|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241308
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,865.92 |
| Max. Negotiated Rate |
$3,503.36 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,284.80
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
IP
|
$7,766.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711755
|
| Min. Negotiated Rate |
$3,805.34 |
| Max. Negotiated Rate |
$7,144.72 |
| Rate for Payer: Aetna Commercial |
$6,989.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,115.98
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$7,144.72
|
| Rate for Payer: Health EOS Commercial |
$6,911.74
|
| Rate for Payer: HFN Commercial |
$7,144.72
|
| Rate for Payer: Multiplan Commercial |
$6,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,659.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,144.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,805.34
|
| Rate for Payer: Quartz Commercial |
$4,659.60
|
| Rate for Payer: WEA Trust Commercial |
$4,271.30
|
| Rate for Payer: WPS Commercial |
$5,752.28
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
OP
|
$7,766.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711755
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$261,906.32 |
| Rate for Payer: Aetna Commercial |
$6,989.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,678.76
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,047.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,883.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,727.68
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,115.98
|
| 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 |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$7,144.72
|
| 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 |
$6,911.74
|
| Rate for Payer: HFN Commercial |
$7,144.72
|
| 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 |
$6,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,144.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,805.34
|
| Rate for Payer: Quartz Commercial |
$5,047.90
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$261,906.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$4,271.30
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,752.28
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711756
|
| Min. Negotiated Rate |
$1,902.67 |
| Max. Negotiated Rate |
$3,572.36 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,329.80
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241311
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,865.92 |
| Max. Negotiated Rate |
$3,503.36 |
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Commercial |
$2,284.80
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241311
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$15,232.00 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,066.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,475.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,284.80
|
| Rate for Payer: The Alliance Commercial |
$15,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Professional
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241311
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,675.52 |
| Max. Negotiated Rate |
$3,617.60 |
| Rate for Payer: Aetna Commercial |
$3,617.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,617.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,904.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,284.80
|
| Rate for Payer: Health EOS Commercial |
$3,465.28
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,617.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.52
|
| Rate for Payer: Quartz Commercial |
$2,170.56
|
| Rate for Payer: The Alliance Commercial |
$1,904.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711756
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$261,906.32 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,523.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,941.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,863.84
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| 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 |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| 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 |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| 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 |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,523.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$261,906.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Professional
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711756
|
| Min. Negotiated Rate |
$185.32 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Aetna Commercial |
$3,688.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$185.32
|
| Rate for Payer: Anthem Medicare Advantage |
$185.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.32
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,688.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,941.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.32
|
| Rate for Payer: Health EOS Commercial |
$3,533.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.32
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,688.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.52
|
| Rate for Payer: Quartz Commercial |
$2,213.31
|
| Rate for Payer: Quartz Medicare Advantage |
$185.32
|
| Rate for Payer: The Alliance Commercial |
$704.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.32
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$926.60
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 RT,TC
|
| Hospital Charge Code |
1241314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$15,232.00 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,066.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,475.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,284.80
|
| Rate for Payer: The Alliance Commercial |
$15,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711752
|
| Min. Negotiated Rate |
$1,902.67 |
| Max. Negotiated Rate |
$3,572.36 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,329.80
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 TC,RT
|
| Hospital Charge Code |
2979989
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,066.24 |
| Max. Negotiated Rate |
$15,232.00 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,066.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,856.00
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,475.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,284.80
|
| Rate for Payer: The Alliance Commercial |
$15,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 RT,TC
|
| Hospital Charge Code |
1241314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,865.92 |
| Max. Negotiated Rate |
$3,503.36 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,284.80
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Professional
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 TC,RT
|
| Hospital Charge Code |
2979989
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,675.52 |
| Max. Negotiated Rate |
$3,617.60 |
| Rate for Payer: Aetna Commercial |
$3,617.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,617.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,904.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,284.80
|
| Rate for Payer: Health EOS Commercial |
$3,465.28
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,617.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.52
|
| Rate for Payer: Quartz Commercial |
$2,170.56
|
| Rate for Payer: The Alliance Commercial |
$1,904.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711752
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$261,906.32 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,523.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,941.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,863.84
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| 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 |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| 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 |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| 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 |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,523.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$261,906.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Professional
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711752
|
| Min. Negotiated Rate |
$185.32 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Aetna Commercial |
$3,688.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$185.32
|
| Rate for Payer: Anthem Medicare Advantage |
$185.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.32
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,688.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,941.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.32
|
| Rate for Payer: Health EOS Commercial |
$3,533.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.32
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,688.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.52
|
| Rate for Payer: Quartz Commercial |
$2,213.31
|
| Rate for Payer: Quartz Medicare Advantage |
$185.32
|
| Rate for Payer: The Alliance Commercial |
$704.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.32
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$926.60
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 TC,RT
|
| Hospital Charge Code |
2979989
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,865.92 |
| Max. Negotiated Rate |
$3,503.36 |
| Rate for Payer: Aetna Commercial |
$3,427.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,018.24
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,503.36
|
| Rate for Payer: Health EOS Commercial |
$3,389.12
|
| Rate for Payer: HFN Commercial |
$3,503.36
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,503.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,865.92
|
| Rate for Payer: Quartz Commercial |
$2,284.80
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Professional
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 RT,TC
|
| Hospital Charge Code |
1241314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,675.52 |
| Max. Negotiated Rate |
$3,617.60 |
| Rate for Payer: Aetna Commercial |
$3,617.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,274.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,617.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,904.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,284.80
|
| Rate for Payer: Health EOS Commercial |
$3,465.28
|
| Rate for Payer: Multiplan Commercial |
$3,046.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,617.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,675.52
|
| Rate for Payer: Quartz Commercial |
$2,170.56
|
| Rate for Payer: The Alliance Commercial |
$1,904.00
|
| Rate for Payer: WEA Trust Commercial |
$2,094.40
|
| Rate for Payer: WPS Commercial |
$2,820.59
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630219
|
| Min. Negotiated Rate |
$2,533.79 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,102.60
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241337
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| 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 Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241337
|
|
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 Upper Extremity w/ Contrast Bilat
|
Facility
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630219
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,361.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,482.08
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,361.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,897.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Professional
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630219
|
| Min. Negotiated Rate |
$202.41 |
| Max. Negotiated Rate |
$4,912.45 |
| Rate for Payer: Aetna Commercial |
$4,912.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Aetna Managed Medicare |
$202.41
|
| Rate for Payer: Anthem Medicare Advantage |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$202.41
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,912.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,585.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.41
|
| Rate for Payer: Health EOS Commercial |
$4,705.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$754.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$202.41
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,912.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,275.24
|
| Rate for Payer: Quartz Commercial |
$2,947.47
|
| Rate for Payer: Quartz Medicare Advantage |
$202.41
|
| Rate for Payer: The Alliance Commercial |
$769.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.41
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$1,012.05
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241337
|
|
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 Upper Extremity w/ Contrast Left
|
Professional
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241339
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,158.52 |
| Max. Negotiated Rate |
$2,501.35 |
| Rate for Payer: Aetna Commercial |
$2,501.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,264.38
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,501.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,316.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.80
|
| Rate for Payer: Health EOS Commercial |
$2,396.03
|
| Rate for Payer: Multiplan Commercial |
$2,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,158.52
|
| Rate for Payer: Quartz Commercial |
$1,500.81
|
| Rate for Payer: The Alliance Commercial |
$1,316.50
|
| Rate for Payer: WEA Trust Commercial |
$1,448.15
|
| Rate for Payer: WPS Commercial |
$1,950.26
|
|
