|
XR OR Finger
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724196
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Fluoroscopy Up to 1 Hour
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6210076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Fluoroscopy Up to 1 Hour
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6210076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Fluoroscopy Up to 1 Hour
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6210076
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Foot
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Foot
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Foot
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724199
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Forearm
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Forearm
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Forearm
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724202
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Hand
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Hand
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Hand
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724205
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Hip
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724208
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Hip
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724208
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$716.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$551.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.15
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$826.80
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Hip
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724208
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Humerus
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Humerus
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Humerus
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Interstim
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6210079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Interstim
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6210079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Interstim
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6210079
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Knee
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Knee
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Knee
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
