|
CT Lower Extremity w/+w/o Contrast Left
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241190
|
|
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 Lower Extremity w/+w/o Contrast Left
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241190
|
|
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 Lower Extremity w/+w/o Contrast Left
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630062
|
| 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 Lower Extremity w/+w/o Contrast Left
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630062
|
| 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 Lower Extremity w/+w/o Contrast Left
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241190
|
|
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 Lower Extremity w/+w/o Contrast Left
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630062
|
| 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 Lower Extremity w/+w/o Contrast Right
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241192
|
|
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 Lower Extremity w/+w/o Contrast Right
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630064
|
| 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 Lower Extremity w/+w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241192
|
|
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 Lower Extremity w/+w/o Contrast Right
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980088
|
|
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 Lower Extremity w/+w/o Contrast Right
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630064
|
| 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 Lower Extremity w/+w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980088
|
|
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 Lower Extremity w/+w/o Contrast Right
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630064
|
| 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 Lower Extremity w/+w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980088
|
|
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 Lower Extremity w/+w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241192
|
|
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 Lumbar Myelography via Lumbar Inj
|
Facility
IP
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,779.68 |
| Max. Negotiated Rate |
$3,341.44 |
| Rate for Payer: Aetna Commercial |
$3,268.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,924.96
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$3,341.44
|
| Rate for Payer: Health EOS Commercial |
$3,232.48
|
| Rate for Payer: HFN Commercial |
$3,341.44
|
| Rate for Payer: Multiplan Commercial |
$2,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,341.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,779.68
|
| Rate for Payer: Quartz Commercial |
$2,179.20
|
| Rate for Payer: WEA Trust Commercial |
$1,997.60
|
| Rate for Payer: WPS Commercial |
$2,690.22
|
|
|
CT Lumbar Myelography via Lumbar Inj
|
Facility
OP
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,016.96 |
| Max. Negotiated Rate |
$14,528.00 |
| Rate for Payer: Aetna Commercial |
$3,268.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,123.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,016.96
|
| 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 |
$1,924.96
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$3,341.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,032.47
|
| Rate for Payer: Health EOS Commercial |
$3,232.48
|
| Rate for Payer: HFN Commercial |
$3,341.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,724.00
|
| Rate for Payer: Multiplan Commercial |
$2,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,341.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,779.68
|
| Rate for Payer: Quartz Commercial |
$2,360.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,179.20
|
| Rate for Payer: The Alliance Commercial |
$14,528.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,997.60
|
| Rate for Payer: WPS Commercial |
$2,690.22
|
|
|
CT Lumbar Myelography via Lumbar Inj
|
Professional
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,598.08 |
| Max. Negotiated Rate |
$3,450.40 |
| Rate for Payer: Aetna Commercial |
$3,450.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,123.52
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$3,450.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,816.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,179.20
|
| Rate for Payer: Health EOS Commercial |
$3,305.12
|
| Rate for Payer: Multiplan Commercial |
$2,905.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,450.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.08
|
| Rate for Payer: Quartz Commercial |
$2,070.24
|
| Rate for Payer: The Alliance Commercial |
$1,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,997.60
|
| Rate for Payer: WPS Commercial |
$2,690.22
|
|
|
CT Lumbar Spine Unenhanced
|
Facility
IP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,833.58 |
| Max. Negotiated Rate |
$3,442.64 |
| Rate for Payer: Aetna Commercial |
$3,367.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,983.26
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,442.64
|
| Rate for Payer: Health EOS Commercial |
$3,330.38
|
| Rate for Payer: HFN Commercial |
$3,442.64
|
| Rate for Payer: Multiplan Commercial |
$2,993.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,245.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,442.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,833.58
|
| Rate for Payer: Quartz Commercial |
$2,245.20
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$2,771.70
|
|
|
CT Lumbar Spine Unenhanced
|
Facility
OP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$584.43 |
| Max. Negotiated Rate |
$14,968.00 |
| Rate for Payer: Aetna Commercial |
