|
XR Hip Operative Left
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$126.38
|
| 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 |
$239.22
|
| 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 |
$415.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.52
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$270.82
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$270.82
|
| Rate for Payer: The Alliance Commercial |
$225.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
XR Hip Operative Left
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630443
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
XR Hip Operative Left
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
1537116
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$428.79 |
| Rate for Payer: Aetna Commercial |
$428.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| 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 |
$428.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.82
|
| Rate for Payer: Health EOS Commercial |
$410.74
|
| Rate for Payer: HFN Commercial |
$428.79
|
| 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 |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$428.79
|
| Rate for Payer: Quartz Beloit One Network |
$198.60
|
| Rate for Payer: Quartz Commercial |
$257.28
|
| Rate for Payer: The Alliance Commercial |
$225.68
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
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 |
$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 Right
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
2980054
|
|
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 Right
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| 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 Right
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
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
|
|
|
XR Hip Operative Right
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
XR Hip Operative Right
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$126.38
|
| 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 |
$239.22
|
| 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 |
$415.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.52
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$270.82
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$270.82
|
| Rate for Payer: The Alliance Commercial |
$225.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
XR Hip Operative Right
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$428.79 |
| Rate for Payer: Aetna Commercial |
$428.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| 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 |
$428.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.82
|
| Rate for Payer: Health EOS Commercial |
$410.74
|
| Rate for Payer: HFN Commercial |
$428.79
|
| 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 |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$428.79
|
| Rate for Payer: Quartz Beloit One Network |
$198.60
|
| Rate for Payer: Quartz Commercial |
$257.28
|
| Rate for Payer: The Alliance Commercial |
$225.68
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
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 |
$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 Right
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| 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 Right w/Pelvis
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$215.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$368.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.42
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$461.14
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$499.56
|
| Rate for Payer: Quartz Medicare Advantage |
$461.14
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
XR Hip Right w/Pelvis
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.17 |
| Max. Negotiated Rate |
$1,277.03 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,277.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$461.14
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,191.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,191.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: The Alliance Commercial |
$384.28
|
| Rate for Payer: United Healthcare Medicaid |
$1,277.03
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
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 |
$376.59 |
| Max. Negotiated Rate |
$707.08 |
| Rate for Payer: Aetna Commercial |
$691.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.34
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$707.08
|
| Rate for Payer: Health EOS Commercial |
$684.02
|
| Rate for Payer: HFN Commercial |
$707.08
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: Preferred Network Access Commercial |
$707.08
|
| Rate for Payer: Quartz Beloit One Network |
$376.59
|
| Rate for Payer: Quartz Commercial |
$461.14
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
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 |
$449.98 |
| Max. Negotiated Rate |
$844.85 |
| Rate for Payer: Aetna Commercial |
$826.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.71
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$844.85
|
| Rate for Payer: Health EOS Commercial |
$817.30
|
| Rate for Payer: HFN Commercial |
$844.85
|
| Rate for Payer: Multiplan Commercial |
$734.66
|
| Rate for Payer: Preferred Network Access Commercial |
$844.85
|
| Rate for Payer: Quartz Beloit One Network |
$449.98
|
| Rate for Payer: Quartz Commercial |
$550.99
|
