|
XR Knee Standing AP Bilateral
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
630351
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$638.25 |
| Rate for Payer: Aetna Commercial |
$638.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$41.71
|
| Rate for Payer: Anthem Medicare Advantage |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.71
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$638.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.71
|
| Rate for Payer: Health EOS Commercial |
$611.37
|
| Rate for Payer: HFN Commercial |
$638.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.71
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$62.57
|
| Rate for Payer: Preferred Network Access Commercial |
$638.25
|
| Rate for Payer: Quartz Beloit One Network |
$295.61
|
| Rate for Payer: Quartz Commercial |
$382.95
|
| Rate for Payer: Quartz Medicare Advantage |
$41.71
|
| Rate for Payer: The Alliance Commercial |
$158.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.71
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$208.57
|
|
|
XR Knee Standing AP Bilateral
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
1537168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna Commercial |
$223.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$223.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$213.89
|
| Rate for Payer: HFN Commercial |
$223.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$223.29
|
| Rate for Payer: Quartz Beloit One Network |
$103.42
|
| Rate for Payer: Quartz Commercial |
$133.97
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
XR Knee Standing AP Bilateral
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
1537168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Aetna Managed Medicare |
$65.81
|
| 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 |
$124.57
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.53
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.28
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: NAPHCARE Commercial |
$141.02
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$152.78
|
| Rate for Payer: Quartz Medicare Advantage |
$141.02
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
|
XR Knee Standing AP Right
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.51 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Aetna Managed Medicare |
$148.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.11
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$487.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$472.06
|
| Rate for Payer: HFN Commercial |
$487.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.80
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: NAPHCARE Commercial |
$318.24
|
| Rate for Payer: Preferred Network Access Commercial |
$487.97
|
| Rate for Payer: Quartz Beloit One Network |
$259.90
|
| Rate for Payer: Quartz Commercial |
$344.76
|
| Rate for Payer: Quartz Medicare Advantage |
$318.24
|
| Rate for Payer: The Alliance Commercial |
$265.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
XR Knee Standing AP Right
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,277.03 |
| Rate for Payer: Aetna Commercial |
$503.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$503.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,277.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.24
|
| Rate for Payer: Health EOS Commercial |
$482.66
|
| Rate for Payer: HFN Commercial |
$503.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,191.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,191.08
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$503.88
|
| Rate for Payer: Quartz Beloit One Network |
$233.38
|
| Rate for Payer: Quartz Commercial |
$302.33
|
| Rate for Payer: The Alliance Commercial |
$265.20
|
| Rate for Payer: United Healthcare Medicaid |
$1,277.03
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
XR Knee Standing AP Right
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.90 |
| Max. Negotiated Rate |
$487.97 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.11
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$487.97
|
| Rate for Payer: Health EOS Commercial |
$472.06
|
| Rate for Payer: HFN Commercial |
$487.97
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$487.97
|
| Rate for Payer: Quartz Beloit One Network |
$259.90
|
| Rate for Payer: Quartz Commercial |
$318.24
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
XR Knee Therapeutic Injection Lt
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
5268618
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$493.29 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,585.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.11
|
| Rate for Payer: Aetna Managed Medicare |
$493.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,145.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$880.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$845.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.73
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,620.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,567.97
|
| Rate for Payer: HFN Commercial |
$1,620.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.32
|
| Rate for Payer: Multiplan Commercial |
$1,409.41
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,620.82
|
| Rate for Payer: Quartz Beloit One Network |
$863.26
|
| Rate for Payer: Quartz Commercial |
$1,145.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.06
|
| Rate for Payer: The Alliance Commercial |
$880.88
|
| Rate for Payer: United Healthcare PPO |
$1,321.32
|
| Rate for Payer: WEA Trust Commercial |
$968.97
|
| Rate for Payer: WPS Commercial |
$1,304.89
|
|
|
XR Knee Therapeutic Injection Lt
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
5268618
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$863.26 |
| Max. Negotiated Rate |
$1,620.82 |
| Rate for Payer: Aetna Commercial |
$1,585.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.73
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,620.82
|
| Rate for Payer: Health EOS Commercial |
$1,567.97
|
| Rate for Payer: HFN Commercial |
$1,620.82
|
| Rate for Payer: Multiplan Commercial |
$1,409.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,620.82
|
| Rate for Payer: Quartz Beloit One Network |
$863.26
|
| Rate for Payer: Quartz Commercial |
$1,057.06
|
| Rate for Payer: WEA Trust Commercial |
$968.97
|
| Rate for Payer: WPS Commercial |
$1,304.89
|
|
|
XR Knee Therapeutic Injection Lt
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
5268618
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$1,673.67 |
| Rate for Payer: Aetna Commercial |
$1,673.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.11
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,673.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.06
|
| Rate for Payer: Health EOS Commercial |
$1,603.20
|
| Rate for Payer: HFN Commercial |
$1,673.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$1,409.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.67
|
| Rate for Payer: Quartz Beloit One Network |
$775.17
|
| Rate for Payer: Quartz Commercial |
$1,004.20
|
| Rate for Payer: The Alliance Commercial |
$880.88
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$968.97
|
| Rate for Payer: WPS Commercial |
$1,304.89
|
|
|
XR Knee Therapeutic Injection Rt
