|
XR Elbow Complete Left
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630683
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$331.20
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
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 |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Left
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630683
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.96
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| 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 |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| 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 |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
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 |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.52
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
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 |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: HFN Commercial |
$566.20
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
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 |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.52
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Right
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630679
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$331.20
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
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 |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Right
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630679
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.96
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| 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 |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| 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 |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
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 |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Elbow Complete Right
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
630679
|
| Min. Negotiated Rate |
$108.69 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$502.32
|
| Rate for Payer: HFN Commercial |
$524.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.69
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$242.88
|
| Rate for Payer: Quartz Commercial |
$314.64
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
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 |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: HFN Commercial |
$566.20
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
OP
|
$1,806.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2587223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$7,224.00 |
| Rate for Payer: Aetna Commercial |
$1,625.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.16
|
| Rate for Payer: Aetna Managed Medicare |
$505.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.18
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$1,661.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.64
|
| Rate for Payer: Health EOS Commercial |
$1,607.34
|
| Rate for Payer: HFN Commercial |
$1,661.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.50
|
| Rate for Payer: Multiplan Commercial |
$1,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.52
|
| Rate for Payer: Quartz Beloit One Network |
$884.94
|
| Rate for Payer: Quartz Commercial |
$1,173.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.60
|
| Rate for Payer: The Alliance Commercial |
$7,224.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$993.30
|
| Rate for Payer: WPS Commercial |
$1,337.70
|
|
|
XR Enteroclysis Tube Placement
|
Professional
|
Both
|
$1,737.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2448807
|
| Min. Negotiated Rate |
$501.61 |
| Max. Negotiated Rate |
$1,650.15 |
| Rate for Payer: Aetna Commercial |
$1,650.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,493.82
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,650.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$868.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,042.20
|
| Rate for Payer: Health EOS Commercial |
$1,580.67
|
| Rate for Payer: HFN Commercial |
$1,650.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$501.61
|
| Rate for Payer: Multiplan Commercial |
$1,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.15
|
| Rate for Payer: Quartz Beloit One Network |
$764.28
|
| Rate for Payer: Quartz Commercial |
$990.09
|
| Rate for Payer: The Alliance Commercial |
$868.50
|
| Rate for Payer: WEA Trust Commercial |
$955.35
|
| Rate for Payer: WPS Commercial |
$1,286.60
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
OP
|
$1,737.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2448807
|
| Min. Negotiated Rate |
$486.36 |
| Max. Negotiated Rate |
$6,948.00 |
| Rate for Payer: Aetna Commercial |
$1,563.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,493.82
|
| Rate for Payer: Aetna Managed Medicare |
$486.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,129.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$868.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$833.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$920.61
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,598.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$972.03
|
| Rate for Payer: Health EOS Commercial |
$1,545.93
|
| Rate for Payer: HFN Commercial |
$1,598.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,302.75
|
| Rate for Payer: Multiplan Commercial |
$1,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.04
|
| Rate for Payer: Quartz Beloit One Network |
$851.13
|
| Rate for Payer: Quartz Commercial |
$1,129.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,042.20
|
| Rate for Payer: The Alliance Commercial |
$6,948.00
|
| Rate for Payer: WEA Trust Commercial |
$955.35
|
| Rate for Payer: WPS Commercial |
$1,286.60
|
|
|
XR Enteroclysis Tube Placement
|
Professional
|
Both
|
$1,806.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2587223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$501.61 |
| Max. Negotiated Rate |
$1,715.70 |
| Rate for Payer: Aetna Commercial |
$1,715.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.16
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$1,715.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$903.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.60
|
| Rate for Payer: Health EOS Commercial |
$1,643.46
|
| Rate for Payer: HFN Commercial |
$1,715.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$501.61
|
| Rate for Payer: Multiplan Commercial |
