|
XR Femur 1 View Left
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4590783
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$429.40 |
| Rate for Payer: Aetna Commercial |
$429.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$429.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.20
|
| Rate for Payer: Health EOS Commercial |
$411.32
|
| Rate for Payer: HFN Commercial |
$429.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.33
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Preferred Network Access Commercial |
$429.40
|
| Rate for Payer: Quartz Beloit One Network |
$198.88
|
| Rate for Payer: Quartz Commercial |
$257.64
|
| Rate for Payer: The Alliance Commercial |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
XR Femur 1 View Left
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4590783
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$271.20
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
XR Femur 1 View Rt
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
XR Femur 1 View Rt
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: Aetna Commercial |
$413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.00
|
| Rate for Payer: Health EOS Commercial |
$395.85
|
| Rate for Payer: HFN Commercial |
$413.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.33
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$413.25
|
| Rate for Payer: Quartz Beloit One Network |
$191.40
|
| Rate for Payer: Quartz Commercial |
$247.95
|
| Rate for Payer: The Alliance Commercial |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
XR Femur 1 View Rt
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
XR Femur Bilateral
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$523.81 |
| Max. Negotiated Rate |
$983.48 |
| Rate for Payer: Aetna Commercial |
$962.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.57
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$983.48
|
| Rate for Payer: Health EOS Commercial |
$951.41
|
| Rate for Payer: HFN Commercial |
$983.48
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: NAPHCARE Commercial |
$641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$983.48
|
| Rate for Payer: Quartz Beloit One Network |
$523.81
|
| Rate for Payer: Quartz Commercial |
$641.40
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
XR Femur Bilateral
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Bilateral
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Bilateral
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$299.32 |
| Max. Negotiated Rate |
$4,276.00 |
| Rate for Payer: Aetna Commercial |
$962.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Aetna Managed Medicare |
$299.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$694.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$534.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.57
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$983.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.21
|
| Rate for Payer: Health EOS Commercial |
$951.41
|
| Rate for Payer: HFN Commercial |
$983.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.75
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: NAPHCARE Commercial |
$641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$983.48
|
| Rate for Payer: Quartz Beloit One Network |
$523.81
|
| Rate for Payer: Quartz Commercial |
$694.85
|
| Rate for Payer: Quartz Medicare Advantage |
$641.40
|
| Rate for Payer: The Alliance Commercial |
$4,276.00
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
XR Femur Bilateral
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: HFN Commercial |
$678.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Bilateral
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$470.36 |
| Max. Negotiated Rate |
$1,015.55 |
| Rate for Payer: Aetna Commercial |
$1,015.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.34
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,015.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$534.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.40
|
| Rate for Payer: Health EOS Commercial |
$972.79
|
| Rate for Payer: HFN Commercial |
$1,015.55
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.55
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$609.33
|
| Rate for Payer: The Alliance Commercial |
$534.50
|
| Rate for Payer: WEA Trust Commercial |
$587.95
|
| Rate for Payer: WPS Commercial |
$791.81
|
|
|
XR Femur Left
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: HFN Commercial |
$678.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Left
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$598.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.00
|
| Rate for Payer: Health EOS Commercial |
$573.30
|
| Rate for Payer: HFN Commercial |
$598.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.20
|
| Rate for Payer: Quartz Commercial |
$359.10
|
| Rate for Payer: The Alliance Commercial |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
XR Femur Left
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Left
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
XR Femur Left
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$302.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$409.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
XR Femur Left
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Femur Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Femur Right
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$235.40 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$508.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.00
|
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: HFN Commercial |
$508.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$508.25
|
| Rate for Payer: Quartz Beloit One Network |
$235.40
|
| Rate for Payer: Quartz Commercial |
$304.95
|
| Rate for Payer: The Alliance Commercial |
$267.50
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
XR Femur Right
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: HFN Commercial |
$678.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
XR Femur Right
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.21 |
| Max. Negotiated Rate |
$678.30 |
| Rate for Payer: Aetna Commercial |
$678.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$678.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.40
|
| Rate for Payer: Health EOS Commercial |
$649.74
|
| Rate for Payer: HFN Commercial |
$678.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.21
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.16
|
| Rate for Payer: Quartz Commercial |
$406.98
|
| Rate for Payer: The Alliance Commercial |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
