|
XR Tibia/Fibula Bilateral
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629946
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,033.16 |
| Rate for Payer: Aetna Commercial |
$1,010.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$965.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$729.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$561.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$539.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.19
|
| 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 |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,033.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$628.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$999.47
|
| Rate for Payer: HFN Commercial |
$1,033.16
|
| 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 |
$898.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,033.16
|
| Rate for Payer: Quartz Beloit One Network |
$550.27
|
| Rate for Payer: Quartz Commercial |
$729.95
|
| 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 |
$617.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$831.81
|
|
|
XR Tibia/Fibula Left
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537393
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: HFN Commercial |
$575.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Left
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629942
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| 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 |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| 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 |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| 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 |
$309.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
XR Tibia/Fibula Left
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537393
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| 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 |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| 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 |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Left
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537393
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Left
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629942
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$533.90 |
| Rate for Payer: Aetna Commercial |
$533.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$533.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.20
|
| Rate for Payer: Health EOS Commercial |
$511.42
|
| Rate for Payer: HFN Commercial |
$533.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: Preferred Network Access Commercial |
$533.90
|
| Rate for Payer: Quartz Beloit One Network |
$247.28
|
| Rate for Payer: Quartz Commercial |
$320.34
|
| Rate for Payer: The Alliance Commercial |
$281.00
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
XR Tibia/Fibula Left
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629942
|
| Min. Negotiated Rate |
$275.38 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
XR Tibia/Fibula Right
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73590 TC,RT
|
| Hospital Charge Code |
2980059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: HFN Commercial |
$575.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Right
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73590 TC,RT
|
| Hospital Charge Code |
2980059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Right
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73590 RT,TC
|
| Hospital Charge Code |
1537395
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| 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 |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| 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 |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Right
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629936
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$533.90 |
| Rate for Payer: Aetna Commercial |
$533.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$533.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.20
|
| Rate for Payer: Health EOS Commercial |
$511.42
|
| Rate for Payer: HFN Commercial |
$533.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: Preferred Network Access Commercial |
$533.90
|
| Rate for Payer: Quartz Beloit One Network |
$247.28
|
| Rate for Payer: Quartz Commercial |
$320.34
|
| Rate for Payer: The Alliance Commercial |
$281.00
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
XR Tibia/Fibula Right
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629936
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| 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 |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| 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 |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| 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 |
$309.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
XR Tibia/Fibula Right
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73590 RT,TC
|
| Hospital Charge Code |
1537395
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: HFN Commercial |
$575.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Right
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73590 TC,RT
|
| Hospital Charge Code |
2980059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| 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 |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| 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 |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Right
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73590 RT,TC
|
| Hospital Charge Code |
1537395
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Tibia/Fibula Right
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629936
|
| Min. Negotiated Rate |
$275.38 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
XR TMJ Open and Closed Bilateral
|
Facility
|
OP
|
$1,254.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
629932
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,153.68 |
| Rate for Payer: Aetna Commercial |
$1,128.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.44
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$815.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$627.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$601.92
