|
XR Hip 1 View Right
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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 |
$386.28 |
| Max. Negotiated Rate |
$725.25 |
| Rate for Payer: Aetna Commercial |
$709.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.81
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$725.25
|
| Rate for Payer: Health EOS Commercial |
$701.60
|
| Rate for Payer: HFN Commercial |
$725.25
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: Preferred Network Access Commercial |
$725.25
|
| Rate for Payer: Quartz Beloit One Network |
$386.28
|
| Rate for Payer: Quartz Commercial |
$472.99
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$583.89
|
|
|
XR Hip Bilateral w/Pelvis
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$748.90 |
| Rate for Payer: Aetna Commercial |
$748.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$748.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$394.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$717.37
|
| Rate for Payer: HFN Commercial |
$748.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$748.90
|
| Rate for Payer: Quartz Beloit One Network |
$346.86
|
| Rate for Payer: Quartz Commercial |
$449.34
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Hip Bilateral w/Pelvis
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537106
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$725.25 |
| Rate for Payer: Aetna Commercial |
$709.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Aetna Managed Medicare |
$220.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.81
|
| 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 |
$725.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.16
|
| Rate for Payer: Health EOS Commercial |
$701.60
|
| Rate for Payer: HFN Commercial |
$725.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.24
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: NAPHCARE Commercial |
$472.99
|
| Rate for Payer: Preferred Network Access Commercial |
$725.25
|
| Rate for Payer: Quartz Beloit One Network |
$386.28
|
| Rate for Payer: Quartz Commercial |
$512.41
|
| Rate for Payer: Quartz Medicare Advantage |
$472.99
|
| Rate for Payer: The Alliance Commercial |
$122.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$583.89
|
|
|
XR Hip Complete Bilateral
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
630457
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.12
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
XR Hip Complete Bilateral
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
630457
|
| Min. Negotiated Rate |
$562.60 |
| Max. Negotiated Rate |
$1,056.31 |
| Rate for Payer: Aetna Commercial |
$1,033.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.52
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,056.31
|
| Rate for Payer: Health EOS Commercial |
$1,021.86
|
| Rate for Payer: HFN Commercial |
$1,056.31
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.31
|
| Rate for Payer: Quartz Beloit One Network |
$562.60
|
| Rate for Payer: Quartz Commercial |
$688.90
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$850.41
|
|
|
XR Hip Complete Bilateral
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
630457
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$1,090.75 |
| Rate for Payer: Aetna Commercial |
$1,090.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.45
|
| Rate for Payer: Anthem Medicare Advantage |
$41.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.45
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,090.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.45
|
| Rate for Payer: Health EOS Commercial |
$1,044.83
|
| Rate for Payer: HFN Commercial |
$1,090.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.45
|
| Rate for Payer: Multiplan Commercial |
$918.53
|
| Rate for Payer: NAPHCARE Commercial |
$62.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,090.75
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$654.45
|
| Rate for Payer: Quartz Medicare Advantage |
$41.45
|
| Rate for Payer: The Alliance Commercial |
$157.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.45
|
| Rate for Payer: WEA Trust Commercial |
$631.49
|
| Rate for Payer: WPS Commercial |
$207.27
|
|
|
XR Hip Complete Bilateral
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$725.25 |
| Rate for Payer: Aetna Commercial |
$709.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Aetna Managed Medicare |
$220.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.81
|
| 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 |
$725.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.16
|
| Rate for Payer: Health EOS Commercial |
$701.60
|
| Rate for Payer: HFN Commercial |
$725.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.24
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: NAPHCARE Commercial |
$472.99
|
| Rate for Payer: Preferred Network Access Commercial |
$725.25
|
| Rate for Payer: Quartz Beloit One Network |
$386.28
|
| Rate for Payer: Quartz Commercial |
$512.41
|
| Rate for Payer: Quartz Medicare Advantage |
$472.99
|
| Rate for Payer: The Alliance Commercial |
$122.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$583.89
|
|
|
XR Hip Complete Bilateral
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.28 |
| Max. Negotiated Rate |
$725.25 |
| Rate for Payer: Aetna Commercial |
$709.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.81