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
5268616
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$863.26 |
| Max. Negotiated Rate |
$1,620.82 |
| Rate for Payer: Aetna Commercial |
$1,585.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.73
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,620.82
|
| Rate for Payer: Health EOS Commercial |
$1,567.97
|
| Rate for Payer: HFN Commercial |
$1,620.82
|
| Rate for Payer: Multiplan Commercial |
$1,409.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,620.82
|
| Rate for Payer: Quartz Beloit One Network |
$863.26
|
| Rate for Payer: Quartz Commercial |
$1,057.06
|
| Rate for Payer: WEA Trust Commercial |
$968.97
|
| Rate for Payer: WPS Commercial |
$1,304.89
|
|
|
XR Knee Therapeutic Injection Rt
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
5268616
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$1,673.67 |
| Rate for Payer: Aetna Commercial |
$1,673.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.11
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,673.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.06
|
| Rate for Payer: Health EOS Commercial |
$1,603.20
|
| Rate for Payer: HFN Commercial |
$1,673.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$1,409.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.67
|
| Rate for Payer: Quartz Beloit One Network |
$775.17
|
| Rate for Payer: Quartz Commercial |
$1,004.20
|
| Rate for Payer: The Alliance Commercial |
$880.88
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$968.97
|
| Rate for Payer: WPS Commercial |
$1,304.89
|
|
|
XR Knee Therapeutic Injection Rt
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
5268616
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$493.29 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,585.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.11
|
| Rate for Payer: Aetna Managed Medicare |
$493.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,145.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$880.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$845.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.73
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,620.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,567.97
|
| Rate for Payer: HFN Commercial |
$1,620.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.32
|
| Rate for Payer: Multiplan Commercial |
$1,409.41
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,620.82
|
| Rate for Payer: Quartz Beloit One Network |
$863.26
|
| Rate for Payer: Quartz Commercial |
$1,145.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.06
|
| Rate for Payer: The Alliance Commercial |
$880.88
|
| Rate for Payer: United Healthcare PPO |
$1,321.32
|
| Rate for Payer: WEA Trust Commercial |
$968.97
|
| Rate for Payer: WPS Commercial |
$1,304.89
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630345
|
| Min. Negotiated Rate |
$545.27 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$667.68
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
|
XR Lower Extremity Infant Bilateral
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630345
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$1,057.16 |
| Rate for Payer: Aetna Commercial |
$1,057.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Aetna Managed Medicare |
$30.40
|
| Rate for Payer: Anthem Medicare Advantage |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.40
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,057.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$556.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.40
|
| Rate for Payer: Health EOS Commercial |
$1,012.65
|
| Rate for Payer: HFN Commercial |
$1,057.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,057.16
|
| Rate for Payer: Quartz Beloit One Network |
$489.63
|
| Rate for Payer: Quartz Commercial |
$634.30
|
| Rate for Payer: Quartz Medicare Advantage |
$30.40
|
| Rate for Payer: The Alliance Commercial |
$115.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.40
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$152.00
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630345
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$723.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$556.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$534.14
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| 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 |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| 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 |
$890.24
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$723.32
|
| 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 |
$612.04
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
|
XR Lower Extremity Infant Bilateral
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$549.33 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.94
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| 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 |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
XR Lower Extremity Infant Left
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630343
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$528.58 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$30.40
|
| Rate for Payer: Anthem Medicare Advantage |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.40
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.40
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: Quartz Medicare Advantage |
$30.40
|
| Rate for Payer: The Alliance Commercial |
$115.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.40
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$152.00
|
|
|
XR Lower Extremity Infant Left
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630343
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| 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 |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| 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 |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| 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 |
$306.02
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Lower Extremity Infant Left
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Lower Extremity Infant Left
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$168.02
|
| 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 |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.06
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| Rate for Payer: Quartz Medicare Advantage |
$360.05
|
| Rate for Payer: The Alliance Commercial |
$300.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Lower Extremity Infant Left
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537174
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.05
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: The Alliance Commercial |
$300.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Lower Extremity Infant Left
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630343
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Lower Extremity Infant Right
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 73592 RT,TC
|
| Hospital Charge Code |
1537176
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.05
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: The Alliance Commercial |
$300.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
