|
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
|
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
|
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
|
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 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 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
|
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 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 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 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 Pelvis 1 view Left
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$185.49 |
| Max. Negotiated Rate |
$348.28 |
| Rate for Payer: Aetna Commercial |
$340.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.64
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$348.28
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$348.28
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: Preferred Network Access Commercial |
$348.28
|
| Rate for Payer: Quartz Beloit One Network |
$185.49
|
| Rate for Payer: Quartz Commercial |
$227.14
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$280.39
|
|
|
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
|
|
|
XR Hip w or w/o Pelvis 1 view Left
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$340.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Aetna Managed Medicare |
$106.00
|
| 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 |
$200.64
|
| 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 |
$348.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$348.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: NAPHCARE Commercial |
$227.14
|
| Rate for Payer: Preferred Network Access Commercial |
$348.28
|
| Rate for Payer: Quartz Beloit One Network |
$185.49
|
| Rate for Payer: Quartz Commercial |
$246.06
|
| Rate for Payer: Quartz Medicare Advantage |
$227.14
|
| Rate for Payer: The Alliance Commercial |
$189.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$280.39
|
|
|
XR Hip w or w/o Pelvis 1 view Right
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
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 w or w/o Pelvis 1 view Right
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
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 w or w/o Pelvis 1 view Right
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
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 w or w/o Pelvis 2 or 3 Views Left
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
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 2 or 3 Views Left
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
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 Pelvis 2 or 3 Views Left
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
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 Humerus Bilateral
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$524.89 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$964.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.74
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$985.50
|
| Rate for Payer: Health EOS Commercial |
$953.37
|
| Rate for Payer: HFN Commercial |
$985.50
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: Preferred Network Access Commercial |
$985.50
|
| Rate for Payer: Quartz Beloit One Network |
$524.89
|
| Rate for Payer: Quartz Commercial |
$642.72
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
|
XR Humerus Bilateral
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$550.32 |
| Rate for Payer: Aetna Commercial |
$550.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$550.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.57
|
| Rate for Payer: Health EOS Commercial |
$527.14
|
| Rate for Payer: HFN Commercial |
$550.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: Preferred Network Access Commercial |
$550.32
|
| Rate for Payer: Quartz Beloit One Network |
$254.88
|
| Rate for Payer: Quartz Commercial |
$330.19
|
| Rate for Payer: The Alliance Commercial |
$289.64
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$429.06
|
|
|
XR Humerus Bilateral
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$1,017.64 |
| Rate for Payer: Aetna Commercial |
$1,017.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$31.73
|
| Rate for Payer: Anthem Medicare Advantage |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.73
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$1,017.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$535.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.73
|
| Rate for Payer: Health EOS Commercial |
$974.79
|
| Rate for Payer: HFN Commercial |
$1,017.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.73
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$47.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.64
|
| Rate for Payer: Quartz Beloit One Network |
$471.33
|
| Rate for Payer: Quartz Commercial |
$610.58
|
| Rate for Payer: Quartz Medicare Advantage |
$31.73
|
| Rate for Payer: The Alliance Commercial |
$120.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.73
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$158.65
|
|
|
XR Humerus Bilateral
|
Facility
|
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Aetna Commercial |
$964.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.18
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.74
|
| 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 |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$985.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$953.37
|
| Rate for Payer: HFN Commercial |
$985.50
|
| 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 |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$985.50
|
| Rate for Payer: Quartz Beloit One Network |
$524.89
|
| Rate for Payer: Quartz Commercial |
$696.28
|
| 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 |
$589.16
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$793.41
|
|
