|
XR Femur 1 View Rt
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| 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 |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.17
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: NAPHCARE Commercial |
$271.44
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$294.06
|
| Rate for Payer: Quartz Medicare Advantage |
$271.44
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Femur 1 View Rt
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.68 |
| Max. Negotiated Rate |
$416.21 |
| Rate for Payer: Aetna Commercial |
$407.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.77
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$416.21
|
| Rate for Payer: Health EOS Commercial |
$402.64
|
| Rate for Payer: HFN Commercial |
$416.21
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$416.21
|
| Rate for Payer: Quartz Beloit One Network |
$221.68
|
| Rate for Payer: Quartz Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Femur 1 View Rt
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
CPT 73551 TC,RT
|
| Hospital Charge Code |
4590786
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$429.78 |
| Rate for Payer: Aetna Commercial |
$429.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$389.06
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$429.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.44
|
| Rate for Payer: Health EOS Commercial |
$411.68
|
| Rate for Payer: HFN Commercial |
$429.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.30
|
| Rate for Payer: Multiplan Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$429.78
|
| Rate for Payer: Quartz Beloit One Network |
$199.06
|
| Rate for Payer: Quartz Commercial |
$257.87
|
| Rate for Payer: The Alliance Commercial |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Femur Bilateral
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Bilateral
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Bilateral
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$544.76 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$667.06
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
XR Femur Bilateral
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 LT,TC
|
| Hospital Charge Code |
1537022
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Bilateral
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$489.17 |
| Max. Negotiated Rate |
$1,056.17 |
| Rate for Payer: Aetna Commercial |
$1,056.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,056.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$555.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.06
|
| Rate for Payer: Health EOS Commercial |
$1,011.70
|
| Rate for Payer: HFN Commercial |
$1,056.17
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.17
|
| Rate for Payer: Quartz Beloit One Network |
$489.17
|
| Rate for Payer: Quartz Commercial |
$633.70
|
| Rate for Payer: The Alliance Commercial |
$555.88
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
XR Femur Bilateral
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630659
|
| Min. Negotiated Rate |
$311.29 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$311.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$722.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$555.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$533.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.16
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$833.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$667.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$722.64
|
| Rate for Payer: Quartz Medicare Advantage |
$667.06
|
| Rate for Payer: The Alliance Commercial |
$555.88
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
XR Femur Left
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.50
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| 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 |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| 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 |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$425.88
|
| 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 |
$360.36
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
XR Femur Left
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$35.42 |
| Max. Negotiated Rate |
$622.44 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$35.42
|
| Rate for Payer: Anthem Medicare Advantage |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.42
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$622.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.42
|
| Rate for Payer: Health EOS Commercial |
$596.23
|
| Rate for Payer: HFN Commercial |
$622.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.42
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$53.13
|
| Rate for Payer: Preferred Network Access Commercial |
$622.44
|
| Rate for Payer: Quartz Beloit One Network |
$288.29
|
| Rate for Payer: Quartz Commercial |
$373.46
|
| Rate for Payer: Quartz Medicare Advantage |
$35.42
|
| Rate for Payer: The Alliance Commercial |
$134.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.42
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$177.11
|
|
|
XR Femur Left
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Left
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
630655
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$393.12
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
XR Femur Left
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Left
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,LT
|
| Hospital Charge Code |
1537024
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Femur Right
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT 73552 RT,TC
|
| Hospital Charge Code |
1537026
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| 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 |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
CPT 73552 TC,RT
|
| Hospital Charge Code |
2980055
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.98 |
| Max. Negotiated Rate |
$705.43 |
| Rate for Payer: Health EOS Commercial |
$675.73
|
| Rate for Payer: Aetna Commercial |
$705.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$705.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.54
|
| Rate for Payer: HFN Commercial |
$705.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.98
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$705.43
|
| Rate for Payer: Quartz Beloit One Network |
$326.73
|
| Rate for Payer: Quartz Commercial |
$423.26
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
XR Femur Right
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$244.82 |
| Max. Negotiated Rate |
$528.58 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.84
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Femur Right
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 73550
|
| Hospital Charge Code |
630651
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Finger 2nd Digit Left
|
Facility
|
OP
|
$399.00
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
630649
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.18
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| 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 |
$119.70
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| 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 |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$269.72
|
| 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 |
$228.23
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
