|
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: 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
|
Professional
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
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 Right
|
Professional
|
$645.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
2980054
|
|
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 Right
|
Professional
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| 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
|
|
|
XR Hip Operative Right
|
Facility
OP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| 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 Right
|
Facility
OP
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
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 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: 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
|
$645.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
2980054
|
|
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 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: 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
|
$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: 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 Right w/Pelvis
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
XR Hip Right w/Pelvis
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
XR Hip Right w/Pelvis
|
Professional
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
XR Hip Therapeutic Injection Lt
|
Facility
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Lt
|
Professional
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$388.52 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$441.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.80
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: The Alliance Commercial |
$441.50
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Lt
|
Facility
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$3,532.00 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$247.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.13
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.25
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$529.80
|
| Rate for Payer: The Alliance Commercial |
$3,532.00
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Rt
|
Professional
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$388.52 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$441.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.80
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: The Alliance Commercial |
$441.50
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Rt
|
Facility
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$3,532.00 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$247.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.13
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.25
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$529.80
|
| Rate for Payer: The Alliance Commercial |
$3,532.00
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Rt
|
Facility
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip w or w/o Pel 2 or 3 Views Right
|
Professional
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
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 w or w/o Pel 2 or 3 Views Right
|
Facility
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
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 w or w/o Pel 2 or 3 Views Right
|
Facility
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
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 w or w/o Pelvis 1 view Left
|
Facility
IP
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Hip w or w/o Pelvis 1 view Left
|
Facility
OP
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$1,456.00 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$1,456.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Hip w or w/o Pelvis 1 view Left
|
Professional
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.16 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.40
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
