|
XR Hand Complete Bilateral
|
Professional
|
Both
|
$1,022.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630483
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$1,009.74 |
| Rate for Payer: Aetna Commercial |
$1,009.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.08
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$1,009.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$967.22
|
| Rate for Payer: HFN Commercial |
$1,009.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$850.30
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,009.74
|
| Rate for Payer: Quartz Beloit One Network |
$467.67
|
| Rate for Payer: Quartz Commercial |
$605.84
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$143.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: WEA Trust Commercial |
$584.58
|
| Rate for Payer: WPS Commercial |
$188.66
|
|
|
XR Hand Complete Bilateral
|
Facility
|
OP
|
$1,022.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630483
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$977.85 |
| Rate for Payer: Aetna Commercial |
$956.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.18
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.33
|
| 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 |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cigna Commercial |
$977.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$945.96
|
| Rate for Payer: HFN Commercial |
$977.85
|
| 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 |
$850.30
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$977.85
|
| Rate for Payer: Quartz Beloit One Network |
$520.81
|
| Rate for Payer: Quartz Commercial |
$690.87
|
| 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 |
$584.58
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$787.25
|
|
|
XR Hand Complete Left
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$544.39 |
| Rate for Payer: Aetna Commercial |
$544.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$544.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.82
|
| Rate for Payer: Health EOS Commercial |
$521.47
|
| Rate for Payer: HFN Commercial |
$544.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$544.39
|
| Rate for Payer: Quartz Beloit One Network |
$252.14
|
| Rate for Payer: Quartz Commercial |
$326.63
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Left
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630479
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$504.87 |
| Rate for Payer: Aetna Commercial |
$504.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$504.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$483.61
|
| Rate for Payer: HFN Commercial |
$504.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$504.87
|
| Rate for Payer: Quartz Beloit One Network |
$233.83
|
| Rate for Payer: Quartz Commercial |
$302.92
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$143.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$188.66
|
|
|
XR Hand Complete Left
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Left
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 LT,TC
|
| Hospital Charge Code |
1537098
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| 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 |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Left
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630479
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.09
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| 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 |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| 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 |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$345.44
|
| 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 |
$292.29
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
XR Hand Complete Left
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630479
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$318.86
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
XR Hand Complete Right
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$504.87 |
| Rate for Payer: Aetna Commercial |
$504.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$504.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$483.61
|
| Rate for Payer: HFN Commercial |
$504.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$504.87
|
| Rate for Payer: Quartz Beloit One Network |
$233.83
|
| Rate for Payer: Quartz Commercial |
$302.92
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$143.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$188.66
|
|
|
XR Hand Complete Right
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 TC,RT
|
| Hospital Charge Code |
2980004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| 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 |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Right
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.09
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| 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 |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| 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 |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$345.44
|
| 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 |
$292.29
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
XR Hand Complete Right
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$544.39 |
| Rate for Payer: Aetna Commercial |
$544.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$544.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.82
|
| Rate for Payer: Health EOS Commercial |
$521.47
|
| Rate for Payer: HFN Commercial |
$544.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$544.39
|
| Rate for Payer: Quartz Beloit One Network |
$252.14
|
| Rate for Payer: Quartz Commercial |
$326.63
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Right
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| 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 |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Right
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Right
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$318.86
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
XR Hand Complete Right
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 73130 TC,RT
|
| Hospital Charge Code |
2980004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$544.39 |
| Rate for Payer: Aetna Commercial |
$544.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$544.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.82
|
| Rate for Payer: Health EOS Commercial |
$521.47
|
| Rate for Payer: HFN Commercial |
$544.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$544.39
|
| Rate for Payer: Quartz Beloit One Network |
$252.14
|
| Rate for Payer: Quartz Commercial |
$326.63
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Right
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 73130 TC,RT
|
| Hospital Charge Code |
2980004
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hip 1 View Left
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$294.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$271.44
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$271.44
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Hip 1 View Left
|
Professional
|
Both
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$199.06 |
| Max. Negotiated Rate |
$429.78 |
| Rate for Payer: Aetna Commercial |
$429.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$429.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.44
|
| Rate for Payer: Health EOS Commercial |
$411.68
|
| Rate for Payer: HFN Commercial |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$429.78
|
| Rate for Payer: Quartz Beloit One Network |
$199.06
|
| Rate for Payer: Quartz Commercial |
$257.87
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Hip 1 View Left
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.88
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Left
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Hip 1 View Left
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| 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 |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Left
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Right
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.88
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Right
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| 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 |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
