|
XR Hip Complete Left
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
1537110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: HFN Commercial |
$713.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.79
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip Complete Left
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
1537110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip Complete Left
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
1537110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| 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 |
$398.03
|
| 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 |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| 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 |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| 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 |
$413.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip Complete Right
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
1537112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip Complete Right
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
1537112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| 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 |
$398.03
|
| 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 |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| 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 |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| 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 |
$413.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip Complete Right
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
1537112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: HFN Commercial |
$713.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.79
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip Operative Bilateral
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$1,140.80 |
| Rate for Payer: Aetna Commercial |
$1,116.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.20
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,140.80
|
| Rate for Payer: Health EOS Commercial |
$1,103.60
|
| Rate for Payer: HFN Commercial |
$1,140.80
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: NAPHCARE Commercial |
$744.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.80
|
| Rate for Payer: Quartz Beloit One Network |
$607.60
|
| Rate for Payer: Quartz Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$682.00
|
| Rate for Payer: WPS Commercial |
$918.47
|
|
|
XR Hip Operative Bilateral
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| 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 |
$341.85
|
| 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 |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| 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 |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$419.25
|
| 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 |
$354.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
XR Hip Operative Bilateral
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.05 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$387.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
XR Hip Operative Bilateral
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna Commercial |
$612.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$612.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.00
|
| Rate for Payer: Health EOS Commercial |
$586.95
|
| Rate for Payer: HFN Commercial |
$612.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$612.75
|
| Rate for Payer: Quartz Beloit One Network |
$283.80
|
| Rate for Payer: Quartz Commercial |
$367.65
|
| Rate for Payer: The Alliance Commercial |
$322.50
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
XR Hip Operative Bilateral
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,140.80 |
| Rate for Payer: Aetna Commercial |
$1,116.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.40
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$806.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$620.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$595.20
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.20
|
| 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 |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,140.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$693.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$1,103.60
|
| Rate for Payer: HFN Commercial |
$1,140.80
|
| 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 |
$992.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.80
|
| Rate for Payer: Quartz Beloit One Network |
$607.60
|
| Rate for Payer: Quartz Commercial |
$806.00
|
| 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 |
$682.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$918.47
|
|
|
XR Hip Operative Bilateral
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$1,178.00 |
| Rate for Payer: Aetna Commercial |
$1,178.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.40
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,178.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$620.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.00
|
| Rate for Payer: Health EOS Commercial |
$1,128.40
|
| Rate for Payer: HFN Commercial |
$1,178.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.00
|
| Rate for Payer: Quartz Beloit One Network |
$545.60
|
| Rate for Payer: Quartz Commercial |
$706.80
|
| Rate for Payer: The Alliance Commercial |
$620.00
|
| Rate for Payer: WEA Trust Commercial |
$682.00
|
| Rate for Payer: WPS Commercial |
$918.47
|
|
|
XR Hip Operative Left
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.40
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: HFN Commercial |
$412.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: The Alliance Commercial |
$217.00
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Hip Operative Left
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| 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 |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| 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 |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| 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 |
$341.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Hip Operative Left
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| 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 |
$230.02
|
| 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 |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| 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 |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| 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 |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Hip Operative Left
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$589.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.00
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| Rate for Payer: HFN Commercial |
$589.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$589.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.80
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$310.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Hip Operative Left
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Hip Operative Left
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Hip Operative Right
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| 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 |
$230.02
|
| 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 |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| 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 |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| 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 |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Hip Operative Right
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
2980054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.05 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$387.00
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
XR Hip Operative Right
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| 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 |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| 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 |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| 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 |
$341.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Hip Operative Right
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Hip Operative Right
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Hip Operative Right
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
2980054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna Commercial |
$612.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$612.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.00
|
| Rate for Payer: Health EOS Commercial |
$586.95
|
| Rate for Payer: HFN Commercial |
$612.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$612.75
|
| Rate for Payer: Quartz Beloit One Network |
$283.80
|
| Rate for Payer: Quartz Commercial |
$367.65
|
| Rate for Payer: The Alliance Commercial |
$322.50
|
| Rate for Payer: WEA Trust Commercial |
$354.75
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
|
XR Hip Operative Right
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
2980054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$593.40 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| 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 |
$341.85
|
| 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 |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$593.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| 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 |
$516.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$593.40
|
| Rate for Payer: Quartz Beloit One Network |
$316.05
|
| Rate for Payer: Quartz Commercial |
$419.25
|
| 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 |
$354.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$477.75
|
|
