|
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 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 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
|
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 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
|
$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 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
|
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
|
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
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
1537052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
1537052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$482.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
630586
|
| Min. Negotiated Rate |
$305.18 |
| Max. Negotiated Rate |
$1,002.73 |
| Rate for Payer: Aetna Commercial |
$980.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.33
|
| Rate for Payer: Aetna Managed Medicare |
$305.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$523.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.66
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$1,002.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$609.94
|
| Rate for Payer: Health EOS Commercial |
$970.03
|
| Rate for Payer: HFN Commercial |
$1,002.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.44
|
| Rate for Payer: Multiplan Commercial |
$871.94
|
| Rate for Payer: NAPHCARE Commercial |
$653.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,002.73
|
| Rate for Payer: Quartz Beloit One Network |
$534.06
|
| Rate for Payer: Quartz Commercial |
$708.45
|
| Rate for Payer: Quartz Medicare Advantage |
$653.95
|
| Rate for Payer: The Alliance Commercial |
$482.68
|
| Rate for Payer: WEA Trust Commercial |
$599.46
|
| Rate for Payer: WPS Commercial |
$807.27
|
|
|
XR Fluoro Guidance Needle Placement
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
4586611
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.62 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$93.62
|
| Rate for Payer: Anthem Medicare Advantage |
$93.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.62
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.62
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.62
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$140.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: Quartz Medicare Advantage |
$93.62
|
| Rate for Payer: The Alliance Commercial |
$355.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.62
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$468.10
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
4586611
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$374.48
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Fluoro Guidance Needle Placement
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
1537052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| 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 |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.67
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| 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 |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$181.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| 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 |
$648.08
|
| Rate for Payer: WPS Commercial |
$603.36
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
630586
|
| Min. Negotiated Rate |
$534.06 |
| Max. Negotiated Rate |
$1,002.73 |
| Rate for Payer: Aetna Commercial |
$980.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$937.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.66
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$1,002.73
|
| Rate for Payer: Health EOS Commercial |
$970.03
|
| Rate for Payer: HFN Commercial |
$1,002.73
|
| Rate for Payer: Multiplan Commercial |
$871.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,002.73
|
| Rate for Payer: Quartz Beloit One Network |
$534.06
|
| Rate for Payer: Quartz Commercial |
$653.95
|
| Rate for Payer: WEA Trust Commercial |
$599.46
|
| Rate for Payer: WPS Commercial |
$807.27
|
|
|
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
|
|
|
XR Fluoro Guidance Needle Placement
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
4586611
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR Fluoro Guidance Venous Access
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
3511537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,152.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Aetna Managed Medicare |
$358.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.53
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,177.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.44
|
| Rate for Payer: Health EOS Commercial |
$1,139.41
|
| Rate for Payer: HFN Commercial |
$1,177.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.18
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: NAPHCARE Commercial |
$768.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.82
|
| Rate for Payer: Quartz Beloit One Network |
$627.32
|
| Rate for Payer: Quartz Commercial |
$832.16
|
| Rate for Payer: Quartz Medicare Advantage |
$768.14
|
| Rate for Payer: The Alliance Commercial |
$390.33
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$948.24
|
|
|
XR Fluoro Guidance Venous Access
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
3511537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.58 |
| Max. Negotiated Rate |
$1,216.23 |
| Rate for Payer: Aetna Commercial |
$1,216.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Aetna Managed Medicare |
$97.58
|
| Rate for Payer: Anthem Medicare Advantage |
$97.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.58
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,216.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$640.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.58
|
| Rate for Payer: Health EOS Commercial |
$1,165.02
|
| Rate for Payer: HFN Commercial |
$1,216.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$361.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.58
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: NAPHCARE Commercial |
$146.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,216.23
|
| Rate for Payer: Quartz Beloit One Network |
$563.31
|
| Rate for Payer: Quartz Commercial |
$729.74
|
| Rate for Payer: Quartz Medicare Advantage |
$97.58
|
| Rate for Payer: The Alliance Commercial |
$370.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.58
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$487.92
|
|
|
XR Fluoro Guidance Venous Access
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
3511537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$627.32 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,152.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.53
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,177.82
|
| Rate for Payer: Health EOS Commercial |
$1,139.41
|
| Rate for Payer: HFN Commercial |
$1,177.82
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.82
|
| Rate for Payer: Quartz Beloit One Network |
$627.32
|
| Rate for Payer: Quartz Commercial |
$768.14
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$948.24
|
|
|
XR Fluoro Guided Midline
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$551.39 |
| Max. Negotiated Rate |
$1,035.26 |
| Rate for Payer: Aetna Commercial |
$1,012.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$596.40
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,035.26
|
| Rate for Payer: Health EOS Commercial |
$1,001.50
|
| Rate for Payer: HFN Commercial |
$1,035.26
|
| Rate for Payer: Multiplan Commercial |
$900.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,035.26
|
| Rate for Payer: Quartz Beloit One Network |
$551.39
|
| Rate for Payer: Quartz Commercial |
$675.17
|
| Rate for Payer: WEA Trust Commercial |
$618.90
|
| Rate for Payer: WPS Commercial |
$833.46
|
|
