|
XR Hand Complete Right
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$318.86
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
XR Hand Complete Right
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$504.87 |
| Rate for Payer: Aetna Commercial |
$504.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$37.73
|
| Rate for Payer: Anthem Medicare Advantage |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.73
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$504.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.73
|
| Rate for Payer: Health EOS Commercial |
$483.61
|
| Rate for Payer: HFN Commercial |
$504.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.73
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$56.60
|
| Rate for Payer: Preferred Network Access Commercial |
$504.87
|
| Rate for Payer: Quartz Beloit One Network |
$233.83
|
| Rate for Payer: Quartz Commercial |
$302.92
|
| Rate for Payer: Quartz Medicare Advantage |
$37.73
|
| Rate for Payer: The Alliance Commercial |
$143.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.73
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$188.66
|
|
|
XR Hand Complete Right
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
630473
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.09
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| 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 |
$153.30
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| 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 |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$345.44
|
| 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 |
$292.29
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
XR Hand Complete Right
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$127.50 |
| Max. Negotiated Rate |
$544.39 |
| Rate for Payer: Aetna Commercial |
$544.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$544.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.82
|
| Rate for Payer: Health EOS Commercial |
$521.47
|
| Rate for Payer: HFN Commercial |
$544.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.50
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$544.39
|
| Rate for Payer: Quartz Beloit One Network |
$252.14
|
| Rate for Payer: Quartz Commercial |
$326.63
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hand Complete Right
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 73130 RT,TC
|
| Hospital Charge Code |
1537100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| 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 |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
XR Hip 1 View Left
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.88
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| 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 |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Left
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| 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 |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Left
|
Professional
|
Both
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| Min. Negotiated Rate |
$199.06 |
| 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: 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: 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 Hip 1 View Left
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| 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 |
$294.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$226.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.15
|
| 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: 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: WEA Trust Commercial |
$248.82
|
| Rate for Payer: WPS Commercial |
$335.08
|
|
|
XR Hip 1 View Left
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
630469
|
| 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 Hip 1 View Left
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
1537102
|
|
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 1 View Right
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| 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 |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
XR Hip 1 View Right
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 TC,RT
|
| Hospital Charge Code |
1537104
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.88
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| 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 |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
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
|
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
|
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
|
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
|
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
|
$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
|
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
|
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: The Alliance Commercial |
$116.74
|
| 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: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$433.58
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
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 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
|
|
