|
XR Knee 1 or 2 Views Bilateral
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$151.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| Rate for Payer: Quartz Medicare Advantage |
$324.00
|
| Rate for Payer: The Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna Commercial |
$499.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$33.00
|
| Rate for Payer: Anthem Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.00
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$499.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$478.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.70
|
| Rate for Payer: Quartz Beloit One Network |
$231.44
|
| Rate for Payer: Quartz Commercial |
$299.82
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$165.00
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.00
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$51.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
IP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
$540.00
|
|
|
Service Code
|
CPT 73560 TC,RT
|
| Hospital Charge Code |
2980056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.00
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 73560 TC,RT
|
| Hospital Charge Code |
2980056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$151.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| Rate for Payer: Quartz Medicare Advantage |
$324.00
|
| Rate for Payer: The Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 TC,RT
|
| Hospital Charge Code |
2980056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 RT,TC
|
| Hospital Charge Code |
1537142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
OP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$51.64 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$51.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
IP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 73560 RT,TC
|
| Hospital Charge Code |
1537142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$2,160.00 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$151.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$351.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| Rate for Payer: Quartz Medicare Advantage |
$324.00
|
| Rate for Payer: The Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
$540.00
|
|
|
Service Code
|
CPT 73560 RT,TC
|
| Hospital Charge Code |
1537142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.60 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.00
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna Commercial |
$499.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$33.00
|
| Rate for Payer: Anthem Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.00
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$499.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$478.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.70
|
| Rate for Payer: Quartz Beloit One Network |
$231.44
|
| Rate for Payer: Quartz Commercial |
$299.82
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$165.00
|
|
|
XR Knee 3 Views Bilateral
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 LT,TC
|
| Hospital Charge Code |
1537144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Knee 3 Views Bilateral
|
Professional
|
$1,170.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630415
|
| Min. Negotiated Rate |
$39.15 |
| Max. Negotiated Rate |
$1,111.50 |
| Rate for Payer: Aetna Commercial |
$1,111.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,006.20
|
| Rate for Payer: Aetna Managed Medicare |
$39.15
|
| Rate for Payer: Anthem Medicare Advantage |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.15
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$1,111.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$585.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.15
|
| Rate for Payer: Health EOS Commercial |
$1,064.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.15
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.50
|
| Rate for Payer: Quartz Beloit One Network |
$514.80
|
| Rate for Payer: Quartz Commercial |
$666.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.15
|
| Rate for Payer: The Alliance Commercial |
$148.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.15
|
| Rate for Payer: WEA Trust Commercial |
$643.50
|
| Rate for Payer: WPS Commercial |
$195.75
|
|
|
XR Knee 3 Views Bilateral
|
Facility
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630415
|
| Min. Negotiated Rate |
$573.30 |
| Max. Negotiated Rate |
$1,076.40 |
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$620.10
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$1,076.40
|
| Rate for Payer: Health EOS Commercial |
$1,041.30
|
| Rate for Payer: HFN Commercial |
$1,076.40
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: NAPHCARE Commercial |
$702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,076.40
|
| Rate for Payer: Quartz Beloit One Network |
$573.30
|
| Rate for Payer: Quartz Commercial |
$702.00
|
| Rate for Payer: WEA Trust Commercial |
$643.50
|
| Rate for Payer: WPS Commercial |
$866.62
|
|
|
XR Knee 3 Views Bilateral
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 73562 LT,TC
|
| Hospital Charge Code |
1537144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Knee 3 Views Bilateral
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73562 LT,TC
|
| Hospital Charge Code |
1537144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Knee 3 Views Bilateral
|
Facility
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630415
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,962.48 |
| Rate for Payer: Aetna Commercial |
$1,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,006.20
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$760.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$561.60
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$620.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$1,076.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$1,041.30
|
| Rate for Payer: HFN Commercial |
$1,076.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,076.40
|
| Rate for Payer: Quartz Beloit One Network |
$573.30
|
| Rate for Payer: Quartz Commercial |
$760.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,962.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$643.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$866.62
|
|
|
XR Knee 3 Views Left
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
1537146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Knee 3 Views Left
|
Professional
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630403
|
| Min. Negotiated Rate |
$39.15 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| Rate for Payer: Aetna Managed Medicare |
$39.15
|
| Rate for Payer: Anthem Medicare Advantage |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.15
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$556.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.15
|
| Rate for Payer: Health EOS Commercial |
$533.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.15
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$556.70
|
| Rate for Payer: Quartz Beloit One Network |
$257.84
|
| Rate for Payer: Quartz Commercial |
$334.02
|
| Rate for Payer: Quartz Medicare Advantage |
$39.15
|
| Rate for Payer: The Alliance Commercial |
$148.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.15
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$195.75
|
|
|
XR Knee 3 Views Left
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
1537146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
