|
CT Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241142
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980022
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT IAC/Sella/Orbit/Temporal w/ Con
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
661607
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,249.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,730.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,660.84
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,936.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,249.05
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
CT IAC/Sella/Orbit/Temporal w/ Con
|
Facility
|
IP
|
$3,327.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
661607
|
| Min. Negotiated Rate |
$1,695.44 |
| Max. Negotiated Rate |
$3,183.27 |
| Rate for Payer: Aetna Commercial |
$3,114.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,833.84
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,183.27
|
| Rate for Payer: Health EOS Commercial |
$3,079.47
|
| Rate for Payer: HFN Commercial |
$3,183.27
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,183.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,695.44
|
| Rate for Payer: Quartz Commercial |
$2,076.05
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$2,562.79
|
|
|
CT IAC/Sella/Orbit/Temporal w/ Con
|
Professional
|
Both
|
$3,327.00
|
|
|
Service Code
|
CPT 70481
|
| Hospital Charge Code |
661607
|
| Min. Negotiated Rate |
$178.61 |
| Max. Negotiated Rate |
$3,287.08 |
| Rate for Payer: Aetna Commercial |
$3,287.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,975.67
|
| Rate for Payer: Aetna Managed Medicare |
$178.61
|
| Rate for Payer: Anthem Medicare Advantage |
$178.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$178.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$178.61
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,287.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,730.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.61
|
| Rate for Payer: Health EOS Commercial |
$3,148.67
|
| Rate for Payer: HFN Commercial |
$3,287.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$697.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$697.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$178.61
|
| Rate for Payer: Multiplan Commercial |
$2,768.06
|
| Rate for Payer: NAPHCARE Commercial |
$267.91
|
| Rate for Payer: Preferred Network Access Commercial |
$3,287.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,522.44
|
| Rate for Payer: Quartz Commercial |
$1,972.25
|
| Rate for Payer: Quartz Medicare Advantage |
$178.61
|
| Rate for Payer: The Alliance Commercial |
$678.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.61
|
| Rate for Payer: WEA Trust Commercial |
$1,903.04
|
| Rate for Payer: WPS Commercial |
$893.05
|
|
|
CT IAC/Sella/Orbit/Temporal w/ Con
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
1241160
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$3,348.33 |
| Rate for Payer: Aetna Commercial |
$3,348.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Medicare Advantage |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.67
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,348.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,762.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.67
|
| Rate for Payer: Health EOS Commercial |
$3,207.35
|
| Rate for Payer: HFN Commercial |
$3,348.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$501.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.67
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: NAPHCARE Commercial |
$190.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,348.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,550.81
|
| Rate for Payer: Quartz Commercial |
$2,009.00
|
| Rate for Payer: Quartz Medicare Advantage |
$126.67
|
| Rate for Payer: The Alliance Commercial |
$481.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.67
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$633.36
|
|
|
CT IAC/Sella/Orbit/Temporal w/ Con
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
1241160
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Aetna Managed Medicare |
$986.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,868.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,242.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,972.40
|
| Rate for Payer: Health EOS Commercial |
$3,136.86
|
| Rate for Payer: HFN Commercial |
$3,242.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,643.42
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: NAPHCARE Commercial |
$2,114.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,242.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.03
|
| Rate for Payer: Quartz Commercial |
$2,290.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,114.74
|
| Rate for Payer: The Alliance Commercial |
$506.69
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$886.70
|
|
|
CT IAC/Sella/Orbit/Temporal w/ Con
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
1241160
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,727.03 |
| Max. Negotiated Rate |
$3,242.60 |
| Rate for Payer: Aetna Commercial |
$3,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,868.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,242.60
|
| Rate for Payer: Health EOS Commercial |
$3,136.86
|
| Rate for Payer: HFN Commercial |
$3,242.60
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,242.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.03
|
| Rate for Payer: Quartz Commercial |
$2,114.74
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$2,610.55
|
|
|
CT IAC/ Sella/ Orbit/ Temporal w/ Contrast
|
Professional
|
Both
|
$3,265.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
3072756
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$3,225.82 |
| Rate for Payer: Aetna Commercial |
$3,225.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Medicare Advantage |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,225.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,697.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.67
|
| Rate for Payer: Health EOS Commercial |
$3,090.00
|
| Rate for Payer: HFN Commercial |
$3,225.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$501.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$501.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.67
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: NAPHCARE Commercial |
$190.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,225.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.06
|
| Rate for Payer: Quartz Commercial |
$1,935.49
|
| Rate for Payer: Quartz Medicare Advantage |
$126.67
|
| Rate for Payer: The Alliance Commercial |
$481.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.67
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$633.36
|
|
|
CT IAC/ Sella/ Orbit/ Temporal w/ Contrast
|
Facility
|
OP
