|
XR IVP
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
630417
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,351.00 |
| Rate for Payer: Aetna Commercial |
$1,321.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.89
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$954.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$734.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$704.87
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,351.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$821.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,306.95
|
| Rate for Payer: HFN Commercial |
$1,351.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,174.78
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,351.00
|
| Rate for Payer: Quartz Beloit One Network |
$719.56
|
| Rate for Payer: Quartz Commercial |
$954.51
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$807.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,087.66
|
|
|
XR IVP
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
630417
|
| Min. Negotiated Rate |
$131.02 |
| Max. Negotiated Rate |
$1,395.06 |
| Rate for Payer: Aetna Commercial |
$1,395.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.89
|
| Rate for Payer: Aetna Managed Medicare |
$131.02
|
| Rate for Payer: Anthem Medicare Advantage |
$131.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.02
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,395.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$734.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.02
|
| Rate for Payer: Health EOS Commercial |
$1,336.32
|
| Rate for Payer: HFN Commercial |
$1,395.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$481.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$481.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.02
|
| Rate for Payer: Multiplan Commercial |
$1,174.78
|
| Rate for Payer: NAPHCARE Commercial |
$196.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.06
|
| Rate for Payer: Quartz Beloit One Network |
$646.13
|
| Rate for Payer: Quartz Commercial |
$837.03
|
| Rate for Payer: Quartz Medicare Advantage |
$131.02
|
| Rate for Payer: The Alliance Commercial |
$497.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.02
|
| Rate for Payer: WEA Trust Commercial |
$807.66
|
| Rate for Payer: WPS Commercial |
$655.10
|
|
|
XR IVP
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
630417
|
| Min. Negotiated Rate |
$719.56 |
| Max. Negotiated Rate |
$1,351.00 |
| Rate for Payer: Quartz Beloit One Network |
$719.56
|
| Rate for Payer: Aetna Commercial |
$1,321.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.29
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,351.00
|
| Rate for Payer: Health EOS Commercial |
$1,306.95
|
| Rate for Payer: HFN Commercial |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,174.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,351.00
|
| Rate for Payer: Quartz Commercial |
$881.09
|
| Rate for Payer: WEA Trust Commercial |
$807.66
|
| Rate for Payer: WPS Commercial |
$1,087.66
|
|
|
XR IVP
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
1537128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
XR Joint Survey Single View
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
1537136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$655.41 |
| Rate for Payer: Aetna Commercial |
$641.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$612.66
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| 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: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.57
|
| 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 |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$655.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$634.04
|
| Rate for Payer: HFN Commercial |
$655.41
|
| 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 |
$569.92
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$655.41
|
| Rate for Payer: Quartz Beloit One Network |
$349.08
|
| Rate for Payer: Quartz Commercial |
$463.06
|
| 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: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$391.82
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$527.66
|
|
|
XR Joint Survey Single View
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
1537136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$676.78 |
| Rate for Payer: Aetna Commercial |
$676.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$612.66
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Medicare Advantage |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.04
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$676.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$356.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.04
|
| Rate for Payer: Health EOS Commercial |
$648.28
|
| Rate for Payer: HFN Commercial |
$676.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$569.92
|
| Rate for Payer: NAPHCARE Commercial |
$70.56
|
| Rate for Payer: Preferred Network Access Commercial |
$676.78
|
| Rate for Payer: Quartz Beloit One Network |
$313.46
|
| Rate for Payer: Quartz Commercial |
$406.07
|
| Rate for Payer: Quartz Medicare Advantage |
$47.04
|
| Rate for Payer: The Alliance Commercial |
$178.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.04
|
| Rate for Payer: WEA Trust Commercial |
$391.82
|
| Rate for Payer: WPS Commercial |
$235.20
|
|
|
XR Joint Survey Single View
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
1537136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.08 |
| Max. Negotiated Rate |
$655.41 |
| Rate for Payer: Aetna Commercial |
$641.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$612.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.57
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$655.41
|
| Rate for Payer: Health EOS Commercial |
$634.04
|
| Rate for Payer: HFN Commercial |
$655.41
|
| Rate for Payer: Multiplan Commercial |
$569.92
|
| Rate for Payer: Preferred Network Access Commercial |
$655.41
|
| Rate for Payer: Quartz Beloit One Network |
$349.08
|
| Rate for Payer: Quartz Commercial |
$427.44
|
| Rate for Payer: WEA Trust Commercial |
$391.82
|
| Rate for Payer: WPS Commercial |
$527.66
|
|
|
XR Joint Survey Single View
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
630410
|
| Min. Negotiated Rate |
$335.83 |
| Max. Negotiated Rate |
$630.53 |
| Rate for Payer: Aetna Commercial |
$616.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$363.24
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$630.53
|
| Rate for Payer: Health EOS Commercial |
$609.97
|
| Rate for Payer: HFN Commercial |
$630.53
|
| Rate for Payer: Multiplan Commercial |
$548.29
|
| Rate for Payer: Preferred Network Access Commercial |
$630.53
|
| Rate for Payer: Quartz Beloit One Network |
$335.83
|
| Rate for Payer: Quartz Commercial |
$411.22
|
| Rate for Payer: WEA Trust Commercial |
$376.95
|
| Rate for Payer: WPS Commercial |
$507.63
|
|
|
XR Joint Survey Single View
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
630410
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$630.53 |
| Rate for Payer: Aetna Commercial |
$616.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.41
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$445.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.97
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$363.24
|
| 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 |
$197.70
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$630.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$609.97
|
| Rate for Payer: HFN Commercial |
$630.53
|
| 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 |
$548.29
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$630.53
|
| Rate for Payer: Quartz Beloit One Network |
$335.83
|
| Rate for Payer: Quartz Commercial |
$445.48
|
| 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 |
$376.95
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$507.63
|
|
|
XR Joint Survey Single View
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
630410
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$651.09 |
| Rate for Payer: Aetna Commercial |
$651.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.41
|
| Rate for Payer: Aetna Managed Medicare |
$47.04
|
| Rate for Payer: Anthem Medicare Advantage |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.04
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$651.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$342.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.04
|
| Rate for Payer: Health EOS Commercial |
$623.68
|
| Rate for Payer: HFN Commercial |
$651.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$548.29
|
| Rate for Payer: NAPHCARE Commercial |
$70.56
|
| Rate for Payer: Preferred Network Access Commercial |
$651.09
|
| Rate for Payer: Quartz Beloit One Network |
$301.56
|
| Rate for Payer: Quartz Commercial |
$390.66
|
| Rate for Payer: Quartz Medicare Advantage |
$47.04
|
| Rate for Payer: The Alliance Commercial |
$178.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.04
|
| Rate for Payer: WEA Trust Commercial |
$376.95
|
| Rate for Payer: WPS Commercial |
$235.20
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
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 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
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630365
|
| Min. Negotiated Rate |
$91.58 |
| 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: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$711.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$547.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$525.16
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$579.86
|
| 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 |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$1,006.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$612.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$973.73
|
| Rate for Payer: HFN Commercial |
$1,006.55
|
| 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 |
$875.26
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,006.55
|
| Rate for Payer: Quartz Beloit One Network |
$536.10
|
| Rate for Payer: Quartz Commercial |
$711.15
|
| 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 |
$601.74
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$810.36
|
|
|
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
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
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 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
|
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 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
|
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
|
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
|
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
|
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 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: Quartz Beloit One Network |
$268.05
|
| 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 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
|
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
|
|