$1,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,715.70
|
| Rate for Payer: Quartz Beloit One Network |
$794.64
|
| Rate for Payer: Quartz Commercial |
$1,029.42
|
| Rate for Payer: The Alliance Commercial |
$903.00
|
| Rate for Payer: WEA Trust Commercial |
$993.30
|
| Rate for Payer: WPS Commercial |
$1,337.70
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
IP
|
$1,806.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2587223
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$884.94 |
| Max. Negotiated Rate |
$1,661.52 |
| Rate for Payer: Aetna Commercial |
$1,625.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,553.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.18
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna Commercial |
$1,661.52
|
| Rate for Payer: Health EOS Commercial |
$1,607.34
|
| Rate for Payer: HFN Commercial |
$1,661.52
|
| Rate for Payer: Multiplan Commercial |
$1,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.52
|
| Rate for Payer: Quartz Beloit One Network |
$884.94
|
| Rate for Payer: Quartz Commercial |
$1,083.60
|
| Rate for Payer: WEA Trust Commercial |
$993.30
|
| Rate for Payer: WPS Commercial |
$1,337.70
|
|
|
XR Enteroclysis Tube Placement
|
Facility
|
IP
|
$1,737.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
2448807
|
| Min. Negotiated Rate |
$851.13 |
| Max. Negotiated Rate |
$1,598.04 |
| Rate for Payer: Aetna Commercial |
$1,563.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,493.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$920.61
|
| Rate for Payer: Cash Price |
$521.10
|
| Rate for Payer: Cigna Commercial |
$1,598.04
|
| Rate for Payer: Health EOS Commercial |
$1,545.93
|
| Rate for Payer: HFN Commercial |
$1,598.04
|
| Rate for Payer: Multiplan Commercial |
$1,389.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,042.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.04
|
| Rate for Payer: Quartz Beloit One Network |
$851.13
|
| Rate for Payer: Quartz Commercial |
$1,042.20
|
| Rate for Payer: WEA Trust Commercial |
$955.35
|
| Rate for Payer: WPS Commercial |
$1,286.60
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2448809
|
| Min. Negotiated Rate |
$573.91 |
| Max. Negotiated Rate |
$2,207.80 |
| Rate for Payer: Aetna Commercial |
$2,207.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,207.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,162.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.40
|
| Rate for Payer: Health EOS Commercial |
$2,114.84
|
| Rate for Payer: HFN Commercial |
$2,207.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$573.91
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,207.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,022.56
|
| Rate for Payer: Quartz Commercial |
$1,324.68
|
| Rate for Payer: The Alliance Commercial |
$1,162.00
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2448809
|
| Min. Negotiated Rate |
$1,138.76 |
| Max. Negotiated Rate |
$2,138.08 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,394.40
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2587217
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$10,040.00 |
| Rate for Payer: Aetna Commercial |
$2,259.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,158.60
|
| Rate for Payer: Aetna Managed Medicare |
$702.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,631.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,204.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.30
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$2,309.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.60
|
| Rate for Payer: Health EOS Commercial |
$2,233.90
|
| Rate for Payer: HFN Commercial |
$2,309.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,882.50
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.90
|
| Rate for Payer: Quartz Commercial |
$1,631.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.00
|
| Rate for Payer: The Alliance Commercial |
$10,040.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,380.50
|
| Rate for Payer: WPS Commercial |
$1,859.16
|
|
|
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 |
$573.91 |
| Max. Negotiated Rate |
$2,384.50 |
| Rate for Payer: Aetna Commercial |
$2,384.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,158.60
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$2,384.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,506.00
|
| Rate for Payer: Health EOS Commercial |
$2,284.10
|
| Rate for Payer: HFN Commercial |
$2,384.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$573.91
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,384.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.40
|
| Rate for Payer: Quartz Commercial |
$1,430.70
|
| Rate for Payer: The Alliance Commercial |
$1,255.00
|
| Rate for Payer: WEA Trust Commercial |
$1,380.50
|
| Rate for Payer: WPS Commercial |
$1,859.16
|
|
|
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 |
$1,229.90 |
| Max. Negotiated Rate |
$2,309.20 |
| Rate for Payer: Aetna Commercial |
$2,259.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,158.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.30
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$2,309.20
|
| Rate for Payer: Health EOS Commercial |
$2,233.90
|
| Rate for Payer: HFN Commercial |
$2,309.20
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,309.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.90
|
| Rate for Payer: Quartz Commercial |
$1,506.00
|
| Rate for Payer: WEA Trust Commercial |
$1,380.50
|
| Rate for Payer: WPS Commercial |
$1,859.16
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2448809
|
| Min. Negotiated Rate |
$650.72 |
| Max. Negotiated Rate |
$9,296.00 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Aetna Managed Medicare |
$650.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.51
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,743.00
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,510.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.40
|
| Rate for Payer: The Alliance Commercial |
$9,296.00
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Biliary Duct
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$715.89 |
| Max. Negotiated Rate |
$1,344.12 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.33
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,344.12
|
| Rate for Payer: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: NAPHCARE Commercial |
$876.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,344.12
|
| Rate for Payer: Quartz Beloit One Network |
$715.89
|
| Rate for Payer: Quartz Commercial |
$876.60
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
