|
XR Toes Great Right
|
Facility
IP
|
$402.00
|
|
|
Service Code
|
CPT 73660 TC,T5
|
| Hospital Charge Code |
1537415
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$369.84 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$241.20
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes Great Right
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629858
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Toes Great Right
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629858
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.12
|
| Rate for Payer: Anthem Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.12
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.12
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.12
|
| Rate for Payer: The Alliance Commercial |
$106.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.12
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$140.60
|
|
|
XR Toes Great Right
|
Facility
OP
|
$402.00
|
|
|
Service Code
|
CPT 73660 TC,T5
|
| Hospital Charge Code |
1537415
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Aetna Managed Medicare |
$112.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.50
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$261.30
|
| Rate for Payer: Quartz Medicare Advantage |
$241.20
|
| Rate for Payer: The Alliance Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes Great Right
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629858
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| 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 |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$515.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Trauma Chest 1 View, Pelvis 1 View
|
Facility
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6182034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Trauma Chest 1 View, Pelvis 1 View
|
Professional
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6182034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Medicare Advantage |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.52
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.52
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Preferred Network Access Commercial |
$459.80
|
| Rate for Payer: Quartz Beloit One Network |
$212.96
|
| Rate for Payer: Quartz Commercial |
$275.88
|
| Rate for Payer: Quartz Medicare Advantage |
$16.52
|
| Rate for Payer: The Alliance Commercial |
$62.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.52
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
XR Trauma Chest 1 View, Pelvis 1 View
|
Facility
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6182034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Upper Extremity Infant Bilateral
|
Facility
IP
|
$922.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613588
|
| Min. Negotiated Rate |
$451.78 |
| Max. Negotiated Rate |
$848.24 |
| Rate for Payer: Aetna Commercial |
$829.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.66
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$848.24
|
| Rate for Payer: Health EOS Commercial |
$820.58
|
| Rate for Payer: HFN Commercial |
$848.24
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: NAPHCARE Commercial |
$553.20
|
| Rate for Payer: Preferred Network Access Commercial |
$848.24
|
| Rate for Payer: Quartz Beloit One Network |
$451.78
|
| Rate for Payer: Quartz Commercial |
$553.20
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
|
XR Upper Extremity Infant Bilateral
|
Professional
|
$922.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613588
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Aetna Commercial |
$875.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Aetna Managed Medicare |
$30.42
|
| Rate for Payer: Anthem Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.42
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$875.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$461.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.42
|
| Rate for Payer: Health EOS Commercial |
$839.02
|
| 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: Independent Care Health Plan Medicare |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: Preferred Network Access Commercial |
$875.90
|
| Rate for Payer: Quartz Beloit One Network |
$405.68
|
| Rate for Payer: Quartz Commercial |
$525.54
|
| Rate for Payer: Quartz Medicare Advantage |
$30.42
|
| Rate for Payer: The Alliance Commercial |
$115.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.42
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$152.10
|
|
|
XR Upper Extremity Infant Bilateral
|
Facility
OP
|
$922.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613588
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$902.80 |
| Rate for Payer: Aetna Commercial |
$829.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.56
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$848.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$820.58
|
| Rate for Payer: HFN Commercial |
$848.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$848.24
|
| Rate for Payer: Quartz Beloit One Network |
$451.78
|
| Rate for Payer: Quartz Commercial |
$599.30
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$902.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
|
XR Upper Extremity Infant Bilateral
|
Facility
OP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$1,916.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.25
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$287.40
|
| Rate for Payer: The Alliance Commercial |
$1,916.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Bilateral
|
Professional
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.76 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna Commercial |
$455.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$455.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.40
|
| Rate for Payer: Health EOS Commercial |
$435.89
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$455.05
|
| Rate for Payer: Quartz Beloit One Network |
$210.76
|
| Rate for Payer: Quartz Commercial |
$273.03
|
| Rate for Payer: The Alliance Commercial |
$239.50
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Bilateral
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Left
|
Professional
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.76 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna Commercial |
$455.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$455.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.40
|
| Rate for Payer: Health EOS Commercial |
$435.89
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$455.05
