|
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 |
$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 Left
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,LT
|
| Hospital Charge Code |
1537146
|
|
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 Left
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630403
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$560.68 |
| Rate for Payer: Aetna Commercial |
$548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.00
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$560.68
|
| Rate for Payer: Health EOS Commercial |
$542.40
|
| Rate for Payer: HFN Commercial |
$560.68
|
| Rate for Payer: Multiplan Commercial |
$487.55
|
| Rate for Payer: Preferred Network Access Commercial |
$560.68
|
| Rate for Payer: Quartz Beloit One Network |
$298.63
|
| Rate for Payer: Quartz Commercial |
$365.66
|
| Rate for Payer: WEA Trust Commercial |
$335.19
|
| Rate for Payer: WPS Commercial |
$451.40
|
|
|
XR Knee 3 Views Left
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630403
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$578.97 |
| Rate for Payer: Aetna Commercial |
$578.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| 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 |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$578.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.08
|
| Rate for Payer: Health EOS Commercial |
$554.59
|
| Rate for Payer: HFN Commercial |
$578.97
|
| 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 |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$63.12
|
| Rate for Payer: Preferred Network Access Commercial |
$578.97
|
| Rate for Payer: Quartz Beloit One Network |
$268.15
|
| Rate for Payer: Quartz Commercial |
$347.38
|
| 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 |
$335.19
|
| Rate for Payer: WPS Commercial |
$210.39
|
|
|
XR Knee 3 Views Left
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630403
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$560.68 |
| Rate for Payer: Aetna Commercial |
$548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$304.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.53
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.00
|
| 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 |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$560.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$542.40
|
| Rate for Payer: HFN Commercial |
$560.68
|
| 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 |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$560.68
|
| Rate for Payer: Quartz Beloit One Network |
$298.63
|
| Rate for Payer: Quartz Commercial |
$396.14
|
| 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 |
$335.19
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$451.40
|
|
|
XR Knee 3 Views Right
|
Facility
|
OP
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630395
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$560.68 |
| Rate for Payer: Aetna Commercial |
$548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$396.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$304.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$292.53
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.00
|
| 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 |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$560.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$542.40
|
| Rate for Payer: HFN Commercial |
$560.68
|
| 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 |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$560.68
|
| Rate for Payer: Quartz Beloit One Network |
$298.63
|
| Rate for Payer: Quartz Commercial |
$396.14
|
| 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 |
$335.19
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$451.40
|
|
|
XR Knee 3 Views Right
|
Facility
|
IP
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630395
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$560.68 |
| Rate for Payer: Aetna Commercial |
$548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.00
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$560.68
|
| Rate for Payer: Health EOS Commercial |
$542.40
|
| Rate for Payer: HFN Commercial |
$560.68
|
| Rate for Payer: Multiplan Commercial |
$487.55
|
| Rate for Payer: Preferred Network Access Commercial |
$560.68
|
| Rate for Payer: Quartz Beloit One Network |
$298.63
|
| Rate for Payer: Quartz Commercial |
$365.66
|
| Rate for Payer: WEA Trust Commercial |
$335.19
|
| Rate for Payer: WPS Commercial |
$451.40
|
|
|
XR Knee 3 Views Right
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73562 RT,TC
|
| Hospital Charge Code |
1537148
|
|
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 Right
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 73562 RT,TC
|
| Hospital Charge Code |
1537148
|
|
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 Right
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
630395
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$578.97 |
| Rate for Payer: Aetna Commercial |
$578.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| 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 |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$578.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.08
|
| Rate for Payer: Health EOS Commercial |
$554.59
|
| Rate for Payer: HFN Commercial |
$578.97
|
| 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 |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$63.12
|
| Rate for Payer: Preferred Network Access Commercial |
$578.97
|
| Rate for Payer: Quartz Beloit One Network |
$268.15
|
| Rate for Payer: Quartz Commercial |
$347.38
|
| 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 |
$335.19
|
| Rate for Payer: WPS Commercial |
$210.39
|
|
|
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 |
$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 Right
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
2980057
|
|
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 Right
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 RT,TC
|
| Hospital Charge Code |
1537148
|
|
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 Right
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 73562 TC,RT
|
| Hospital Charge Code |
2980057
|
|
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 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 |
$239.08 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Aetna Managed Medicare |
$239.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| 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 |
