|
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
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
1537146
|
|
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 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
|
|
|
XR Knee 3 Views Right
|
Facility
IP
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630395
|
| Min. Negotiated Rate |
$287.14 |
| Max. Negotiated Rate |
$539.12 |
| Rate for Payer: Aetna Commercial |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.58
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$539.12
|
| Rate for Payer: Health EOS Commercial |
$521.54
|
| Rate for Payer: HFN Commercial |
$539.12
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: NAPHCARE Commercial |
$351.60
|
| Rate for Payer: Preferred Network Access Commercial |
$539.12
|
| Rate for Payer: Quartz Beloit One Network |
$287.14
|
| Rate for Payer: Quartz Commercial |
$351.60
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$434.05
|
|
|
XR Knee 3 Views Right
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
2980057
|
|
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 Right
|
Facility
OP
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630395
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,962.48 |
| Rate for Payer: Aetna Commercial |
$527.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$380.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.28
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.58
|
| 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 |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$539.12
|
| 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 |
$521.54
|
| Rate for Payer: HFN Commercial |
$539.12
|
| 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 |
$468.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$539.12
|
| Rate for Payer: Quartz Beloit One Network |
$287.14
|
| Rate for Payer: Quartz Commercial |
$380.90
|
| 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 |
$322.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$434.05
|
|
|
XR Knee 3 Views Right
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
2980057
|
|
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 Right
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 73562 RT,TC
|
| Hospital Charge Code |
1537148
|
|
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 Right
|
Professional
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630395
|
| 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 Right
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
2980057
|
|
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 Right
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 RT,TC
|
| Hospital Charge Code |
1537148
|
|
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 Right
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73562 RT,TC
|
| Hospital Charge Code |
1537148
|
|
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 4 Views w/ Patella Left
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711788
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee 4 Views w/ Patella Left
|
Facility
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee 4 Views w/ Patella Left
|
Professional
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711788
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna Commercial |
$722.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$45.01
|
| Rate for Payer: Anthem Medicare Advantage |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.01
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$722.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.01
|
| Rate for Payer: Health EOS Commercial |
$691.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.00
|
| Rate for Payer: Quartz Beloit One Network |
$334.40
|
| Rate for Payer: Quartz Commercial |
$433.20
|
| Rate for Payer: Quartz Medicare Advantage |
$45.01
|
| Rate for Payer: The Alliance Commercial |
$171.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.01
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$225.05
|
|
|
XR Knee 4 Views w/ Patella Left
|
Facility
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$3,284.00 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$229.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$533.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.75
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$492.60
|
| Rate for Payer: The Alliance Commercial |
$3,284.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee 4 Views w/ Patella Left
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711788
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$195.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee 4 Views w/ Patella Left
|
Professional
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.24 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna Commercial |
$779.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$779.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.60
|
| Rate for Payer: Health EOS Commercial |
$747.11
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$779.95
|
| Rate for Payer: Quartz Beloit One Network |
$361.24
|
| Rate for Payer: Quartz Commercial |
$467.97
|
| Rate for Payer: The Alliance Commercial |
$410.50
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee 4 Views w/ Patella Right
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711789
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee 4 Views w/ Patella Right
|
Facility
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$3,284.00 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$229.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$533.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$410.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.75
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$492.60
|
| Rate for Payer: The Alliance Commercial |
$3,284.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee 4 Views w/ Patella Right
|
Professional
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711789
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna Commercial |
$722.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$45.01
|
| Rate for Payer: Anthem Medicare Advantage |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.01
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$722.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.01
|
| Rate for Payer: Health EOS Commercial |
$691.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.00
|
| Rate for Payer: Quartz Beloit One Network |
$334.40
|
| Rate for Payer: Quartz Commercial |
$433.20
|
| Rate for Payer: Quartz Medicare Advantage |
$45.01
|
| Rate for Payer: The Alliance Commercial |
$171.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.01
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$225.05
|
|
|
XR Knee 4 Views w/ Patella Right
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711789
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$195.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee 4 Views w/ Patella Right
|
Facility
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee 4 Views w/ Patella Right
|
Professional
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$361.24 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna Commercial |
$779.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$779.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.60
|
| Rate for Payer: Health EOS Commercial |
$747.11
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$779.95
|
| Rate for Payer: Quartz Beloit One Network |
$361.24
|
| Rate for Payer: Quartz Commercial |
$467.97
|
| Rate for Payer: The Alliance Commercial |
$410.50
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee 4 Views w/ Tunnel + Sunrise Left
|
Facility
IP
|
$790.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