$3,367.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,047.76
|
| 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 |
$1,983.26
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,442.64
|
| Rate for Payer: Health EOS Commercial |
$3,330.38
|
| Rate for Payer: HFN Commercial |
$3,442.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,806.50
|
| Rate for Payer: Multiplan Commercial |
$2,993.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,245.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,442.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,833.58
|
| Rate for Payer: Quartz Commercial |
$2,432.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,245.20
|
| Rate for Payer: The Alliance Commercial |
$14,968.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$584.43
|
|
|
CT Lumbar Spine Unenhanced
|
Professional
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$3,554.90 |
| Rate for Payer: Aetna Commercial |
$3,554.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.12
|
| Rate for Payer: Aetna Managed Medicare |
$83.49
|
| Rate for Payer: Anthem Medicare Advantage |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.49
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,554.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,871.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.49
|
| Rate for Payer: Health EOS Commercial |
$3,405.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$2,993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,554.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,646.48
|
| Rate for Payer: Quartz Commercial |
$2,132.94
|
| Rate for Payer: Quartz Medicare Advantage |
$83.49
|
| Rate for Payer: The Alliance Commercial |
$317.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.49
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$417.45
|
|
|
CT Lung Screening Follow Up 12 Months
|
Facility
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$615.93 |
| Max. Negotiated Rate |
$13,544.00 |
| Rate for Payer: Aetna Commercial |
$3,047.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,911.96
|
| Rate for Payer: Aetna Managed Medicare |
$948.08
|
| 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 |
$1,794.58
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,115.12
|
| Rate for Payer: Health EOS Commercial |
$3,013.54
|
| Rate for Payer: HFN Commercial |
$3,115.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,539.50
|
| Rate for Payer: Multiplan Commercial |
$2,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,031.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,115.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,659.14
|
| Rate for Payer: Quartz Commercial |
$2,200.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,031.60
|
| Rate for Payer: The Alliance Commercial |
$13,544.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,862.30
|
| Rate for Payer: WPS Commercial |
$615.93
|
|
|
CT Lung Screening Follow Up 12 Months
|
Professional
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.99 |
| Max. Negotiated Rate |
$3,216.70 |
| Rate for Payer: Aetna Commercial |
$3,216.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,911.96
|
| Rate for Payer: Aetna Managed Medicare |
$87.99
|
| Rate for Payer: Anthem Medicare Advantage |
$87.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.99
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,216.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,693.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.99
|
| Rate for Payer: Health EOS Commercial |
$3,081.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.99
|
| Rate for Payer: Multiplan Commercial |
$2,708.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,489.84
|
| Rate for Payer: Quartz Commercial |
$1,930.02
|
| Rate for Payer: Quartz Medicare Advantage |
$87.99
|
| Rate for Payer: The Alliance Commercial |
$334.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.99
|
| Rate for Payer: WEA Trust Commercial |
$1,862.30
|
| Rate for Payer: WPS Commercial |
$439.95
|
|
|
CT Lung Screening Follow Up 12 Months
|
Facility
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,659.14 |
| Max. Negotiated Rate |
$3,115.12 |
| Rate for Payer: Aetna Commercial |
$3,047.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,794.58
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,115.12
|
| Rate for Payer: Health EOS Commercial |
$3,013.54
|
| Rate for Payer: HFN Commercial |
$3,115.12
|
| Rate for Payer: Multiplan Commercial |
$2,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,031.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,115.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,659.14
|
| Rate for Payer: Quartz Commercial |
$2,031.60
|
| Rate for Payer: WEA Trust Commercial |
$1,862.30
|
| Rate for Payer: WPS Commercial |
$2,508.01
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Facility
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$584.43 |
| Max. Negotiated Rate |
$13,544.00 |
| Rate for Payer: Aetna Commercial |
$3,047.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,911.96
|
| Rate for Payer: Aetna Managed Medicare |
$948.08
|
| 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 |
$1,794.58
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,115.12
|
| Rate for Payer: Health EOS Commercial |
$3,013.54
|
| Rate for Payer: HFN Commercial |
$3,115.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,539.50
|
| Rate for Payer: Multiplan Commercial |
$2,708.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,031.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,115.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,659.14
|
| Rate for Payer: Quartz Commercial |
$2,200.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,031.60
|
| Rate for Payer: The Alliance Commercial |
$13,544.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,862.30
|
| Rate for Payer: WPS Commercial |
$584.43
|
|
