|
CT Femur w/ + w/o Contrast Bilateral
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241036
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Bilateral
|
Facility
IP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629838
|
| Min. Negotiated Rate |
$3,768.10 |
| Max. Negotiated Rate |
$7,074.80 |
| Rate for Payer: Aetna Commercial |
$6,921.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,075.70
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,074.80
|
| Rate for Payer: Health EOS Commercial |
$6,844.10
|
| Rate for Payer: HFN Commercial |
$7,074.80
|
| Rate for Payer: Multiplan Commercial |
$6,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,614.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,074.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,768.10
|
| Rate for Payer: Quartz Commercial |
$4,614.00
|
| Rate for Payer: WEA Trust Commercial |
$4,229.50
|
| Rate for Payer: WPS Commercial |
$5,695.98
|
|
|
CT Femur w/ + w/o Contrast Bilateral
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241036
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Left
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629840
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,499.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,845.60
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,499.25
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$286.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Femur w/ + w/o Contrast Left
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241038
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Left
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629840
|
| Min. Negotiated Rate |
$1,884.05 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,307.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,307.00
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Femur w/ + w/o Contrast Left
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241038
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Left
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241038
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Left
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629840
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$3,652.75 |
| Rate for Payer: Aetna Commercial |
$3,652.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$195.75
|
| Rate for Payer: Anthem Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.75
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,652.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,922.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.75
|
| Rate for Payer: Health EOS Commercial |
$3,498.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$718.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.80
|
| Rate for Payer: Quartz Commercial |
$2,191.65
|
| Rate for Payer: Quartz Medicare Advantage |
$195.75
|
| Rate for Payer: The Alliance Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$978.75
|
|
|
CT Femur w/ + w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Right
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629842
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$3,652.75 |
| Rate for Payer: Aetna Commercial |
$3,652.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$195.75
|
| Rate for Payer: Anthem Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.75
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,652.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,922.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.75
|
| Rate for Payer: Health EOS Commercial |
$3,498.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$718.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.80
|
| Rate for Payer: Quartz Commercial |
$2,191.65
|
| Rate for Payer: Quartz Medicare Advantage |
$195.75
|
| Rate for Payer: The Alliance Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$978.75
|
|
|
CT Femur w/ + w/o Contrast Right
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629842
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,499.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,845.60
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,499.25
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$286.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Femur w/ + w/o Contrast Right
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980084
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Right
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241040
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980084
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Femur w/ + w/o Contrast Right
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
629842
|
| Min. Negotiated Rate |
$1,884.05 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,307.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,307.00
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Femur w/ + w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980084
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Fistula or Sinus Tract Abscess Study
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 76080 TC
|
| Hospital Charge Code |
1241054
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$237.37 |
| Max. Negotiated Rate |
$8,648.00 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$605.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.50
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,297.20
|
| Rate for Payer: The Alliance Commercial |
$8,648.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$237.37
|
|
|
CT Fistula or Sinus Tract Abscess Study
|
Professional
|
$2,162.00
|
|
|
Service Code
|
CPT 76080 TC
|
| Hospital Charge Code |
1241054
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$33.91
|
| Rate for Payer: Anthem Medicare Advantage |
$33.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.91
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,081.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.91
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.91
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: Quartz Medicare Advantage |
$33.91
|
| Rate for Payer: The Alliance Commercial |
$128.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.91
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$169.55
|
|
|
CT Fistula or Sinus Tract Abscess Study
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 76080 TC
|
| Hospital Charge Code |
1241054
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
CT Foot w/ Contrast Bilateral
|
Facility
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,375.92 |
| Max. Negotiated Rate |
$2,583.36 |
| Rate for Payer: Aetna Commercial |
$2,527.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,488.24
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,583.36
|
| Rate for Payer: Health EOS Commercial |
$2,499.12
|
| Rate for Payer: HFN Commercial |
$2,583.36
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,583.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.92
|
| Rate for Payer: Quartz Commercial |
$1,684.80
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Foot w/ Contrast Bilateral
|
Facility
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629868
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$5,278.04 |
| Rate for Payer: Aetna Commercial |
$5,163.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,933.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,729.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,868.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,753.76
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,278.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$5,105.93
|
| Rate for Payer: HFN Commercial |
$5,278.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$4,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,278.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,811.13
|
| Rate for Payer: Quartz Commercial |
$3,729.05
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$283.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$4,249.40
|
|
|
CT Foot w/ Contrast Bilateral
|
Professional
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,235.52 |
| Max. Negotiated Rate |
$2,667.60 |
| Rate for Payer: Aetna Commercial |
$2,667.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,667.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,404.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,684.80
|
| Rate for Payer: Health EOS Commercial |
$2,555.28
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.52
|
| Rate for Payer: Quartz Commercial |
$1,600.56
|
| Rate for Payer: The Alliance Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Foot w/ Contrast Bilateral
|
Professional
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629868
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$5,450.15 |
| Rate for Payer: Aetna Commercial |
$5,450.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,933.82
|
| Rate for Payer: Aetna Managed Medicare |
$167.00
|
| Rate for Payer: Anthem Medicare Advantage |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.00
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,450.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,868.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.00
|
| Rate for Payer: Health EOS Commercial |
$5,220.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$4,589.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,450.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.28
|
| Rate for Payer: Quartz Commercial |
$3,270.09
|
| Rate for Payer: Quartz Medicare Advantage |
$167.00
|
| Rate for Payer: The Alliance Commercial |
$634.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.00
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: WPS Commercial |
$835.00
|
|
