|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Facility
OP
|
$3,077.00
|
|
|
Service Code
|
CPT 70480 TC
|
| Hospital Charge Code |
1241156
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$697.06 |
| Max. Negotiated Rate |
$12,308.00 |
| Rate for Payer: Aetna Commercial |
$2,769.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,646.22
|
| Rate for Payer: Aetna Managed Medicare |
$861.56
|
| 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 |
$1,630.81
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cigna Commercial |
$2,830.84
|
| Rate for Payer: Health EOS Commercial |
$2,738.53
|
| Rate for Payer: HFN Commercial |
$2,830.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,307.75
|
| Rate for Payer: Multiplan Commercial |
$2,461.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,846.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,830.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,507.73
|
| Rate for Payer: Quartz Commercial |
$2,000.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,846.20
|
| Rate for Payer: The Alliance Commercial |
$12,308.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,692.35
|
| Rate for Payer: WPS Commercial |
$697.06
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Professional
|
$3,077.00
|
|
|
Service Code
|
CPT 70480 TC
|
| Hospital Charge Code |
1241156
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$99.58 |
| Max. Negotiated Rate |
$2,923.15 |
| Rate for Payer: Aetna Commercial |
$2,923.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,646.22
|
| Rate for Payer: Aetna Managed Medicare |
$99.58
|
| Rate for Payer: Anthem Medicare Advantage |
$99.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.58
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cigna Commercial |
$2,923.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,538.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.58
|
| Rate for Payer: Health EOS Commercial |
$2,800.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$369.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.58
|
| Rate for Payer: Multiplan Commercial |
$2,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,923.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,353.88
|
| Rate for Payer: Quartz Commercial |
$1,753.89
|
| Rate for Payer: Quartz Medicare Advantage |
$99.58
|
| Rate for Payer: The Alliance Commercial |
$378.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.58
|
| Rate for Payer: WEA Trust Commercial |
$1,692.35
|
| Rate for Payer: WPS Commercial |
$497.90
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Professional
|
$4,064.00
|
|
|
Service Code
|
CPT 70482 TC
|
| Hospital Charge Code |
1241158
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$153.13 |
| Max. Negotiated Rate |
$3,860.80 |
| Rate for Payer: Aetna Commercial |
$3,860.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Aetna Managed Medicare |
$153.13
|
| Rate for Payer: Anthem Medicare Advantage |
$153.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.13
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,860.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,032.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.13
|
| Rate for Payer: Health EOS Commercial |
$3,698.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$577.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$577.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.13
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,860.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.16
|
| Rate for Payer: Quartz Commercial |
$2,316.48
|
| Rate for Payer: Quartz Medicare Advantage |
$153.13
|
| Rate for Payer: The Alliance Commercial |
$581.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.13
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$765.65
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Professional
|
$3,987.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
661609
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$3,787.65 |
| Rate for Payer: Aetna Commercial |
$3,787.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,428.82
|
| Rate for Payer: Aetna Managed Medicare |
$211.40
|
| Rate for Payer: Anthem Medicare Advantage |
$211.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.40
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,787.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,993.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.40
|
| Rate for Payer: Health EOS Commercial |
$3,628.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$787.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$787.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$3,189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,787.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,754.28
|
| Rate for Payer: Quartz Commercial |
$2,272.59
|
| Rate for Payer: Quartz Medicare Advantage |
$211.40
|
| Rate for Payer: The Alliance Commercial |
$803.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.40
|
| Rate for Payer: WEA Trust Commercial |
$2,192.85
|
| Rate for Payer: WPS Commercial |
$1,057.00
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
IP
|
$4,064.00
|
|
|
Service Code
|
CPT 70482 TC
|
| Hospital Charge Code |
1241158
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,991.36 |
| Max. Negotiated Rate |
$3,738.88 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,438.40
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
OP
|
$4,064.00
|
|
|
Service Code
|
CPT 70482 TC
|
| Hospital Charge Code |
1241158
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,071.91 |
| Max. Negotiated Rate |
$16,256.00 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,137.92
|
| 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 |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,048.00
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,641.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,438.40
|
| Rate for Payer: The Alliance Commercial |
$16,256.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$1,071.91
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
OP
|
$3,987.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
661609
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,668.04 |
| Rate for Payer: Aetna Commercial |
$3,588.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,428.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,591.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,993.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,913.76
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,113.11
|
| 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 |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,668.04
|
| 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 |
$3,548.43
|
| Rate for Payer: HFN Commercial |
$3,668.04
|
| 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 |
$3,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,668.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,953.63
|
| Rate for Payer: Quartz Commercial |
$2,591.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$1,116.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,192.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,953.17
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
IP
|
$3,987.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
661609
|
| Min. Negotiated Rate |
$1,953.63 |
| Max. Negotiated Rate |
$3,668.04 |
| Rate for Payer: Aetna Commercial |
$3,588.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,113.11