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$725.25
|
| Rate for Payer: Health EOS Commercial |
$701.60
|
| Rate for Payer: HFN Commercial |
$725.25
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: Preferred Network Access Commercial |
$725.25
|
| Rate for Payer: Quartz Beloit One Network |
$386.28
|
| Rate for Payer: Quartz Commercial |
$472.99
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$583.89
|
|
|
XR Hip Complete Bilateral
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537108
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$748.90 |
| Rate for Payer: Aetna Commercial |
$748.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.96
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$748.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$394.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$717.37
|
| Rate for Payer: HFN Commercial |
$748.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$630.66
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$748.90
|
| Rate for Payer: Quartz Beloit One Network |
$346.86
|
| Rate for Payer: Quartz Commercial |
$449.34
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
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 |
$382.71 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$718.56
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$468.62
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$218.69 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Aetna Managed Medicare |
$218.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| 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 |
$718.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.08
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.78
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: NAPHCARE Commercial |
$468.62
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$507.68
|
| Rate for Payer: Quartz Medicare Advantage |
$468.62
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$164.10 |
| Max. Negotiated Rate |
$741.99 |
| Rate for Payer: Aetna Commercial |
$741.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| 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 |
$741.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.62
|
| Rate for Payer: Health EOS Commercial |
$710.75
|
| Rate for Payer: HFN Commercial |
$741.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.10
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$741.99
|
| Rate for Payer: Quartz Beloit One Network |
$343.66
|
| Rate for Payer: Quartz Commercial |
$445.19
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$218.69 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Aetna Managed Medicare |
$218.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| 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 |
$718.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.08
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.78
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: NAPHCARE Commercial |
$468.62
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$507.68
|
| Rate for Payer: Quartz Medicare Advantage |
$468.62
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$164.10 |
| Max. Negotiated Rate |
$741.99 |
| Rate for Payer: Aetna Commercial |
$741.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| 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 |
$741.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.62
|
| Rate for Payer: Health EOS Commercial |
$710.75
|
| Rate for Payer: HFN Commercial |
$741.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.10
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$741.99
|
| Rate for Payer: Quartz Beloit One Network |
$343.66
|
| Rate for Payer: Quartz Commercial |
$445.19
|
| Rate for Payer: The Alliance Commercial |
$390.52
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
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 |
$382.71 |
| Max. Negotiated Rate |
$718.56 |
| Rate for Payer: Aetna Commercial |
$702.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.95
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$718.56
|
| Rate for Payer: Health EOS Commercial |
$695.13
|
| Rate for Payer: HFN Commercial |
$718.56
|
| Rate for Payer: Multiplan Commercial |
$624.83
|
| Rate for Payer: Preferred Network Access Commercial |
$718.56
|
| Rate for Payer: Quartz Beloit One Network |
$382.71
|
| Rate for Payer: Quartz Commercial |
$468.62
|
| Rate for Payer: WEA Trust Commercial |
$429.57
|
| Rate for Payer: WPS Commercial |
$578.50
|
|
|
XR Hip Operative Bilateral
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$617.14 |
| Rate for Payer: Aetna Commercial |
$603.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Aetna Managed Medicare |
$187.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.52
|
| 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 |
$617.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.39
|
| Rate for Payer: Health EOS Commercial |
$597.01
|
| Rate for Payer: HFN Commercial |
$617.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.10
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: NAPHCARE Commercial |
$402.48
|
| Rate for Payer: Preferred Network Access Commercial |
$617.14
|
| Rate for Payer: Quartz Beloit One Network |
$328.69
|
| Rate for Payer: Quartz Commercial |
$436.02
|
| Rate for Payer: Quartz Medicare Advantage |
$402.48
|
| Rate for Payer: The Alliance Commercial |
