203.33 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
XR Finger 2nd Digit Left
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F1,TC
|
| Hospital Charge Code |
1537028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 2nd Digit Left
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$394.21 |
| Rate for Payer: Aetna Commercial |
$394.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$39.01
|
| Rate for Payer: Anthem Medicare Advantage |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.01
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$394.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.01
|
| Rate for Payer: Health EOS Commercial |
$377.61
|
| Rate for Payer: HFN Commercial |
$394.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.01
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$58.52
|
| Rate for Payer: Preferred Network Access Commercial |
$394.21
|
| Rate for Payer: Quartz Beloit One Network |
$182.58
|
| Rate for Payer: Quartz Commercial |
$236.53
|
| Rate for Payer: Quartz Medicare Advantage |
$39.01
|
| Rate for Payer: The Alliance Commercial |
$148.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.01
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$195.05
|
|
|
XR Finger 2nd Digit Left
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F1,TC
|
| Hospital Charge Code |
1537028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| 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 |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 2nd Digit Left
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
CPT 73140 F1,TC
|
| Hospital Charge Code |
1537028
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.84 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Aetna Commercial |
$425.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$425.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.94
|
| Rate for Payer: Health EOS Commercial |
$407.90
|
| Rate for Payer: HFN Commercial |
$425.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.84
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$425.83
|
| Rate for Payer: Quartz Beloit One Network |
$197.23
|
| Rate for Payer: Quartz Commercial |
$255.50
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 2nd Digit Left
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.18
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| 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 |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$269.72
|
| 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 |
$228.23
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
XR Finger 2nd Digit Right
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F6,TC
|
| Hospital Charge Code |
1537030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| 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 |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 2nd Digit Right
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630647
|
| Min. Negotiated Rate |
$203.33 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
XR Finger 2nd Digit Right
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
CPT 73140 F6,TC
|
| Hospital Charge Code |
1537030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.84 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Aetna Commercial |
$425.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$425.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.94
|
| Rate for Payer: Health EOS Commercial |
$407.90
|
| Rate for Payer: HFN Commercial |
$425.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.84
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$425.83
|
| Rate for Payer: Quartz Beloit One Network |
$197.23
|
| Rate for Payer: Quartz Commercial |
$255.50
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 2nd Digit Right
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630647
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$394.21 |
| Rate for Payer: Aetna Commercial |
$394.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$39.01
|
| Rate for Payer: Anthem Medicare Advantage |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.01
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$394.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.01
|
| Rate for Payer: Health EOS Commercial |
$377.61
|
| Rate for Payer: HFN Commercial |
$394.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.01
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$58.52
|
| Rate for Payer: Preferred Network Access Commercial |
$394.21
|
| Rate for Payer: Quartz Beloit One Network |
$182.58
|
| Rate for Payer: Quartz Commercial |
$236.53
|
| Rate for Payer: Quartz Medicare Advantage |
$39.01
|
| Rate for Payer: The Alliance Commercial |
$148.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.01
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$195.05
|
|
|
XR Finger 2nd Digit Right
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630647
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.18
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| 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 |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$269.72
|
| 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 |
$228.23
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
XR Finger 2nd Digit Right
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F6,TC
|
| Hospital Charge Code |
1537030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 3rd Digit Left
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F2,TC
|
| Hospital Charge Code |
1537032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
XR Finger 3rd Digit Left
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
CPT 73140 F2,TC
|
| Hospital Charge Code |
1537032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.84 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Aetna Commercial |
$425.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$425.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.94
|
| Rate for Payer: Health EOS Commercial |
$407.90
|
| Rate for Payer: HFN Commercial |
$425.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.84
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$425.83
|
| Rate for Payer: Quartz Beloit One Network |
$197.23
|
| Rate for Payer: Quartz Commercial |
$255.50
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
