|
CT Knee w/ + w/o Contrast Bilateral
|
Facility
IP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630026
|
| Min. Negotiated Rate |
$3,768.10 |
| Max. Negotiated Rate |
$7,074.80 |
| Rate for Payer: Aetna Commercial |
$6,921.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,075.70
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,074.80
|
| Rate for Payer: Health EOS Commercial |
$6,844.10
|
| Rate for Payer: HFN Commercial |
$7,074.80
|
| Rate for Payer: Multiplan Commercial |
$6,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,614.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,074.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,768.10
|
| Rate for Payer: Quartz Commercial |
$4,614.00
|
| Rate for Payer: WEA Trust Commercial |
$4,229.50
|
| Rate for Payer: WPS Commercial |
$5,695.98
|
|
|
CT Knee w/ + w/o Contrast Bilateral
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241162
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Bilateral
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241162
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Bilateral
|
Facility
OP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630026
|
| Min. Negotiated Rate |
$181.60 |
| 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: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,998.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,845.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,691.20
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,075.70
|
| 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 |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,074.80
|
| 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 |
$6,844.10
|
| Rate for Payer: HFN Commercial |
$7,074.80
|
| 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 |
$6,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| 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 |
$4,998.50
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$286.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$4,229.50
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,695.98
|
|
|
CT Knee w/ + w/o Contrast Bilateral
|
Professional
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630026
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$7,305.50 |
| Rate for Payer: Aetna Commercial |
$7,305.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,613.40
|
| Rate for Payer: Aetna Managed Medicare |
$195.75
|
| Rate for Payer: Anthem Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.75
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,305.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,845.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.75
|
| Rate for Payer: Health EOS Commercial |
$6,997.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$718.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$6,152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,305.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,383.60
|
| Rate for Payer: Quartz Commercial |
$4,383.30
|
| Rate for Payer: Quartz Medicare Advantage |
$195.75
|
| Rate for Payer: The Alliance Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$4,229.50
|
| Rate for Payer: WPS Commercial |
$978.75
|
|
|
CT Knee w/ + w/o Contrast Bilateral
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241162
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Left
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241164
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Left
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630030
|
| Min. Negotiated Rate |
$1,884.05 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,307.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,307.00
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Knee w/ + w/o Contrast Left
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241164
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Left
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630030
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,499.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,845.60
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,499.25
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$286.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Knee w/ + w/o Contrast Left
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241164
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Left
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630030
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$3,652.75 |
| Rate for Payer: Aetna Commercial |
$3,652.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$195.75
|
| Rate for Payer: Anthem Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.75
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,652.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,922.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.75
|
| Rate for Payer: Health EOS Commercial |
$3,498.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$718.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.80
|
| Rate for Payer: Quartz Commercial |
$2,191.65
|
| Rate for Payer: Quartz Medicare Advantage |
$195.75
|
| Rate for Payer: The Alliance Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$978.75
|
|
|
CT Knee w/ + w/o Contrast Right
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241166
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Right
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630034
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,499.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,922.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,845.60
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,499.25
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$286.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Knee w/ + w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241166
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241166
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Right
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980087
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.12 |
| Max. Negotiated Rate |
$3,584.35 |
| Rate for Payer: Aetna Commercial |
$3,584.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,584.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,886.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,263.80
|
| Rate for Payer: Health EOS Commercial |
$3,433.43
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,584.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.12
|
| Rate for Payer: Quartz Commercial |
$2,150.61
|
| Rate for Payer: The Alliance Commercial |
$1,886.50
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Right
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630034
|
| Min. Negotiated Rate |
$1,884.05 |
| Max. Negotiated Rate |
$3,537.40 |
| Rate for Payer: Aetna Commercial |
$3,460.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,037.85
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,537.40
|
| Rate for Payer: Health EOS Commercial |
$3,422.05
|
| Rate for Payer: HFN Commercial |
$3,537.40
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,307.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.05
|
| Rate for Payer: Quartz Commercial |
$2,307.00
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$2,847.99
|
|
|
CT Knee w/ + w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980087
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Knee w/ + w/o Contrast Right
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630034
|
| Min. Negotiated Rate |
$195.75 |
| Max. Negotiated Rate |
$3,652.75 |
| Rate for Payer: Aetna Commercial |
$3,652.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,306.70
|
| Rate for Payer: Aetna Managed Medicare |
$195.75
|
| Rate for Payer: Anthem Medicare Advantage |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.75
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,652.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,922.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.75
|
| Rate for Payer: Health EOS Commercial |
$3,498.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$718.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$3,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,652.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,691.80
|
| Rate for Payer: Quartz Commercial |
$2,191.65
|
| Rate for Payer: Quartz Medicare Advantage |
$195.75
|
| Rate for Payer: The Alliance Commercial |
$743.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.75
|
| Rate for Payer: WEA Trust Commercial |
$2,114.75
|
| Rate for Payer: WPS Commercial |
$978.75
|
|
|
CT Knee w/ + w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980087
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Liver Triple Phase w + w/o Contrast
|
Facility
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724148
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,219.70 |
| Max. Negotiated Rate |
$4,167.60 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,718.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Liver Triple Phase w + w/o Contrast
|
Facility
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724148
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,268.40 |
| Max. Negotiated Rate |
$18,120.00 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,268.40
|
| 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 |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,397.50
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,944.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,718.00
|
| Rate for Payer: The Alliance Commercial |
$18,120.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$1,403.15
|
|
|
CT Liver Triple Phase w + w/o Contrast
|
Professional
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724148
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$200.45 |
| Max. Negotiated Rate |
$4,303.50 |
| Rate for Payer: Aetna Commercial |
$4,303.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Aetna Managed Medicare |
$200.45
|
| Rate for Payer: Anthem Medicare Advantage |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$200.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$200.45
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,303.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.45
|
| Rate for Payer: Health EOS Commercial |
$4,122.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$737.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$200.45
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,303.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,993.20
|
| Rate for Payer: Quartz Commercial |
$2,582.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.45
|
| Rate for Payer: The Alliance Commercial |
$761.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.45
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$1,002.25
|
|
|
CT Liver Triple Phase w + w/o, Pelvis w/
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724151
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,761.48 |
| Max. Negotiated Rate |
$30,148.00 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| 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 |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: The Alliance Commercial |
$30,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$1,761.48
|
|
