|
CT Tibia/Fibula w/o Contrast Right
|
Facility
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
630205
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| 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 |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Professional
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
630205
|
| Min. Negotiated Rate |
$129.71 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$129.71
|
| Rate for Payer: Anthem Medicare Advantage |
$129.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.71
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.71
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.71
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: Quartz Medicare Advantage |
$129.71
|
| Rate for Payer: The Alliance Commercial |
$492.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.71
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$648.55
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241306
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241306
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980075
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Facility
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
630205
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$21.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Tibia/Fibula w/o Contrast Right
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241306
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| 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 |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Bilat
|
Facility
OP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630182
|
| 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 Tibia/Fibula w/ + w/o Contrast Bilat
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241290
|
|
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 Tibia/Fibula w/ + w/o Contrast Bilat
|
Professional
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630182
|
| 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 Tibia/Fibula w/ + w/o Contrast Bilat
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241290
|
|
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 Tibia/Fibula w/ + w/o Contrast Bilat
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241290
|
|
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 Tibia/Fibula w/ + w/o Contrast Bilat
|
Facility
IP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630182
|
| 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 Tibia/Fibula w/ + w/o Contrast Left
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630184
|
| 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 Tibia/Fibula w/ + w/o Contrast Left
|
Facility
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630184
|
| 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 Tibia/Fibula w/ + w/o Contrast Left
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241292
|
|
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 Tibia/Fibula w/ + w/o Contrast Left
|
Professional
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241292
|
|
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 Tibia/Fibula w/ + w/o Contrast Left
|
Professional
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630184
|
| 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 Tibia/Fibula w/ + w/o Contrast Left
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241292
|
|
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 Tibia/Fibula w/ + w/o Contrast Right
|
Facility
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630188
|
| 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 Tibia/Fibula w/ + w/o Contrast Right
|
Facility
IP
|
$3,918.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241294
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,919.82 |
| Max. Negotiated Rate |
$3,604.56 |
| Rate for Payer: Aetna Commercial |
$3,526.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.54
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$3,604.56
|
| Rate for Payer: Health EOS Commercial |
$3,487.02
|
| Rate for Payer: HFN Commercial |
$3,604.56
|
| Rate for Payer: Multiplan Commercial |
$3,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,350.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,604.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.82
|
| Rate for Payer: Quartz Commercial |
$2,350.80
|
| Rate for Payer: WEA Trust Commercial |
$2,154.90
|
| Rate for Payer: WPS Commercial |
$2,902.06
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Professional
|
$3,918.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241294
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,723.92 |
| Max. Negotiated Rate |
$3,722.10 |
| Rate for Payer: Aetna Commercial |
$3,722.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,369.48
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$3,722.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,959.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,350.80
|
| Rate for Payer: Health EOS Commercial |
$3,565.38
|
| Rate for Payer: Multiplan Commercial |
$3,134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,722.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.92
|
| Rate for Payer: Quartz Commercial |
$2,233.26
|
| Rate for Payer: The Alliance Commercial |
$1,959.00
|
| Rate for Payer: WEA Trust Commercial |
$2,154.90
|
| Rate for Payer: WPS Commercial |
$2,902.06
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980089
|
|
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
|
|
