|
CT Knee w/ + w/o Contrast Right
|
Professional
|
Both
|
$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: HFN Commercial |
$3,584.35
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| 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: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.99
|
| 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 |
$3,355.37
|
|
|
CT Liver Triple Phase w + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724148
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$737.52 |
| 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: 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 |
$2,718.00
|
| Rate for Payer: Health EOS Commercial |
$4,122.30
|
| Rate for Payer: HFN Commercial |
$4,303.50
|
| 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: 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: The Alliance Commercial |
$2,265.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Liver Triple Phase w + w/o, Pelvis w/
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724151
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$935.91 |
| Max. Negotiated Rate |
$7,160.15 |
| Rate for Payer: Aetna Commercial |
$7,160.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,160.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,768.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,522.20
|
| Rate for Payer: Health EOS Commercial |
$6,858.67
|
| Rate for Payer: HFN Commercial |
$7,160.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$935.91
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,160.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.28
|
| Rate for Payer: Quartz Commercial |
$4,296.09
|
| Rate for Payer: The Alliance Commercial |
$3,768.50
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
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 |
$2,065.00 |
| 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: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| 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 |
$5,582.66
|
|
|
CT Liver Triple Phase w + w/o, Pelvis w/
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724151
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| 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: 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: 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 |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
CT Lower Extremity w/ Contrast Bilat
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241182
|
|
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: HFN Commercial |
$2,770.20
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
| 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 Lower Extremity w/ Contrast Bilat
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241182
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| 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 Lower Extremity w/ Contrast Bilat
|
Professional
|
Both
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630066
|
| Min. Negotiated Rate |
$616.16 |
| 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: 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 |
$3,442.20
|
| Rate for Payer: Health EOS Commercial |
$5,220.67
|
| Rate for Payer: HFN Commercial |
$5,450.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Multiplan Commercial |
$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: The Alliance Commercial |
$2,868.50
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: WPS Commercial |
$4,249.40
|
|
|
CT Lower Extremity w/ Contrast Bilat
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630066
|
| 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 DHI/DHP/ASO |
$3,210.43
|
| 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 |
$726.40
|
| 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 Lower Extremity w/ Contrast Bilat
|
Facility
|
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630066
|
| Min. Negotiated Rate |
$2,811.13 |
| 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: 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 Lower Extremity w/ Contrast Bilat
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241182
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$816.48 |
| Max. Negotiated Rate |
$11,664.00 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Aetna Managed Medicare |
$816.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.79
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.00
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,895.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.60
|
| Rate for Payer: The Alliance Commercial |
$11,664.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Lower Extremity w/ Contrast Left
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630068
|
| 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 DHI/DHP/ASO |
$1,604.93
|
| 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 |
$726.40
|
| 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 Lower Extremity w/ Contrast Left
|
Facility
|
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630068
|
| Min. Negotiated Rate |
$1,405.32 |
| 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: 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 Lower Extremity w/ Contrast Left
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241184
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| 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 Lower Extremity w/ Contrast Left
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241184
|
|
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: HFN Commercial |
$2,770.20
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
| 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 Lower Extremity w/ Contrast Left
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241184
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$816.48 |
| Max. Negotiated Rate |
$11,664.00 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Aetna Managed Medicare |
$816.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,631.79
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.00
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,895.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.60
|
| Rate for Payer: The Alliance Commercial |
$11,664.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Lower Extremity w/ Contrast Left
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630068
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$2,724.60 |
| Rate for Payer: Aetna Commercial |
$2,724.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.48
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,724.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,434.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,720.80
|
| Rate for Payer: Health EOS Commercial |
$2,609.88
|
| Rate for Payer: HFN Commercial |
$2,724.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.92
|
| Rate for Payer: Quartz Commercial |
$1,634.76
|
| Rate for Payer: The Alliance Commercial |
$1,434.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Lower Extremity w/ Contrast Right
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241186
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| 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 Lower Extremity w/ Contrast Right
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980081
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| 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 Lower Extremity w/ Contrast Right
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630070
|
| Min. Negotiated Rate |
$616.16 |
| Max. Negotiated Rate |
$2,724.60 |
| Rate for Payer: Aetna Commercial |
$2,724.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.48
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,724.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,434.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,720.80
|
| Rate for Payer: Health EOS Commercial |
$2,609.88
|
| Rate for Payer: HFN Commercial |
$2,724.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.92
|
| Rate for Payer: Quartz Commercial |
$1,634.76
|
| Rate for Payer: The Alliance Commercial |
$1,434.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Lower Extremity w/ Contrast Right
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241186
|
|
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: HFN Commercial |
$2,770.20
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
| 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 Lower Extremity w/ Contrast Right
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980081
|
|
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: HFN Commercial |
$2,770.20
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.04
|
| 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 Lower Extremity w/ Contrast Right
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630070
|
| 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 DHI/DHP/ASO |
$1,604.93
|
| 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 |
$726.40
|
| 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
|
|