$335.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
XR Hip Operative Bilateral
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.69 |
| Max. Negotiated Rate |
$617.14 |
| Rate for Payer: Aetna Commercial |
$603.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.52
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cigna Commercial |
$617.14
|
| Rate for Payer: Health EOS Commercial |
$597.01
|
| Rate for Payer: HFN Commercial |
$617.14
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: Preferred Network Access Commercial |
$617.14
|
| Rate for Payer: Quartz Beloit One Network |
$328.69
|
| Rate for Payer: Quartz Commercial |
$402.48
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
XR Hip Operative Bilateral
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,186.43 |
| Rate for Payer: Aetna Commercial |
$1,160.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.06
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$838.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$644.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$619.01
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,186.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$721.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,147.74
|
| Rate for Payer: HFN Commercial |
$1,186.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$1,031.68
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.43
|
| Rate for Payer: Quartz Beloit One Network |
$631.90
|
| Rate for Payer: Quartz Commercial |
$838.24
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$709.28
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$955.17
|
|
|
XR Hip Operative Bilateral
|
Professional
|
Both
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$1,225.12 |
| Rate for Payer: Aetna Commercial |
$1,225.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.43
|
| Rate for Payer: Anthem Medicare Advantage |
$33.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.43
|
| 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 |
$1,225.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$644.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.43
|
| Rate for Payer: Health EOS Commercial |
$1,173.54
|
| Rate for Payer: HFN Commercial |
$1,225.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.43
|
| Rate for Payer: Multiplan Commercial |
$1,031.68
|
| Rate for Payer: NAPHCARE Commercial |
$50.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.12
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$735.07
|
| Rate for Payer: Quartz Medicare Advantage |
$33.43
|
| Rate for Payer: The Alliance Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.43
|
| Rate for Payer: WEA Trust Commercial |
$709.28
|
| Rate for Payer: WPS Commercial |
$167.13
|
|
|
XR Hip Operative Bilateral
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630445
|
| Min. Negotiated Rate |
$631.90 |
| Max. Negotiated Rate |
$1,186.43 |
| Rate for Payer: Aetna Commercial |
$1,160.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.49
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,186.43
|
| Rate for Payer: Health EOS Commercial |
$1,147.74
|
| Rate for Payer: HFN Commercial |
$1,186.43
|
| Rate for Payer: Multiplan Commercial |
$1,031.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.43
|
| Rate for Payer: Quartz Beloit One Network |
$631.90
|
| Rate for Payer: Quartz Commercial |
$773.76
|
| Rate for Payer: WEA Trust Commercial |
$709.28
|
| Rate for Payer: WPS Commercial |
$955.17
|
|
|
XR Hip Operative Bilateral
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$637.26 |
| Rate for Payer: Aetna Commercial |
$637.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.89
|
| 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 |
$637.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.48
|
| Rate for Payer: Health EOS Commercial |
$610.43
|
| Rate for Payer: HFN Commercial |
$637.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Multiplan Commercial |
$536.64
|
| Rate for Payer: Preferred Network Access Commercial |
$637.26
|
| Rate for Payer: Quartz Beloit One Network |
$295.15
|
| Rate for Payer: Quartz Commercial |
$382.36
|
| Rate for Payer: The Alliance Commercial |
$335.40
|
| Rate for Payer: WEA Trust Commercial |
$368.94
|
| Rate for Payer: WPS Commercial |
$496.84
|
|
|
XR Hip Operative Left
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.50
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
XR Hip Operative Left
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$612.56 |
| Rate for Payer: Aetna Commercial |
$612.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$33.43
|
| Rate for Payer: Anthem Medicare Advantage |
$33.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.43
|
| 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 |
$612.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.43
|
| Rate for Payer: Health EOS Commercial |
$586.77
|
| Rate for Payer: HFN Commercial |
$612.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.43
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$50.14
|
| Rate for Payer: Preferred Network Access Commercial |
$612.56
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: Quartz Medicare Advantage |
$33.43
|
| Rate for Payer: The Alliance Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.43
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$167.13
|
|
|
XR Hip Operative Left
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
