|
XR Finger 5th Digit Left
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630618
|
| 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 5th Digit Left
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630618
|
| 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 5th Digit Left
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630618
|
| 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 5th Digit Right
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630609
|
| 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 5th Digit Right
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630609
|
| 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 5th Digit Right
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630609
|
| 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 5th Digit Right
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F9,TC
|
| Hospital Charge Code |
1537042
|
|
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 5th Digit Right
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
CPT 73140 F9,TC
|
| Hospital Charge Code |
1537042
|
|
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 5th Digit Right
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F9,TC
|
| Hospital Charge Code |
1537042
|
|
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 Thumb Left
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
CPT 73140 FA,TC
|
| Hospital Charge Code |
1537044
|
|
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 Thumb Left
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630603
|
| 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 Thumb Left
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630603
|
| 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 Thumb Left
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630603
|
| 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 Thumb Left
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 FA,TC
|
| Hospital Charge Code |
1537044
|
|
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 Thumb Left
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 FA,TC
|
| Hospital Charge Code |
1537044
|
|
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 Thumb Right
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630599
|
| 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 Thumb Right
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F5,TC
|
| Hospital Charge Code |
1537046
|
|
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 Thumb Right
|
Facility
|
IP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630599
|
| 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 Thumb Right
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
CPT 73140 F5,TC
|
| Hospital Charge Code |
1537046
|
|
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 Thumb Right
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 73140 F5,TC
|
| Hospital Charge Code |
1537046
|
|
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 Thumb Right
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630599
|
| 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 Fluoro Guidance Needle Loc Spine
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
630591
|
| Min. Negotiated Rate |
$103.90 |
| Max. Negotiated Rate |
$1,186.59 |
| Rate for Payer: Aetna Commercial |
$1,186.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,074.17
|
| Rate for Payer: Aetna Managed Medicare |
$103.90
|
| Rate for Payer: Anthem Medicare Advantage |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$103.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$103.90
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cigna Commercial |
$1,186.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$624.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.90
|
| Rate for Payer: Health EOS Commercial |
$1,136.63
|
| Rate for Payer: HFN Commercial |
$1,186.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$103.90
|
| Rate for Payer: Multiplan Commercial |
$999.23
|
| Rate for Payer: NAPHCARE Commercial |
$155.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.59
|
| Rate for Payer: Quartz Beloit One Network |
$549.58
|
| Rate for Payer: Quartz Commercial |
$711.95
|
| Rate for Payer: Quartz Medicare Advantage |
$103.90
|
| Rate for Payer: The Alliance Commercial |
$394.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.90
|
| Rate for Payer: WEA Trust Commercial |
$686.97
|
| Rate for Payer: WPS Commercial |
$519.48
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
|
OP
|
$1,201.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
630591
|
| Min. Negotiated Rate |
$349.73 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$1,124.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,074.17
|
| Rate for Payer: Aetna Managed Medicare |
$349.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$811.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$624.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$599.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.99
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cigna Commercial |
$1,149.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$698.98
|
| Rate for Payer: Health EOS Commercial |
$1,111.65
|
| Rate for Payer: HFN Commercial |
$1,149.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$936.78
|
| Rate for Payer: Multiplan Commercial |
$999.23
|
| Rate for Payer: NAPHCARE Commercial |
$749.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,149.12
|
| Rate for Payer: Quartz Beloit One Network |
$612.03
|
| Rate for Payer: Quartz Commercial |
$811.88
|
| Rate for Payer: Quartz Medicare Advantage |
$749.42
|
| Rate for Payer: The Alliance Commercial |
$415.58
|
| Rate for Payer: WEA Trust Commercial |
$686.97
|
| Rate for Payer: WPS Commercial |
$925.13
|
|
|
XR Fluoro Guidance Needle Loc Spine
|
Facility
|
IP
|
$1,201.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
630591
|
| Min. Negotiated Rate |
$612.03 |
| Max. Negotiated Rate |
$1,149.12 |
| Rate for Payer: Aetna Commercial |
$1,124.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,074.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.99
|
| Rate for Payer: Cash Price |
$360.30
|
| Rate for Payer: Cigna Commercial |
$1,149.12
|
| Rate for Payer: Health EOS Commercial |
$1,111.65
|
| Rate for Payer: HFN Commercial |
$1,149.12
|
| Rate for Payer: Multiplan Commercial |
$999.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,149.12
|
| Rate for Payer: Quartz Beloit One Network |
$612.03
|
| Rate for Payer: Quartz Commercial |
$749.42
|
| Rate for Payer: WEA Trust Commercial |
$686.97
|
| Rate for Payer: WPS Commercial |
$925.13
|
|
|
XR Fluoro Guidance Needle Placement
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
630586
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$1,035.42 |
| Rate for Payer: Aetna Commercial |
$1,035.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.33
|
| Rate for Payer: Aetna Managed Medicare |
$120.67
|
| Rate for Payer: Anthem Medicare Advantage |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.67
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$1,035.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$544.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.67
|
| Rate for Payer: Health EOS Commercial |
$991.83
|
| Rate for Payer: HFN Commercial |
$1,035.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.67
|
| Rate for Payer: Multiplan Commercial |
$871.94
|
| Rate for Payer: NAPHCARE Commercial |
$181.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.42
|
| Rate for Payer: Quartz Beloit One Network |
$479.56
|
| Rate for Payer: Quartz Commercial |
$621.25
|
| Rate for Payer: Quartz Medicare Advantage |
$120.67
|
| Rate for Payer: The Alliance Commercial |
$458.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.67
|
| Rate for Payer: WEA Trust Commercial |
$599.46
|
| Rate for Payer: WPS Commercial |
$603.36
|
|
