|
XR Knee Complete Right
|
Facility
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 TC,RT
|
| Hospital Charge Code |
2980058
|
|
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 Complete Right
|
Facility
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630369
|
| 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 Complete Right
|
Professional
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630369
|
| 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 Complete Right
|
Facility
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630369
|
| 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 Complete Right
|
Professional
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537166
|
|
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 Complete Right
|
Professional
|
$821.00
|
|
|
Service Code
|
CPT 73564 TC,RT
|
| Hospital Charge Code |
2980058
|
|
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 Complete Right
|
Facility
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537166
|
|
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 Standing AP Bilateral
|
Facility
OP
|
$226.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
1537168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.28 |
| Max. Negotiated Rate |
$904.00 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Aetna Managed Medicare |
$63.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.78
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Health EOS Commercial |
$201.14
|
| Rate for Payer: HFN Commercial |
$207.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$169.50
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: NAPHCARE Commercial |
$135.60
|
| Rate for Payer: Preferred Network Access Commercial |
$207.92
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$146.90
|
| Rate for Payer: Quartz Medicare Advantage |
$135.60
|
| Rate for Payer: The Alliance Commercial |
$904.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
XR Knee Standing AP Bilateral
|
Facility
IP
|
$226.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
1537168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$207.92 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.78
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Health EOS Commercial |
$201.14
|
| Rate for Payer: HFN Commercial |
$207.92
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: NAPHCARE Commercial |
$135.60
|
| Rate for Payer: Preferred Network Access Commercial |
$207.92
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$135.60
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
XR Knee Standing AP Bilateral
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
630351
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Knee Standing AP Bilateral
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
630351
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| 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 |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| 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 |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| 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 |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$313.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Knee Standing AP Bilateral
|
Professional
|
$226.00
|
|
|
Service Code
|
CPT 73565 TC
|
| Hospital Charge Code |
1537168
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$214.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Aetna Managed Medicare |
$30.37
|
| Rate for Payer: Anthem Medicare Advantage |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.37
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$214.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.37
|
| Rate for Payer: Health EOS Commercial |
$205.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.37
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.70
|
| Rate for Payer: Quartz Beloit One Network |
$99.44
|
| Rate for Payer: Quartz Commercial |
$128.82
|
| Rate for Payer: Quartz Medicare Advantage |
$30.37
|
| Rate for Payer: The Alliance Commercial |
$115.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.37
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$151.85
|
|
|
XR Knee Standing AP Bilateral
|
Professional
|
$646.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
630351
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$613.70 |
| Rate for Payer: Aetna Commercial |
$613.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$38.47
|
| Rate for Payer: Anthem Medicare Advantage |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.47
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$323.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.47
|
| Rate for Payer: Health EOS Commercial |
$587.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.47
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Preferred Network Access Commercial |
$613.70
|
| Rate for Payer: Quartz Beloit One Network |
$284.24
|
| Rate for Payer: Quartz Commercial |
$368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$38.47
|
| Rate for Payer: The Alliance Commercial |
$146.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.47
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$192.35
|
|
|
XR Knee Standing AP Right
|
Facility
OP
|
$510.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Aetna Managed Medicare |
$142.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.40
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$306.00
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$331.50
|
| Rate for Payer: Quartz Medicare Advantage |
$306.00
|
| Rate for Payer: The Alliance Commercial |
$2,040.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
XR Knee Standing AP Right
|
Professional
|
$510.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.00
|
| Rate for Payer: Health EOS Commercial |
$464.10
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$484.50
|
| Rate for Payer: Quartz Beloit One Network |
$224.40
|
| Rate for Payer: Quartz Commercial |
$290.70
|
| Rate for Payer: The Alliance Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
XR Knee Standing AP Right
|
Facility
IP
|
$510.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980133
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$306.00
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$306.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