|
$3,265.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
3072756
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Aetna Managed Medicare |
$950.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.23
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,546.70
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,207.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,037.36
|
| Rate for Payer: The Alliance Commercial |
$506.69
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$886.70
|
|
|
CT IAC/ Sella/ Orbit/ Temporal w/ Contrast
|
Facility
|
IP
|
$3,265.00
|
|
|
Service Code
|
CPT 70481 TC
|
| Hospital Charge Code |
3072756
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,663.84 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,037.36
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Facility
|
IP
|
$3,077.00
|
|
|
Service Code
|
CPT 70480 TC
|
| Hospital Charge Code |
1241156
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,568.04 |
| Max. Negotiated Rate |
$2,944.07 |
| Rate for Payer: Aetna Commercial |
$2,880.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.04
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cigna Commercial |
$2,944.07
|
| Rate for Payer: Health EOS Commercial |
$2,848.07
|
| Rate for Payer: HFN Commercial |
$2,944.07
|
| Rate for Payer: Multiplan Commercial |
$2,560.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.04
|
| Rate for Payer: Quartz Commercial |
$1,920.05
|
| Rate for Payer: WEA Trust Commercial |
$1,760.04
|
| Rate for Payer: WPS Commercial |
$2,370.21
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Professional
|
Both
|
$2,677.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
661605
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$2,644.88 |
| Rate for Payer: Aetna Commercial |
$2,644.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,394.31
|
| Rate for Payer: Aetna Managed Medicare |
$157.53
|
| Rate for Payer: Anthem Medicare Advantage |
$157.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$157.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$157.53
|
| Rate for Payer: Cash Price |
$803.10
|
| Rate for Payer: Cash Price |
$803.10
|
| Rate for Payer: Cash Price |
$803.10
|
| Rate for Payer: Cigna Commercial |
$2,644.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,392.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.53
|
| Rate for Payer: Health EOS Commercial |
$2,533.51
|
| Rate for Payer: HFN Commercial |
$2,644.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$605.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$157.53
|
| Rate for Payer: Multiplan Commercial |
$2,227.26
|
| Rate for Payer: NAPHCARE Commercial |
$236.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,644.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.00
|
| Rate for Payer: Quartz Commercial |
$1,586.93
|
| Rate for Payer: Quartz Medicare Advantage |
$157.53
|
| Rate for Payer: The Alliance Commercial |
$598.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.53
|
| Rate for Payer: WEA Trust Commercial |
$1,531.24
|
| Rate for Payer: WPS Commercial |
$787.64
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Facility
|
OP
|
$2,677.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
661605
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,561.35 |
| Rate for Payer: Aetna Commercial |
$2,505.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,394.31
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,809.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,392.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,336.36
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,475.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$803.10
|
| Rate for Payer: Cash Price |
$803.10
|
| Rate for Payer: Cigna Commercial |
$2,561.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,558.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,477.83
|
| Rate for Payer: HFN Commercial |
$2,561.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$2,227.26
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,561.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,364.20
|
| Rate for Payer: Quartz Commercial |
$1,809.65
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$1,531.24
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,062.09
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Facility
|
IP
|
$2,677.00
|
|
|
Service Code
|
CPT 70480
|
| Hospital Charge Code |
661605
|
| Min. Negotiated Rate |
$1,364.20 |
| Max. Negotiated Rate |
$2,561.35 |
| Rate for Payer: Aetna Commercial |
$2,505.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,394.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,475.56
|
| Rate for Payer: Cash Price |
$803.10
|
| Rate for Payer: Cigna Commercial |
$2,561.35
|
| Rate for Payer: Health EOS Commercial |
$2,477.83
|
| Rate for Payer: HFN Commercial |
$2,561.35
|
| Rate for Payer: Multiplan Commercial |
$2,227.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,561.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,364.20
|
| Rate for Payer: Quartz Commercial |
$1,670.45
|
| Rate for Payer: WEA Trust Commercial |
$1,531.24
|
| Rate for Payer: WPS Commercial |
$2,062.09
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Facility
|
OP
|
$3,077.00
|
|
|
Service Code
|
CPT 70480 TC
|
| Hospital Charge Code |
1241156
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$393.54 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,880.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.07
|
| Rate for Payer: Aetna Managed Medicare |
$896.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.04
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cigna Commercial |
$2,944.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,790.81
|
| Rate for Payer: Health EOS Commercial |
$2,848.07
|
| Rate for Payer: HFN Commercial |
$2,944.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,400.06
|
| Rate for Payer: Multiplan Commercial |
$2,560.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.07
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.04
|
| Rate for Payer: Quartz Commercial |
$2,080.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,920.05
|
| Rate for Payer: The Alliance Commercial |
$393.54
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,760.04
|
| Rate for Payer: WPS Commercial |
$688.69
|
|
|
CT IAC/Sella/Orbit/Temporal w/o Con
|
Professional
|
Both
|
$3,077.00
|
|
|
Service Code
|
CPT 70480 TC
|
| Hospital Charge Code |
1241156
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$98.38 |
| Max. Negotiated Rate |
$3,040.08 |
| Rate for Payer: Aetna Commercial |
$3,040.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.07
|
| Rate for Payer: Aetna Managed Medicare |
$98.38
|
| Rate for Payer: Anthem Medicare Advantage |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.38
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cash Price |
$923.10
|
| Rate for Payer: Cigna Commercial |