| Rate for Payer: WEA Trust Commercial |
$505.08
|
| Rate for Payer: WPS Commercial |
$680.17
|
|
|
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 |
$257.13 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$826.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.76
|
| Rate for Payer: Aetna Managed Medicare |
$257.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.71
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$844.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$817.30
|
| Rate for Payer: HFN Commercial |
$844.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$688.74
|
| Rate for Payer: Multiplan Commercial |
$734.66
|
| Rate for Payer: NAPHCARE Commercial |
$550.99
|
| Rate for Payer: Preferred Network Access Commercial |
$844.85
|
| Rate for Payer: Quartz Beloit One Network |
$449.98
|
| Rate for Payer: Quartz Commercial |
$596.91
|
| Rate for Payer: Quartz Medicare Advantage |
$550.99
|
| Rate for Payer: The Alliance Commercial |
$459.16
|
| Rate for Payer: United Healthcare PPO |
$688.74
|
| Rate for Payer: WEA Trust Commercial |
$505.08
|
| Rate for Payer: WPS Commercial |
$680.17
|
|
|
XR Hip Therapeutic Injection Lt
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$872.40 |
| Rate for Payer: Aetna Commercial |
$872.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.76
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.99
|
| Rate for Payer: Health EOS Commercial |
$835.67
|
| Rate for Payer: HFN Commercial |
$872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$734.66
|
| Rate for Payer: Preferred Network Access Commercial |
$872.40
|
| Rate for Payer: Quartz Beloit One Network |
$404.06
|
| Rate for Payer: Quartz Commercial |
$523.44
|
| Rate for Payer: The Alliance Commercial |
$459.16
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$505.08
|
| Rate for Payer: WPS Commercial |
$680.17
|
|
|
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 |
$257.13 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$826.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.76
|
| Rate for Payer: Aetna Managed Medicare |
$257.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.71
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$844.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$817.30
|
| Rate for Payer: HFN Commercial |
$844.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$688.74
|
| Rate for Payer: Multiplan Commercial |
$734.66
|
| Rate for Payer: NAPHCARE Commercial |
$550.99
|
| Rate for Payer: Preferred Network Access Commercial |
$844.85
|
| Rate for Payer: Quartz Beloit One Network |
$449.98
|
| Rate for Payer: Quartz Commercial |
$596.91
|
| Rate for Payer: Quartz Medicare Advantage |
$550.99
|
| Rate for Payer: The Alliance Commercial |
$459.16
|
| Rate for Payer: United Healthcare PPO |
$688.74
|
| Rate for Payer: WEA Trust Commercial |
$505.08
|
| Rate for Payer: WPS Commercial |
$680.17
|
|
|
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 |
$449.98 |
| Max. Negotiated Rate |
$844.85 |
| Rate for Payer: Aetna Commercial |
$826.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.71
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$844.85
|
| Rate for Payer: Health EOS Commercial |
$817.30
|
| Rate for Payer: HFN Commercial |
$844.85
|
| Rate for Payer: Multiplan Commercial |
$734.66
|
| Rate for Payer: Preferred Network Access Commercial |
$844.85
|
| Rate for Payer: Quartz Beloit One Network |
$449.98
|
| Rate for Payer: Quartz Commercial |
$550.99
|
| Rate for Payer: WEA Trust Commercial |
$505.08
|
| Rate for Payer: WPS Commercial |
$680.17
|
|
|
XR Hip Therapeutic Injection Rt
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$67.24 |
| Max. Negotiated Rate |
$872.40 |
| Rate for Payer: Aetna Commercial |
$872.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.76
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.99
|
| Rate for Payer: Health EOS Commercial |
$835.67
|
| Rate for Payer: HFN Commercial |
$872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Multiplan Commercial |
$734.66
|
| Rate for Payer: Preferred Network Access Commercial |
$872.40
|
| Rate for Payer: Quartz Beloit One Network |
$404.06
|
| Rate for Payer: Quartz Commercial |
$523.44
|
| Rate for Payer: The Alliance Commercial |
$459.16
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: WEA Trust Commercial |
$505.08
|
| Rate for Payer: WPS Commercial |
$680.17
|
|
|
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 |
$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 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 |
$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 w or w/o Pel 2 or 3 Views Right
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
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 w or w/o Pelvis 1 view Left
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.11 |
| Max. Negotiated Rate |
$359.63 |
| Rate for Payer: Aetna Commercial |
$359.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| 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 |
$359.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$189.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.14
|
| Rate for Payer: Health EOS Commercial |
$344.49
|
| Rate for Payer: HFN Commercial |
$359.63
|
| 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 |
$302.85
|
| Rate for Payer: Preferred Network Access Commercial |
$359.63
|
| Rate for Payer: Quartz Beloit One Network |
$166.57
|
| Rate for Payer: Quartz Commercial |
$215.78
|
| Rate for Payer: The Alliance Commercial |
$189.28
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$280.39
|
|
