|
CT Ankle w/o Contrast Right
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980069
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$2,506.56 |
| Rate for Payer: Aetna Commercial |
$2,506.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| 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 |
$2,506.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,319.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.09
|
| Rate for Payer: Health EOS Commercial |
$2,401.02
|
| Rate for Payer: HFN Commercial |
$2,506.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.80
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.93
|
| Rate for Payer: Quartz Commercial |
$1,503.93
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Ankle w/o Contrast Right
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980069
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,292.86 |
| Max. Negotiated Rate |
$2,427.40 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.39
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,427.40
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,583.09
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Ankle w/o Contrast Right
|
Facility
|
OP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1240873
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$816.52 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,624.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.90
|
| Rate for Payer: Aetna Managed Medicare |
$816.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.56
|
| 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 |
$2,682.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.93
|
| Rate for Payer: Health EOS Commercial |
$2,595.38
|
| Rate for Payer: HFN Commercial |
$2,682.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.12
|
| Rate for Payer: Multiplan Commercial |
$2,332.93
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.92
|
| Rate for Payer: Quartz Commercial |
$1,895.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.70
|
| Rate for Payer: The Alliance Commercial |
$1,458.08
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,603.89
|
| Rate for Payer: WPS Commercial |
$2,159.92
|
|
|
CT Ankle w/o Contrast Right
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1240873
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,428.92 |
| Max. Negotiated Rate |
$2,682.87 |
| Rate for Payer: Aetna Commercial |
$2,624.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.56
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,682.87
|
| Rate for Payer: Health EOS Commercial |
$2,595.38
|
| Rate for Payer: HFN Commercial |
$2,682.87
|
| Rate for Payer: Multiplan Commercial |
$2,332.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.92
|
| Rate for Payer: Quartz Commercial |
$1,749.70
|
| Rate for Payer: WEA Trust Commercial |
$1,603.89
|
| Rate for Payer: WPS Commercial |
$2,159.92
|
|
|
CT Ankle w/o Contrast Right
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
625696
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,747.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.43
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| 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 |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,504.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| 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 |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,747.46
|
| 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 |
$1,478.62
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Ankle w/o Contrast Right
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
625696
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$2,553.98 |
| Rate for Payer: Aetna Commercial |
$2,553.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$129.64
|
| Rate for Payer: Anthem Medicare Advantage |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.64
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,553.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,344.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.64
|
| Rate for Payer: Health EOS Commercial |
$2,446.44
|
| Rate for Payer: HFN Commercial |
$2,553.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.64
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$194.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.90
|
| Rate for Payer: Quartz Commercial |
$1,532.39
|
| Rate for Payer: Quartz Medicare Advantage |
$129.64
|
| Rate for Payer: The Alliance Commercial |
$492.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.64
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$648.18
|
|
|
CT Ankle w/o Contrast Right
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
625696
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Ankle w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1240857
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| 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 |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625680
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$7,357.79 |
| Rate for Payer: Aetna Commercial |
$7,197.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,877.94
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,198.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,998.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,838.85
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,238.73
|
| 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 |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,357.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,475.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$7,117.86
|
| Rate for Payer: HFN Commercial |
$7,357.79
|
| 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 |
$6,398.08
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,357.79
|
| Rate for Payer: Quartz Beloit One Network |
$3,918.82
|
| Rate for Payer: Quartz Commercial |
$5,198.44
|
| 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 |
$4,398.68
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$5,923.61
|
|
|
CT Ankle w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1240857
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| 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 |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625680
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$7,597.72 |
| Rate for Payer: Aetna Commercial |
$7,597.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,877.94
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,597.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,998.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$7,277.82
|
| Rate for Payer: HFN Commercial |
$7,597.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$6,398.08
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$7,597.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.94
|
| Rate for Payer: Quartz Commercial |
$4,558.63
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$4,398.68
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Ankle w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625680
|
| Min. Negotiated Rate |
$3,918.82 |
| Max. Negotiated Rate |
$7,357.79 |
| Rate for Payer: Aetna Commercial |
$7,197.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,877.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,238.73
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,357.79
|
| Rate for Payer: Health EOS Commercial |
$7,117.86
|
| Rate for Payer: HFN Commercial |
$7,357.79
|
| Rate for Payer: Multiplan Commercial |
$6,398.08
|
| Rate for Payer: Preferred Network Access Commercial |
$7,357.79
|
| Rate for Payer: Quartz Beloit One Network |
$3,918.82
|
| Rate for Payer: Quartz Commercial |
$4,798.56
|
| Rate for Payer: WEA Trust Commercial |
$4,398.68
|
| Rate for Payer: WPS Commercial |
$5,923.61
|
|
|
CT Ankle w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1240857
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Professional
|
Both
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625682
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$3,798.86 |
| Rate for Payer: Aetna Commercial |
$3,798.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,798.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$3,638.91
|
| Rate for Payer: HFN Commercial |
$3,798.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.47
|
| Rate for Payer: Quartz Commercial |
$2,279.32
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1240859
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1240859
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| 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 |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625682
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,599.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,999.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,919.42
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| 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 |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,237.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| 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 |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,599.22
|
| 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 |
$2,199.34
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1240859
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| 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 |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625682
|
| Min. Negotiated Rate |
$1,959.41 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,399.28
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1240861
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| 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 |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980083
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| 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 |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980083
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
625684
|
| Min. Negotiated Rate |
$1,959.41 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,399.28
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1240861
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| 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 |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Ankle w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1240861
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