|
| Rate for Payer: Quartz Beloit One Network |
$210.76
|
| Rate for Payer: Quartz Commercial |
$273.03
|
| Rate for Payer: The Alliance Commercial |
$239.50
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Left
|
Professional
|
$461.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613590
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Aetna Commercial |
$437.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$30.42
|
| Rate for Payer: Anthem Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.42
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$437.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.42
|
| Rate for Payer: Health EOS Commercial |
$419.51
|
| 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: Independent Care Health Plan Medicare |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Preferred Network Access Commercial |
$437.95
|
| Rate for Payer: Quartz Beloit One Network |
$202.84
|
| Rate for Payer: Quartz Commercial |
$262.77
|
| Rate for Payer: Quartz Medicare Advantage |
$30.42
|
| Rate for Payer: The Alliance Commercial |
$115.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.42
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$152.10
|
|
|
XR Upper Extremity Infant Left
|
Facility
IP
|
$461.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613590
|
| Min. Negotiated Rate |
$225.89 |
| Max. Negotiated Rate |
$424.12 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.33
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$424.12
|
| Rate for Payer: Health EOS Commercial |
$410.29
|
| Rate for Payer: HFN Commercial |
$424.12
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: NAPHCARE Commercial |
$276.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.12
|
| Rate for Payer: Quartz Beloit One Network |
$225.89
|
| Rate for Payer: Quartz Commercial |
$276.60
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
|
XR Upper Extremity Infant Left
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Left
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613590
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$902.80 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.28
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$424.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$410.29
|
| Rate for Payer: HFN Commercial |
$424.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$424.12
|
| Rate for Payer: Quartz Beloit One Network |
$225.89
|
| Rate for Payer: Quartz Commercial |
$299.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$902.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
|
XR Upper Extremity Infant Left
|
Facility
OP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$1,916.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.25
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$287.40
|
| Rate for Payer: The Alliance Commercial |
$1,916.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Right
|
Facility
OP
|
$508.00
|
|
|
Service Code
|
CPT 73092 RT,TC
|
| Hospital Charge Code |
1537437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.24 |
| Max. Negotiated Rate |
$2,032.00 |
| Rate for Payer: Aetna Commercial |
$457.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Aetna Managed Medicare |
$142.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$243.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.24
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$467.36
|
| Rate for Payer: Health EOS Commercial |
$452.12
|
| Rate for Payer: HFN Commercial |
$467.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$381.00
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: NAPHCARE Commercial |
$304.80
|
| Rate for Payer: Preferred Network Access Commercial |
$467.36
|
| Rate for Payer: Quartz Beloit One Network |
$248.92
|
| Rate for Payer: Quartz Commercial |
$330.20
|
| Rate for Payer: Quartz Medicare Advantage |
$304.80
|
| Rate for Payer: The Alliance Commercial |
$2,032.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
|
XR Upper Extremity Infant Right
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 73092 TC,RT
|
| Hospital Charge Code |
2980000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
XR Upper Extremity Infant Right
|
Professional
|
$470.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613592
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Aetna Managed Medicare |
$30.42
|
| Rate for Payer: Anthem Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.42
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$446.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.42
|
| Rate for Payer: Health EOS Commercial |
$427.70
|
| 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: Independent Care Health Plan Medicare |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Preferred Network Access Commercial |
$446.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.80
|
| Rate for Payer: Quartz Commercial |
$267.90
|
| Rate for Payer: Quartz Medicare Advantage |
$30.42
|
| Rate for Payer: The Alliance Commercial |
$115.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.42
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$152.10
|
|
|
XR Upper Extremity Infant Right
|
Facility
IP
|
$508.00
|
|
|
Service Code
|
CPT 73092 RT,TC
|
| Hospital Charge Code |
1537437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$467.36 |
| Rate for Payer: Aetna Commercial |
$457.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.24
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$467.36
|
| Rate for Payer: Health EOS Commercial |
$452.12
|
| Rate for Payer: HFN Commercial |
$467.36
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: NAPHCARE Commercial |
$304.80
|
| Rate for Payer: Preferred Network Access Commercial |
$467.36
|
| Rate for Payer: Quartz Beloit One Network |
$248.92
|
| Rate for Payer: Quartz Commercial |
$304.80
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
|
XR Upper Extremity Infant Right
|
Professional
|
$508.00
|
|
|
Service Code
|
CPT 73092 RT,TC
|
| Hospital Charge Code |
1537437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.52 |
| Max. Negotiated Rate |
$482.60 |
| Rate for Payer: Aetna Commercial |
$482.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$482.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.80
|
| Rate for Payer: Health EOS Commercial |
$462.28
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$482.60
|
| Rate for Payer: Quartz Beloit One Network |
$223.52
|
| Rate for Payer: Quartz Commercial |
$289.56
|
| Rate for Payer: The Alliance Commercial |
$254.00
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
