|
XR Hip Bilateral w/Pelvis
|
Professional
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$720.10 |
| Rate for Payer: Aetna Commercial |
$720.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$720.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$689.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$720.10
|
| Rate for Payer: Quartz Beloit One Network |
$333.52
|
| Rate for Payer: Quartz Commercial |
$432.06
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$111.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$147.00
|
|
|
XR Hip Bilateral w/Pelvis
|
Facility
IP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.42 |
| Max. Negotiated Rate |
$697.36 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$454.80
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
XR Hip Complete Bilateral
|
Professional
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$720.10 |
| Rate for Payer: Aetna Commercial |
$720.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$720.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$689.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$720.10
|
| Rate for Payer: Quartz Beloit One Network |
$333.52
|
| Rate for Payer: Quartz Commercial |
$432.06
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$111.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$147.00
|
|
|
XR Hip Complete Bilateral
|
Facility
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
630457
|
| Min. Negotiated Rate |
$540.96 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$662.40
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
XR Hip Complete Bilateral
|
Facility
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
630457
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$717.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$552.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.92
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$717.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$55.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
XR Hip Complete Bilateral
|
Facility
OP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.24 |
| Max. Negotiated Rate |
$3,032.00 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$212.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.50
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$492.70
|
| Rate for Payer: Quartz Medicare Advantage |
$454.80
|
| Rate for Payer: The Alliance Commercial |
$3,032.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
XR Hip Complete Bilateral
|
Facility
IP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.42 |
| Max. Negotiated Rate |
$697.36 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$454.80
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
XR Hip Complete Bilateral
|
Professional
|
$1,104.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
630457
|
| Min. Negotiated Rate |
$39.86 |
| Max. Negotiated Rate |
$1,048.80 |
| Rate for Payer: Aetna Commercial |
$1,048.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Aetna Managed Medicare |
$39.86
|
| Rate for Payer: Anthem Medicare Advantage |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.86
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,048.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$552.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.86
|
| Rate for Payer: Health EOS Commercial |
$1,004.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.86
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,048.80
|
| Rate for Payer: Quartz Beloit One Network |
$485.76
|
| Rate for Payer: Quartz Commercial |
$629.28
|
| Rate for Payer: Quartz Medicare Advantage |
$39.86
|
| Rate for Payer: The Alliance Commercial |
$151.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.86
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: WPS Commercial |
$199.30
|
|
|
XR Hip Complete Left
|
Professional
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
1537110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.44 |
| 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: 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: 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
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,LT
|
| Hospital Charge Code |
1537110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.28 |
| Max. Negotiated Rate |
$3,004.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Aetna Managed Medicare |
$210.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| 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: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.25
|
| 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 |
$488.15
|
| Rate for Payer: Quartz Medicare Advantage |
$450.60
|
| Rate for Payer: The Alliance Commercial |
$3,004.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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: 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 |
$210.28 |
| Max. Negotiated Rate |
$3,004.00 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Aetna Managed Medicare |
$210.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$488.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$375.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| 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: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$563.25
|
| 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 |
$488.15
|
| Rate for Payer: Quartz Medicare Advantage |
$450.60
|
| Rate for Payer: The Alliance Commercial |
$3,004.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| 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: 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
|
Professional
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
1537112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.44 |
| 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: 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: 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: 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 |
$180.60 |
| Max. Negotiated Rate |
$2,580.00 |
| Rate for Payer: Aetna Commercial |
$580.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.70
|
| Rate for Payer: Aetna Managed Medicare |
$180.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.85
|
| 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: Health EOS Commercial |
$574.05
|
| Rate for Payer: HFN Commercial |
$593.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.75
|
| 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 |
$419.25
|
| Rate for Payer: Quartz Medicare Advantage |
$387.00
|
| Rate for Payer: The Alliance Commercial |
$2,580.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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 |
$1,867.68 |
| 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 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 |
$1,867.68
|
| 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
|
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: 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
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$31.74 |
| 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: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Medicare Advantage |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.74
|
| 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 |
$31.74
|
| Rate for Payer: Health EOS Commercial |
$1,128.40
|
| 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: Independent Care Health Plan Medicare |
$31.74
|
| 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: Quartz Medicare Advantage |
$31.74
|
| Rate for Payer: The Alliance Commercial |
$120.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.74
|
| Rate for Payer: WEA Trust Commercial |
$682.00
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
|
XR Hip Operative Bilateral
|
Professional
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.80 |
| 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: 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: 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 Left
|
Facility
OP
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$121.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| 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: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$325.50
|
| 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 |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$260.40
|
| Rate for Payer: The Alliance Commercial |
$1,736.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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: 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 Left
|
Facility
OP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,867.68 |
| 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 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 |
$1,867.68
|
| 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
|
Professional
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.96 |
| 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: 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: 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
|
Professional
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Medicare Advantage |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.74
|
| 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 |
$31.74
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| 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: Independent Care Health Plan Medicare |
$31.74
|
| 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: Quartz Medicare Advantage |
$31.74
|
| Rate for Payer: The Alliance Commercial |
$120.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.74
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