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,668.04
|
| Rate for Payer: Health EOS Commercial |
$3,548.43
|
| Rate for Payer: HFN Commercial |
$3,668.04
|
| Rate for Payer: Multiplan Commercial |
$3,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,392.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,668.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,953.63
|
| Rate for Payer: Quartz Commercial |
$2,392.20
|
| Rate for Payer: WEA Trust Commercial |
$2,192.85
|
| Rate for Payer: WPS Commercial |
$2,953.17
|
|
|
CT Knee w/ Contrast Bilateral
|
Facility
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241168
|
|
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 Knee w/ Contrast Bilateral
|
Facility
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630036
|
| Min. Negotiated Rate |
$2,811.13 |
| Max. Negotiated Rate |
$5,278.04 |
| Rate for Payer: Aetna Commercial |
$5,163.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.61
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,278.04
|
| Rate for Payer: Health EOS Commercial |
$5,105.93
|
| Rate for Payer: HFN Commercial |
$5,278.04
|
| Rate for Payer: Multiplan Commercial |
$4,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,442.20
|
| 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 |
$3,442.20
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: WPS Commercial |
$4,249.40
|
|
|
CT Knee w/ Contrast Bilateral
|
Professional
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630036
|
| 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
|
|
|
CT Knee w/ Contrast Bilateral
|
Facility
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241168
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$11,232.00 |
| Rate for Payer: Aetna Commercial |
$2,527.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Aetna Managed Medicare |
$786.24
|
| 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 |
$1,488.24
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$2,106.00
|
| 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 |
$1,825.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.80
|
| Rate for Payer: The Alliance Commercial |
$11,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Knee w/ Contrast Bilateral
|
Facility
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630036
|
| 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 Knee w/ Contrast Bilateral
|
Professional
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241168
|
|
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 Knee w/ Contrast Left
|
Professional
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630038
|
| Min. Negotiated Rate |
$167.00 |
| 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: 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 |
$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 |
$167.00
|
| Rate for Payer: Health EOS Commercial |
$2,609.88
|
| 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 |
$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: 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 |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$835.00
|
|
|
CT Knee w/ Contrast Left
|
Professional
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241170
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,283.04 |
| Max. Negotiated Rate |
$2,770.20 |
| 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: 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
|
| 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
|
|
|
CT Knee w/ Contrast Left
|
Facility
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241170
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,428.84 |
| Max. Negotiated Rate |
$2,682.72 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| 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: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| 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 |
$1,749.60
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Knee w/ Contrast Left
|
Facility
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630038
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$2,638.56 |
| Rate for Payer: Aetna Commercial |
$2,581.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.48
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,376.64
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.04
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,638.56
|
| 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 |
$2,552.52
|
| Rate for Payer: HFN Commercial |
$2,638.56
|
| 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 |
$2,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.32
|
| Rate for Payer: Quartz Commercial |
$1,864.20
|
| 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 |
$1,577.40
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Knee w/ Contrast Left
|
Facility
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241170
|
|
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: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| 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 Knee w/ Contrast Left
|
Facility
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630038
|
| Min. Negotiated Rate |
$1,405.32 |
| Max. Negotiated Rate |
$2,638.56 |
| Rate for Payer: Aetna Commercial |
$2,581.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.04
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,638.56
|
| Rate for Payer: Health EOS Commercial |
$2,552.52
|
| Rate for Payer: HFN Commercial |
$2,638.56
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.32
|
| Rate for Payer: Quartz Commercial |
$1,720.80
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Knee w/ Contrast Right
|
Facility
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630040
|
| Min. Negotiated Rate |
$1,405.32 |
| Max. Negotiated Rate |
$2,638.56 |
| Rate for Payer: Aetna Commercial |
$2,581.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.04
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,638.56
|
| Rate for Payer: Health EOS Commercial |
$2,552.52
|
| Rate for Payer: HFN Commercial |
$2,638.56
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.32
|
| Rate for Payer: Quartz Commercial |
$1,720.80
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Knee w/ Contrast Right
|
Facility
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980080
|
|
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 Knee w/ Contrast Right
|
Professional
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,283.04 |
| Max. Negotiated Rate |
$2,770.20 |
| 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: 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
|
| 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
|
|
|
CT Knee w/ Contrast Right
|
Facility
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980080
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$11,232.00 |
| Rate for Payer: Aetna Commercial |
$2,527.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Aetna Managed Medicare |
$786.24
|
| 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 |
$1,488.24
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$2,106.00
|
| 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 |
$1,825.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.80
|
| Rate for Payer: The Alliance Commercial |
$11,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Knee w/ Contrast Right
|
Professional
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980080
|
|
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
|
|
