|
XR Sternoclavicular Joint(s)
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$590.82 |
| Rate for Payer: Aetna Commercial |
$590.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$590.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$565.95
|
| Rate for Payer: HFN Commercial |
$590.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$590.82
|
| Rate for Payer: Quartz Beloit One Network |
$273.64
|
| Rate for Payer: Quartz Commercial |
$354.49
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$531.02 |
| Rate for Payer: Aetna Commercial |
$519.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.39
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.06
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.92
|
| 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 |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$531.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$513.71
|
| Rate for Payer: HFN Commercial |
$531.02
|
| 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 |
$461.76
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$531.02
|
| Rate for Payer: Quartz Beloit One Network |
$282.83
|
| Rate for Payer: Quartz Commercial |
$375.18
|
| 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 |
$317.46
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$427.52
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| 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 |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$93.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
XR Sternum Minimum 2 Views
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$23.40
|
| Rate for Payer: Anthem Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.40
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.40
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$35.10
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$23.40
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$117.00
|
|
|
XR Sternum Minimum 2 Views
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$454.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Aetna Managed Medicare |
$32.78
|
| Rate for Payer: Anthem Medicare Advantage |
$32.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.78
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.78
|
| Rate for Payer: Health EOS Commercial |
$435.34
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: NAPHCARE Commercial |
$49.17
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$210.50
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: Quartz Medicare Advantage |
$32.78
|
| Rate for Payer: The Alliance Commercial |
$124.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.78
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$163.90
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.63
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| 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 |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| 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 |
$382.72
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$310.96
|
| 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 |
$263.12
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
XR Swallow Function w/Video Pediatric
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$322.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.27
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$863.46
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$690.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$748.33
|
| Rate for Payer: Quartz Medicare Advantage |
$690.77
|
| Rate for Payer: The Alliance Commercial |
$379.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
XR Swallow Function w/Video Pediatric
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.13 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$690.77
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
XR Swallow Function w/Video Pediatric
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.95 |
| Max. Negotiated Rate |
$1,093.72 |
| Rate for Payer: Aetna Commercial |
$1,093.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$94.95
|
| Rate for Payer: Anthem Medicare Advantage |
$94.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.95
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,093.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$575.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.95
|
| Rate for Payer: Health EOS Commercial |
$1,047.66
|
| Rate for Payer: HFN Commercial |
$1,093.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.95
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$142.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,093.72
|
| Rate for Payer: Quartz Beloit One Network |
$506.56
|
| Rate for Payer: Quartz Commercial |
$656.23
|
| Rate for Payer: Quartz Medicare Advantage |
$94.95
|
| Rate for Payer: The Alliance Commercial |
$360.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.95
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$474.76
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$495.21
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$577.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$670.59
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
|
XR Swallowing Function w/ Video
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
1537377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$1,093.72 |
| Rate for Payer: Aetna Commercial |
$1,093.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$119.65
|
| Rate for Payer: Anthem Medicare Advantage |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.65
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,093.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$575.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.65
|
| Rate for Payer: Health EOS Commercial |
$1,047.66
|
| Rate for Payer: HFN Commercial |
$1,093.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$471.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$471.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.65
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$179.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,093.72
|
| Rate for Payer: Quartz Beloit One Network |
$506.56
|
| Rate for Payer: Quartz Commercial |
$656.23
|
| Rate for Payer: Quartz Medicare Advantage |
$119.65
|
| Rate for Payer: The Alliance Commercial |
$454.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.65
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$598.26
|
|
|
XR Swallowing Function w/ Video
|
Professional
|
Both
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$980.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Aetna Managed Medicare |
$119.65
|
| Rate for Payer: Anthem Medicare Advantage |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.65
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$980.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$515.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.65
|
| Rate for Payer: Health EOS Commercial |
$938.83
|
| Rate for Payer: HFN Commercial |
$980.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$471.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$471.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.65
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: NAPHCARE Commercial |
$179.48
|
| Rate for Payer: Preferred Network Access Commercial |
$980.10
|
| Rate for Payer: Quartz Beloit One Network |
$453.94
|
| Rate for Payer: Quartz Commercial |
$588.06
|
| Rate for Payer: Quartz Medicare Advantage |
$119.65
|
| Rate for Payer: The Alliance Commercial |
$454.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.65
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$598.26
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
1537377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.13 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$690.77
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$505.52 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$619.01
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
1537377
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$748.33
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
XR Tibia/Fibula Bilateral
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$598.73 |
| Rate for Payer: Aetna Commercial |
$598.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$598.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.14
|
| Rate for Payer: Health EOS Commercial |
$573.52
|
| Rate for Payer: HFN Commercial |
$598.73
|
| 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 |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$598.73
|
| Rate for Payer: Quartz Beloit One Network |
$277.31
|
| Rate for Payer: Quartz Commercial |
$359.24
|
| Rate for Payer: The Alliance Commercial |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.82 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$378.14
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537391
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Aetna Managed Medicare |
$176.47
|
| 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 |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.69
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.68
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: NAPHCARE Commercial |
$378.14
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$409.66
|
| Rate for Payer: Quartz Medicare Advantage |
$378.14
|
| Rate for Payer: The Alliance Commercial |
$315.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR Tibia/Fibula Bilateral
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629946
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$1,109.52 |
| Rate for Payer: Aetna Commercial |
$1,109.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,004.41
|
| Rate for Payer: Aetna Managed Medicare |
$31.06
|
| Rate for Payer: Anthem Medicare Advantage |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.06
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,109.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$583.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.06
|
| Rate for Payer: Health EOS Commercial |
$1,062.81
|
| Rate for Payer: HFN Commercial |
$1,109.52
|
| 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 |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$934.34
|
| Rate for Payer: NAPHCARE Commercial |
$46.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.52
|
| Rate for Payer: Quartz Beloit One Network |
$513.88
|
| Rate for Payer: Quartz Commercial |
$665.71
|
| Rate for Payer: Quartz Medicare Advantage |
$31.06
|
| Rate for Payer: The Alliance Commercial |
$118.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.06
|
| Rate for Payer: WEA Trust Commercial |
$642.36
|
| Rate for Payer: WPS Commercial |
$155.32
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629946
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,074.49 |
| Rate for Payer: Aetna Commercial |
$1,051.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,004.41
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$759.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$583.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$560.60
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.00
|
| 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 |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,074.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$653.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,039.45
|
| Rate for Payer: HFN Commercial |
$1,074.49
|
| 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 |
$934.34
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,074.49
|
| Rate for Payer: Quartz Beloit One Network |
$572.28
|
| Rate for Payer: Quartz Commercial |
$759.15
|
| 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 |
$642.36
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$865.05
|
|
|
XR Tibia/Fibula Bilateral
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
629946
|
| Min. Negotiated Rate |
$572.28 |
| Max. Negotiated Rate |
$1,074.49 |
| Rate for Payer: Aetna Commercial |
$1,051.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,004.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$619.00
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,074.49
|
| Rate for Payer: Health EOS Commercial |
$1,039.45
|
| Rate for Payer: HFN Commercial |
$1,074.49
|
| Rate for Payer: Multiplan Commercial |
$934.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,074.49
|
| Rate for Payer: Quartz Beloit One Network |
$572.28
|
| Rate for Payer: Quartz Commercial |
$700.75
|
| Rate for Payer: WEA Trust Commercial |
$642.36
|
| Rate for Payer: WPS Commercial |
$865.05
|
|
|
XR Tibia/Fibula Left
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73590 LT,TC
|
| Hospital Charge Code |
1537393
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.82 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$378.14
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
