|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630365
|
| Min. Negotiated Rate |
$536.10 |
| Max. Negotiated Rate |
$1,006.55 |
| Rate for Payer: Aetna Commercial |
$984.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.86
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$1,006.55
|
| Rate for Payer: Health EOS Commercial |
$973.73
|
| Rate for Payer: HFN Commercial |
$1,006.55
|
| Rate for Payer: Multiplan Commercial |
$875.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,006.55
|
| Rate for Payer: Quartz Beloit One Network |
$536.10
|
| Rate for Payer: Quartz Commercial |
$656.45
|
| Rate for Payer: WEA Trust Commercial |
$601.74
|
| Rate for Payer: WPS Commercial |
$810.36
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630365
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$1,039.38 |
| Rate for Payer: Aetna Commercial |
$1,039.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$940.91
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$1,039.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$547.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$995.61
|
| Rate for Payer: HFN Commercial |
$1,039.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$875.26
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,039.38
|
| Rate for Payer: Quartz Beloit One Network |
$481.40
|
| Rate for Payer: Quartz Commercial |
$623.63
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$601.74
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.19 |
| Max. Negotiated Rate |
$533.52 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| 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 |
$533.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.96
|
| Rate for Payer: Health EOS Commercial |
$511.06
|
| Rate for Payer: HFN Commercial |
$533.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$533.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.10
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.58
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$355.58
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$328.22
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
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 |
$157.25 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$157.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| 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 |
$516.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.28
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$365.04
|
| Rate for Payer: Quartz Medicare Advantage |
$336.96
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$519.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$519.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$497.81
|
| Rate for Payer: HFN Commercial |
$519.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$519.69
|
| Rate for Payer: Quartz Beloit One Network |
$240.70
|
| Rate for Payer: Quartz Commercial |
$311.81
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.19 |
| Max. Negotiated Rate |
$533.52 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| 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 |
$533.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.96
|
| Rate for Payer: Health EOS Commercial |
$511.06
|
| Rate for Payer: HFN Commercial |
$533.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$533.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.10
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
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 |
$275.18 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$336.96
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$519.69 |
| Rate for Payer: Aetna Commercial |
$519.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$519.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$497.81
|
| Rate for Payer: HFN Commercial |
$519.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$519.69
|
| Rate for Payer: Quartz Beloit One Network |
$240.70
|
| Rate for Payer: Quartz Commercial |
$311.81
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
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 |
$157.25 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$157.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| 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 |
$516.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.28
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$365.04
|
| Rate for Payer: Quartz Medicare Advantage |
$336.96
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 73560 RT,TC
|
| Hospital Charge Code |
1537142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.19 |
| Max. Negotiated Rate |
$533.52 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| 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 |
$533.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.96
|
| Rate for Payer: Health EOS Commercial |
$511.06
|
| Rate for Payer: HFN Commercial |
$533.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$533.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.10
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
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 |
$275.18 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$336.96
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
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 |
$275.18 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$336.96
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$268.05 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$328.22
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$503.28 |
| Rate for Payer: Aetna Commercial |
$492.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.45
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.58
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$503.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$486.87
|
| Rate for Payer: HFN Commercial |
$503.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$437.63
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$503.28
|
| Rate for Payer: Quartz Beloit One Network |
$268.05
|
| Rate for Payer: Quartz Commercial |
$355.58
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$300.87
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$405.18
|
|
|
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 |
$157.25 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$157.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| 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 |
$516.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.28
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$365.04
|
| Rate for Payer: Quartz Medicare Advantage |
$336.96
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 1 or 2 Views Right
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 73560 TC,RT
|
| Hospital Charge Code |
2980056
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.19 |
| Max. Negotiated Rate |
$533.52 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| 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 |
$533.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.96
|
| Rate for Payer: Health EOS Commercial |
$511.06
|
| Rate for Payer: HFN Commercial |
$533.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.19
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$533.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.10
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
XR Knee 3 Views Bilateral
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630415
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,119.46 |
| Rate for Payer: Aetna Commercial |
$1,095.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.45
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$584.06
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$1,119.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,082.95
|
| Rate for Payer: HFN Commercial |
$1,119.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$973.44
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.46
|
| Rate for Payer: Quartz Beloit One Network |
$596.23
|
| Rate for Payer: Quartz Commercial |
$790.92
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$669.24
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$901.25
|
|
|
XR Knee 3 Views Bilateral
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73562 LT,TC
|
| Hospital Charge Code |
1537144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.07 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| 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 |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.07
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Knee 3 Views Bilateral
|
Professional
|
Both
|
$1,170.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630415
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$1,155.96 |
| Rate for Payer: Aetna Commercial |
$1,155.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.45
|
| Rate for Payer: Aetna Managed Medicare |
$42.08
|
| Rate for Payer: Anthem Medicare Advantage |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.08
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$1,155.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$608.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.08
|
| Rate for Payer: Health EOS Commercial |
$1,107.29
|
| Rate for Payer: HFN Commercial |
$1,155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.08
|
| Rate for Payer: Multiplan Commercial |
$973.44
|
| Rate for Payer: NAPHCARE Commercial |
$63.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.96
|
| Rate for Payer: Quartz Beloit One Network |
$535.39
|
| Rate for Payer: Quartz Commercial |
$693.58
|
| Rate for Payer: Quartz Medicare Advantage |
$42.08
|
| Rate for Payer: The Alliance Commercial |
$159.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.08
|
| Rate for Payer: WEA Trust Commercial |
$669.24
|
| Rate for Payer: WPS Commercial |
$210.39
|
|
|
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 |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
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 |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| 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 |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Knee 3 Views Bilateral
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630415
|
| Min. Negotiated Rate |
$596.23 |
| Max. Negotiated Rate |
$1,119.46 |
| Rate for Payer: Aetna Commercial |
$1,095.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,046.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.90
|
| Rate for Payer: Cash Price |
$351.00
|
| Rate for Payer: Cigna Commercial |
$1,119.46
|
| Rate for Payer: Health EOS Commercial |
$1,082.95
|
| Rate for Payer: HFN Commercial |
$1,119.46
|
| Rate for Payer: Multiplan Commercial |
$973.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.46
|
| Rate for Payer: Quartz Beloit One Network |
$596.23
|
| Rate for Payer: Quartz Commercial |
$730.08
|
| Rate for Payer: WEA Trust Commercial |
$669.24
|
| Rate for Payer: WPS Commercial |
$901.25
|
|
|
XR Knee 3 Views Left
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
1537146
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.07 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| 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 |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.07
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