XR Knee Therapeutic Injection Lt
|
Facility
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
5268618
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$830.06 |
| Max. Negotiated Rate |
$1,558.48 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.82
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,558.48
|
| Rate for Payer: Health EOS Commercial |
$1,507.66
|
| Rate for Payer: HFN Commercial |
$1,558.48
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,016.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$830.06
|
| Rate for Payer: Quartz Commercial |
$1,016.40
|
| Rate for Payer: WEA Trust Commercial |
$931.70
|
| Rate for Payer: WPS Commercial |
$1,254.75
|
|
|
XR Knee Therapeutic Injection Lt
|
Facility
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
5268618
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$6,776.00 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.84
|
| Rate for Payer: Aetna Managed Medicare |
$474.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.82
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$947.96
|
| Rate for Payer: Health EOS Commercial |
$1,507.66
|
| Rate for Payer: HFN Commercial |
$1,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,016.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$830.06
|
| Rate for Payer: Quartz Commercial |
$1,101.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,016.40
|
| Rate for Payer: The Alliance Commercial |
$6,776.00
|
| Rate for Payer: United Healthcare PPO |
$1,270.50
|
| Rate for Payer: WEA Trust Commercial |
$931.70
|
| Rate for Payer: WPS Commercial |
$1,254.75
|
|
|
XR Knee Therapeutic Injection Lt
|
Professional
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
5268618
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$745.36 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.84
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,609.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$847.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,016.40
|
| Rate for Payer: Health EOS Commercial |
$1,541.54
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,609.30
|
| Rate for Payer: Quartz Beloit One Network |
$745.36
|
| Rate for Payer: Quartz Commercial |
$965.58
|
| Rate for Payer: The Alliance Commercial |
$847.00
|
| Rate for Payer: WEA Trust Commercial |
$931.70
|
| Rate for Payer: WPS Commercial |
$1,254.75
|
|
|
XR Knee Therapeutic Injection Rt
|
Facility
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
5268616
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$830.06 |
| Max. Negotiated Rate |
$1,558.48 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.82
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,558.48
|
| Rate for Payer: Health EOS Commercial |
$1,507.66
|
| Rate for Payer: HFN Commercial |
$1,558.48
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,016.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$830.06
|
| Rate for Payer: Quartz Commercial |
$1,016.40
|
| Rate for Payer: WEA Trust Commercial |
$931.70
|
| Rate for Payer: WPS Commercial |
$1,254.75
|
|
|
XR Knee Therapeutic Injection Rt
|
Facility
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
5268616
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$474.32 |
| Max. Negotiated Rate |
$6,776.00 |
| Rate for Payer: Aetna Commercial |
$1,524.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.84
|
| Rate for Payer: Aetna Managed Medicare |
$474.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.82
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,558.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$947.96
|
| Rate for Payer: Health EOS Commercial |
$1,507.66
|
| Rate for Payer: HFN Commercial |
$1,558.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,270.50
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,016.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.48
|
| Rate for Payer: Quartz Beloit One Network |
$830.06
|
| Rate for Payer: Quartz Commercial |
$1,101.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,016.40
|
| Rate for Payer: The Alliance Commercial |
$6,776.00
|
| Rate for Payer: United Healthcare PPO |
$1,270.50
|
| Rate for Payer: WEA Trust Commercial |
$931.70
|
| Rate for Payer: WPS Commercial |
$1,254.75
|
|
|
XR Knee Therapeutic Injection Rt
|
Professional
|
$1,694.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
5268616
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$745.36 |
| Max. Negotiated Rate |
$1,609.30 |
| Rate for Payer: Aetna Commercial |
$1,609.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.84
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cash Price |
$508.20
|
| Rate for Payer: Cigna Commercial |
$1,609.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$847.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,016.40
|
| Rate for Payer: Health EOS Commercial |
$1,541.54
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,609.30
|
| Rate for Payer: Quartz Beloit One Network |
$745.36
|
| Rate for Payer: Quartz Commercial |
$965.58
|
| Rate for Payer: The Alliance Commercial |
$847.00
|
| Rate for Payer: WEA Trust Commercial |
$931.70
|
| Rate for Payer: WPS Commercial |
$1,254.75
|
|
|
XR Lower Extremity Infant Bilateral
|
Professional
|
$556.00
|
|
|
Service Code
|
CPT 73592 LT,TC
|
| Hospital Charge Code |
1537172
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630345
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$984.40 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$695.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.60
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| 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 |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| 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 |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| 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 |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$243.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
XR Lower Extremity Infant Bilateral
|
Facility
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 73592
|
| Hospital Charge Code |
630345
|
| Min. Negotiated Rate |
$524.30 |
| Max. Negotiated Rate |
$984.40 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$642.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$642.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