$785.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.82
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.38
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: NAPHCARE Commercial |
$512.30
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: Quartz Medicare Advantage |
$512.30
|
| Rate for Payer: The Alliance Commercial |
$426.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
XR Knee 4 Views w/ Patella Left
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711788
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
XR Knee 4 Views w/ Patella Left
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.68 |
| Max. Negotiated Rate |
$811.15 |
| Rate for Payer: Aetna Commercial |
$811.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| 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 |
$811.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$426.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.30
|
| Rate for Payer: Health EOS Commercial |
$776.99
|
| Rate for Payer: HFN Commercial |
$811.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.68
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: Preferred Network Access Commercial |
$811.15
|
| Rate for Payer: Quartz Beloit One Network |
$375.69
|
| Rate for Payer: Quartz Commercial |
$486.69
|
| Rate for Payer: The Alliance Commercial |
$426.92
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
XR Knee 4 Views w/ Patella Left
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711788
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
|
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 |
$418.38 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$785.53
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$512.30
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
XR Knee 4 Views w/ Patella Left
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711788
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$750.88 |
| Rate for Payer: Aetna Commercial |
$750.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$49.11
|
| Rate for Payer: Anthem Medicare Advantage |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.11
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$750.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$395.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.11
|
| Rate for Payer: Health EOS Commercial |
$719.26
|
| Rate for Payer: HFN Commercial |
$750.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.11
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$73.66
|
| Rate for Payer: Preferred Network Access Commercial |
$750.88
|
| Rate for Payer: Quartz Beloit One Network |
$347.78
|
| Rate for Payer: Quartz Commercial |
$450.53
|
| Rate for Payer: Quartz Medicare Advantage |
$49.11
|
| Rate for Payer: The Alliance Commercial |
$186.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.11
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$245.54
|
|
|
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 |
$239.08 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Aetna Managed Medicare |
$239.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| 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 |
$785.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.82
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.38
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: NAPHCARE Commercial |
$512.30
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: Quartz Medicare Advantage |
$512.30
|
| Rate for Payer: The Alliance Commercial |
$426.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
XR Knee 4 Views w/ Patella Right
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537153
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.68 |
| Max. Negotiated Rate |
$811.15 |
| Rate for Payer: Aetna Commercial |
$811.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| 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 |
$811.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$426.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.30
|
| Rate for Payer: Health EOS Commercial |
$776.99
|
| Rate for Payer: HFN Commercial |
$811.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.68
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: Preferred Network Access Commercial |
$811.15
|
| Rate for Payer: Quartz Beloit One Network |
$375.69
|
| Rate for Payer: Quartz Commercial |
$486.69
|
| Rate for Payer: The Alliance Commercial |
$426.92
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
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 |
$418.38 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$785.53
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$512.30
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
XR Knee 4 Views w/ Patella Right
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711789
|
| Min. Negotiated Rate |
$49.11 |
| Max. Negotiated Rate |
$750.88 |
| Rate for Payer: Aetna Commercial |
$750.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$49.11
|
| Rate for Payer: Anthem Medicare Advantage |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.11
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$750.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$395.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.11
|
| Rate for Payer: Health EOS Commercial |
$719.26
|
| Rate for Payer: HFN Commercial |
$750.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.11
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$73.66
|
| Rate for Payer: Preferred Network Access Commercial |
$750.88
|
| Rate for Payer: Quartz Beloit One Network |
$347.78
|
| Rate for Payer: Quartz Commercial |
$450.53
|
| Rate for Payer: Quartz Medicare Advantage |
$49.11
|
| Rate for Payer: The Alliance Commercial |
$186.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.11
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$245.54
|
|
|
XR Knee 4 Views w/ Patella Right
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711789
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$727.17 |
| Rate for Payer: Aetna Commercial |
$711.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$395.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$379.39
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$727.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$703.46
|
| Rate for Payer: HFN Commercial |
$727.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$727.17
|
| Rate for Payer: Quartz Beloit One Network |
$387.30
|
| Rate for Payer: Quartz Commercial |
$513.76
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$585.43
|
|