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.62
|
| 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 |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$1,153.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$701.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$1,116.06
|
| Rate for Payer: HFN Commercial |
$1,153.68
|
| 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 |
$1,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,153.68
|
| Rate for Payer: Quartz Beloit One Network |
$614.46
|
| Rate for Payer: Quartz Commercial |
$815.10
|
| 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 |
$689.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$928.84
|
|
|
XR TMJ Open and Closed Bilateral
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
CPT 70330 TC,LT
|
| Hospital Charge Code |
1537379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.12 |
| Max. Negotiated Rate |
$643.15 |
| Rate for Payer: Aetna Commercial |
$643.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$643.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$338.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.20
|
| Rate for Payer: Health EOS Commercial |
$616.07
|
| Rate for Payer: HFN Commercial |
$643.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$643.15
|
| Rate for Payer: Quartz Beloit One Network |
$297.88
|
| Rate for Payer: Quartz Commercial |
$385.89
|
| Rate for Payer: The Alliance Commercial |
$338.50
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
XR TMJ Open and Closed Bilateral
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 70330 TC,LT
|
| Hospital Charge Code |
1537379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$622.84 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.81
|
| 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 |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$622.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$602.53
|
| Rate for Payer: HFN Commercial |
$622.84
|
| 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 |
$541.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$622.84
|
| Rate for Payer: Quartz Beloit One Network |
$331.73
|
| Rate for Payer: Quartz Commercial |
$440.05
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
XR TMJ Open and Closed Bilateral
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 70330 TC,LT
|
| Hospital Charge Code |
1537379
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.73 |
| Max. Negotiated Rate |
$622.84 |
| Rate for Payer: Aetna Commercial |
$609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$582.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.81
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$622.84
|
| Rate for Payer: Health EOS Commercial |
$602.53
|
| Rate for Payer: HFN Commercial |
$622.84
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: NAPHCARE Commercial |
$406.20
|
| Rate for Payer: Preferred Network Access Commercial |
$622.84
|
| Rate for Payer: Quartz Beloit One Network |
$331.73
|
| Rate for Payer: Quartz Commercial |
$406.20
|
| Rate for Payer: WEA Trust Commercial |
$372.35
|
| Rate for Payer: WPS Commercial |
$501.45
|
|
|
XR TMJ Open and Closed Bilateral
|
Facility
|
IP
|
$1,254.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
629932
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$1,153.68 |
| Rate for Payer: Aetna Commercial |
$1,128.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.62
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$1,153.68
|
| Rate for Payer: Health EOS Commercial |
$1,116.06
|
| Rate for Payer: HFN Commercial |
$1,153.68
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$752.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,153.68
|
| Rate for Payer: Quartz Beloit One Network |
$614.46
|
| Rate for Payer: Quartz Commercial |
$752.40
|
| Rate for Payer: WEA Trust Commercial |
$689.70
|
| Rate for Payer: WPS Commercial |
$928.84
|
|
|
XR TMJ Open and Closed Bilateral
|
Professional
|
Both
|
$1,254.00
|
|
|
Service Code
|
CPT 70330
|
| Hospital Charge Code |
629932
|
| Min. Negotiated Rate |
$181.12 |
| Max. Negotiated Rate |
$1,191.30 |
| Rate for Payer: Aetna Commercial |
$1,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,078.44
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cash Price |
$376.20
|
| Rate for Payer: Cigna Commercial |
$1,191.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$627.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$752.40
|
| Rate for Payer: Health EOS Commercial |
$1,141.14
|
| Rate for Payer: HFN Commercial |
$1,191.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$1,003.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,191.30
|
| Rate for Payer: Quartz Beloit One Network |
$551.76
|
| Rate for Payer: Quartz Commercial |
$714.78
|
| Rate for Payer: The Alliance Commercial |
$627.00
|
| Rate for Payer: WEA Trust Commercial |
$689.70
|
| Rate for Payer: WPS Commercial |
$928.84
|
|
|
XR TMJ Open and Closed Left
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
629928
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
XR TMJ Open and Closed Left
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
629928
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| 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 |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| 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 |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| 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 |
$344.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
XR TMJ Open and Closed Left
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 70328 TC,LT
|
| Hospital Charge Code |
1537381
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$598.92 |
| Rate for Payer: Aetna Commercial |
$585.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.03
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$598.92
|
| Rate for Payer: Health EOS Commercial |
$579.39
|
| Rate for Payer: HFN Commercial |
$598.92
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: NAPHCARE Commercial |
$390.60
|
| Rate for Payer: Preferred Network Access Commercial |
$598.92
|
| Rate for Payer: Quartz Beloit One Network |
$318.99
|
| Rate for Payer: Quartz Commercial |
$390.60
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