$3,040.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,600.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.38
|
| Rate for Payer: Health EOS Commercial |
$2,912.07
|
| Rate for Payer: HFN Commercial |
$3,040.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$384.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.38
|
| Rate for Payer: Multiplan Commercial |
$2,560.06
|
| Rate for Payer: NAPHCARE Commercial |
$147.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,040.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,408.04
|
| Rate for Payer: Quartz Commercial |
$1,824.05
|
| Rate for Payer: Quartz Medicare Advantage |
$98.38
|
| Rate for Payer: The Alliance Commercial |
$373.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.38
|
| Rate for Payer: WEA Trust Commercial |
$1,760.04
|
| Rate for Payer: WPS Commercial |
$491.92
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Professional
|
Both
|
$3,987.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
661609
|
| Min. Negotiated Rate |
$208.09 |
| Max. Negotiated Rate |
$3,939.16 |
| Rate for Payer: Aetna Commercial |
$3,939.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,565.97
|
| Rate for Payer: Aetna Managed Medicare |
$208.09
|
| Rate for Payer: Anthem Medicare Advantage |
$208.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$208.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$208.09
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,939.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,073.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.09
|
| Rate for Payer: Health EOS Commercial |
$3,773.30
|
| Rate for Payer: HFN Commercial |
$3,939.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$819.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$208.09
|
| Rate for Payer: Multiplan Commercial |
$3,317.18
|
| Rate for Payer: NAPHCARE Commercial |
$312.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.45
|
| Rate for Payer: Quartz Commercial |
$2,363.49
|
| Rate for Payer: Quartz Medicare Advantage |
$208.09
|
| Rate for Payer: The Alliance Commercial |
$790.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$208.09
|
| Rate for Payer: WEA Trust Commercial |
$2,280.56
|
| Rate for Payer: WPS Commercial |
$1,040.47
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
|
OP
|
$4,064.00
|
|
|
Service Code
|
CPT 70482 TC
|
| Hospital Charge Code |
1241158
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$599.87 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,183.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,365.25
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,169.92
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,747.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,535.94
|
| Rate for Payer: The Alliance Commercial |
$599.87
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$1,049.78
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
|
IP
|
$4,064.00
|
|
|
Service Code
|
CPT 70482 TC
|
| Hospital Charge Code |
1241158
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,071.01 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,535.94
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$3,130.50
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
|
IP
|
$3,987.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
661609
|
| Min. Negotiated Rate |
$2,031.78 |
| Max. Negotiated Rate |
$3,814.76 |
| Rate for Payer: Aetna Commercial |
$3,731.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,565.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,197.63
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,814.76
|
| Rate for Payer: Health EOS Commercial |
$3,690.37
|
| Rate for Payer: HFN Commercial |
$3,814.76
|
| Rate for Payer: Multiplan Commercial |
$3,317.18
|
| Rate for Payer: Preferred Network Access Commercial |
$3,814.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,031.78
|
| Rate for Payer: Quartz Commercial |
$2,487.89
|
| Rate for Payer: WEA Trust Commercial |
$2,280.56
|
| Rate for Payer: WPS Commercial |
$3,071.19
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Facility
|
OP
|
$3,987.00
|
|
|
Service Code
|
CPT 70482
|
| Hospital Charge Code |
661609
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,814.76 |
| Rate for Payer: Aetna Commercial |
$3,731.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,565.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,695.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,073.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,990.31
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,197.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,814.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,320.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,690.37
|
| Rate for Payer: HFN Commercial |
$3,814.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$3,317.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,814.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,031.78
|
| Rate for Payer: Quartz Commercial |
$2,695.21
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,280.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,071.19
|
|
|
CT IAC/ Sel/ Orbit/ Temp w + w/o Con
|
Professional
|
Both
|
$4,064.00
|
|
|
Service Code
|
CPT 70482 TC
|
| Hospital Charge Code |
1241158
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$149.97 |
| Max. Negotiated Rate |
$4,015.23 |
| Rate for Payer: Aetna Commercial |
$4,015.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Aetna Managed Medicare |
$149.97
|
| Rate for Payer: Anthem Medicare Advantage |
$149.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$149.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$149.97
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$4,015.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,113.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.97
|
| Rate for Payer: Health EOS Commercial |
$3,846.17
|
| Rate for Payer: HFN Commercial |
$4,015.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$600.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$149.97
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: NAPHCARE Commercial |
$224.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,015.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.69
|
| Rate for Payer: Quartz Commercial |
$2,409.14
|
| Rate for Payer: Quartz Medicare Advantage |
$149.97
|
| Rate for Payer: The Alliance Commercial |
$569.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.97
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$749.84
|
|
|
CT Knee w/ Contrast Bilateral
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630036
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,878.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,983.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.91
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,878.21
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
