|
CT Femur w/ Contrast Right
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241046
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,283.04 |
| Max. Negotiated Rate |
$2,770.20 |
| Rate for Payer: Quartz Commercial |
$1,662.12
|
| Rate for Payer: The Alliance Commercial |
$1,458.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
| Rate for Payer: Aetna Commercial |
$2,770.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,770.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,458.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,749.60
|
| Rate for Payer: Health EOS Commercial |
$2,653.56
|
| Rate for Payer: HFN Commercial |
$2,770.20
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
|
|
CT Femur w/ Contrast Right
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241046
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$816.48 |
| Max. Negotiated Rate |
$11,664.00 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Aetna Managed Medicare |
$816.48
|
| 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 |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.79
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.00
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,895.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.60
|
| Rate for Payer: The Alliance Commercial |
$11,664.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Femur w/ Contrast Right
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629848
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$2,724.60 |
| Rate for Payer: Aetna Commercial |
$2,724.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.48
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,724.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,434.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,720.80
|
| Rate for Payer: Health EOS Commercial |
$2,609.88
|
| Rate for Payer: HFN Commercial |
$2,724.60
|
| 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: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.92
|
| Rate for Payer: Quartz Commercial |
$1,634.76
|
| Rate for Payer: The Alliance Commercial |
$1,434.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Femur w/o Contrast Bilateral
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241048
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Femur w/o Contrast Bilateral
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629850
|
| Min. Negotiated Rate |
$475.77 |
| Max. Negotiated Rate |
$4,912.45 |
| Rate for Payer: Aetna Commercial |
$4,912.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,912.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,585.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,102.60
|
| Rate for Payer: Health EOS Commercial |
$4,705.61
|
| Rate for Payer: HFN Commercial |
$4,912.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.77
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,912.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,275.24
|
| Rate for Payer: Quartz Commercial |
$2,947.47
|
| Rate for Payer: The Alliance Commercial |
$2,585.50
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Femur w/o Contrast Bilateral
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241048
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| 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 |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.71
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Femur w/o Contrast Bilateral
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241048
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: HFN Commercial |
$2,410.15
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Femur w/o Contrast Bilateral
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629850
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,361.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,482.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,893.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,361.15
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Femur w/o Contrast Bilateral
|
Facility
|
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629850
|
| Min. Negotiated Rate |
$2,533.79 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,102.60
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Femur w/o Contrast Left
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629852
|
| Min. Negotiated Rate |
$475.77 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,551.00
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: HFN Commercial |
$2,455.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.77
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: The Alliance Commercial |
$1,292.50
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Femur w/o Contrast Left
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241050
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,373.96 |
| Max. Negotiated Rate |
$2,579.68 |
| Rate for Payer: Aetna Commercial |
$2,523.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.12
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,579.68
|
| Rate for Payer: Health EOS Commercial |
$2,495.56
|
| Rate for Payer: HFN Commercial |
$2,579.68
|
| Rate for Payer: Multiplan Commercial |
$2,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,579.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.96
|
| Rate for Payer: Quartz Commercial |
$1,682.40
|
| Rate for Payer: WEA Trust Commercial |
$1,542.20
|
| Rate for Payer: WPS Commercial |
$2,076.92
|
|
|
CT Femur w/o Contrast Left
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629852
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Femur w/o Contrast Left
|
Facility
|
OP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241050
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$785.12 |
| Max. Negotiated Rate |
$11,216.00 |
| Rate for Payer: Aetna Commercial |
$2,523.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.44
|
| Rate for Payer: Aetna Managed Medicare |
$785.12
|
| 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 |
$1,486.12
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,579.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,569.12
|
| Rate for Payer: Health EOS Commercial |
$2,495.56
|
| Rate for Payer: HFN Commercial |
$2,579.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,103.00
|
| Rate for Payer: Multiplan Commercial |
$2,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,579.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.96
|
| Rate for Payer: Quartz Commercial |
$1,822.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,682.40
|
| Rate for Payer: The Alliance Commercial |
$11,216.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.20
|
| Rate for Payer: WPS Commercial |
$2,076.92
|
|
|
CT Femur w/o Contrast Left
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629852
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Femur w/o Contrast Left
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241050
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,233.76 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Aetna Commercial |
$2,663.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.44
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,663.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,402.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,682.40
|
| Rate for Payer: Health EOS Commercial |
$2,551.64
|
| Rate for Payer: HFN Commercial |
$2,663.80
|
| Rate for Payer: Multiplan Commercial |
$2,243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,663.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,233.76
|
| Rate for Payer: Quartz Commercial |
$1,598.28
|
| Rate for Payer: The Alliance Commercial |
$1,402.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.20
|
| Rate for Payer: WPS Commercial |
$2,076.92
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241052
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,373.96 |
| Max. Negotiated Rate |
$2,579.68 |
| Rate for Payer: Aetna Commercial |
$2,523.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.12
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,579.68
|
| Rate for Payer: Health EOS Commercial |
$2,495.56
|
| Rate for Payer: HFN Commercial |
$2,579.68
|
| Rate for Payer: Multiplan Commercial |
$2,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,579.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.96
|
| Rate for Payer: Quartz Commercial |
$1,682.40
|
| Rate for Payer: WEA Trust Commercial |
$1,542.20
|
| Rate for Payer: WPS Commercial |
$2,076.92
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980070
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629854
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980070
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| 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 |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.71
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Femur w/o Contrast Right
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629854
|
| Min. Negotiated Rate |
$475.77 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,551.00
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: HFN Commercial |
$2,455.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.77
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: The Alliance Commercial |
$1,292.50
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Femur w/o Contrast Right
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241052
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,233.76 |
| Max. Negotiated Rate |
$2,663.80 |
| Rate for Payer: Aetna Commercial |
$2,663.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.44
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,663.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,402.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,682.40
|
| Rate for Payer: Health EOS Commercial |
$2,551.64
|
| Rate for Payer: HFN Commercial |
$2,663.80
|
| Rate for Payer: Multiplan Commercial |
$2,243.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,663.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,233.76
|
| Rate for Payer: Quartz Commercial |
$1,598.28
|
| Rate for Payer: The Alliance Commercial |
$1,402.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.20
|
| Rate for Payer: WPS Commercial |
$2,076.92
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
OP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241052
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$785.12 |
| Max. Negotiated Rate |
$11,216.00 |
| Rate for Payer: Aetna Commercial |
$2,523.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.44
|
| Rate for Payer: Aetna Managed Medicare |
$785.12
|
| 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 |
$1,486.12
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,579.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,569.12
|
| Rate for Payer: Health EOS Commercial |
$2,495.56
|
| Rate for Payer: HFN Commercial |
$2,579.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,103.00
|
| Rate for Payer: Multiplan Commercial |
$2,243.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,579.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.96
|
| Rate for Payer: Quartz Commercial |
$1,822.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,682.40
|
| Rate for Payer: The Alliance Commercial |
$11,216.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,542.20
|
| Rate for Payer: WPS Commercial |
$2,076.92
|
|
|
CT Femur w/o Contrast Right
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629854
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Femur w/o Contrast Right
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980070
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: HFN Commercial |
$2,410.15
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$6,613.40
|
| 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
|
|
