|
CT Tibia/Fibula w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630184
|
| Min. Negotiated Rate |
$1,959.41 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,399.28
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Left
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241292
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| 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 |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630184
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,599.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,999.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,919.42
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| 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 |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,237.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| 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 |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,599.22
|
| 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 |
$2,199.34
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Left
|
Professional
|
Both
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630184
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$3,798.86 |
| Rate for Payer: Aetna Commercial |
$3,798.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,798.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$3,638.91
|
| Rate for Payer: HFN Commercial |
$3,798.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.47
|
| Rate for Payer: Quartz Commercial |
$2,279.32
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630188
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$3,798.86 |
| Rate for Payer: Aetna Commercial |
$3,798.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,798.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$3,638.91
|
| Rate for Payer: HFN Commercial |
$3,798.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.47
|
| Rate for Payer: Quartz Commercial |
$2,279.32
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630188
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,599.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,999.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,919.42
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| 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 |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,237.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| 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 |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,599.22
|
| 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 |
$2,199.34
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
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 |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,918.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241294
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,140.92 |
| Max. Negotiated Rate |
$3,748.74 |
| Rate for Payer: Aetna Commercial |
$3,667.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,140.92
|
| 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 |
$2,159.60
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$3,748.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,280.28
|
| Rate for Payer: Health EOS Commercial |
$3,626.50
|
| Rate for Payer: HFN Commercial |
$3,748.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,056.04
|
| Rate for Payer: Multiplan Commercial |
$3,259.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,444.83
|
| Rate for Payer: Preferred Network Access Commercial |
$3,748.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.61
|
| Rate for Payer: Quartz Commercial |
$2,648.57
|
| Rate for Payer: Quartz Medicare Advantage |
$2,444.83
|
| Rate for Payer: The Alliance Commercial |
$2,037.36
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,241.10
|
| Rate for Payer: WPS Commercial |
$3,018.04
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,918.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241294
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,870.98 |
| Rate for Payer: Aetna Commercial |
$3,870.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.26
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$3,870.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,037.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,444.83
|
| Rate for Payer: Health EOS Commercial |
$3,708.00
|
| Rate for Payer: HFN Commercial |
$3,870.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,259.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,870.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.88
|
| Rate for Payer: Quartz Commercial |
$2,322.59
|
| Rate for Payer: The Alliance Commercial |
$2,037.36
|
| Rate for Payer: WEA Trust Commercial |
$2,241.10
|
| Rate for Payer: WPS Commercial |
$3,018.04
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980089
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| 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 |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630188
|
| Min. Negotiated Rate |
$1,959.41 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,399.28
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Tibia/Fibula w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980089
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| 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 |
$2,079.68
|
| 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 |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
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 |
$1,996.61 |
| Max. Negotiated Rate |
$3,748.74 |
| Rate for Payer: Aetna Commercial |
$3,667.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.60
|
| Rate for Payer: Cash Price |
$1,175.40
|
| Rate for Payer: Cigna Commercial |
$3,748.74
|
| Rate for Payer: Health EOS Commercial |
$3,626.50
|
| Rate for Payer: HFN Commercial |
$3,748.74
|
| Rate for Payer: Multiplan Commercial |
$3,259.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,748.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.61
|
| Rate for Payer: Quartz Commercial |
$2,444.83
|
| Rate for Payer: WEA Trust Commercial |
$2,241.10
|
| Rate for Payer: WPS Commercial |
$3,018.04
|
|
|
CT TMJ w/ Contrast Bilateral
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 70487 LT,TC
|
| Hospital Charge Code |
1241317
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,574.15 |
| Max. Negotiated Rate |
$2,955.56 |
| Rate for Payer: Aetna Commercial |
$2,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,702.66
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,955.56
|
| Rate for Payer: Health EOS Commercial |
$2,859.18
|
| Rate for Payer: HFN Commercial |
$2,955.56
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.15
|
| Rate for Payer: Quartz Commercial |
$1,927.54
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
CT TMJ w/ Contrast Bilateral
|
Facility
|
IP
|
$6,296.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
711753
|
| Min. Negotiated Rate |
$3,208.44 |
| Max. Negotiated Rate |
$6,024.01 |
| Rate for Payer: Aetna Commercial |
$5,893.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,631.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,470.36
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cigna Commercial |
$6,024.01
|
| Rate for Payer: Health EOS Commercial |
$5,827.58
|
| Rate for Payer: HFN Commercial |
$6,024.01
|
| Rate for Payer: Multiplan Commercial |
$5,238.27
|
| Rate for Payer: Preferred Network Access Commercial |
$6,024.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,208.44
|
| Rate for Payer: Quartz Commercial |
$3,928.70
|
| Rate for Payer: WEA Trust Commercial |
$3,601.31
|
| Rate for Payer: WPS Commercial |
$4,849.81
|
|
|
CT TMJ w/ Contrast Bilateral
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
CPT 70487 LT,TC
|
| Hospital Charge Code |
1241317
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$583.87 |
| Max. Negotiated Rate |
$3,051.93 |
| Rate for Payer: Aetna Commercial |
$3,051.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$3,051.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,606.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,927.54
|
| Rate for Payer: Health EOS Commercial |
$2,923.43
|
| Rate for Payer: HFN Commercial |
$3,051.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.87
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,051.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,413.53
|
| Rate for Payer: Quartz Commercial |
$1,831.16
|
| Rate for Payer: The Alliance Commercial |
$1,606.28
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
CT TMJ w/ Contrast Bilateral
|
Professional
|
Both
|
$6,296.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
711753
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$6,220.45 |
| Rate for Payer: Aetna Commercial |
$6,220.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,631.14
|
| Rate for Payer: Aetna Managed Medicare |
$150.65
|
| Rate for Payer: Anthem Medicare Advantage |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.65
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cigna Commercial |
$6,220.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,273.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.65
|
| Rate for Payer: Health EOS Commercial |
$5,958.53
|
| Rate for Payer: HFN Commercial |
$6,220.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.65
|
| Rate for Payer: Multiplan Commercial |
$5,238.27
|
| Rate for Payer: NAPHCARE Commercial |
$225.98
|
| Rate for Payer: Preferred Network Access Commercial |
$6,220.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,881.05
|
| Rate for Payer: Quartz Commercial |
$3,732.27
|
| Rate for Payer: Quartz Medicare Advantage |
$150.65
|
| Rate for Payer: The Alliance Commercial |
$572.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.65
|
| Rate for Payer: WEA Trust Commercial |
$3,601.31
|
| Rate for Payer: WPS Commercial |
$753.27
|
|
|
CT TMJ w/ Contrast Bilateral
|
Facility
|
OP
|
$6,296.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
711753
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$6,024.01 |
| Rate for Payer: Aetna Commercial |
$5,893.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,631.14
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,256.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,273.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,142.96
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,470.36
|
| 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 |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cigna Commercial |
$6,024.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,664.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$5,827.58
|
| Rate for Payer: HFN Commercial |
$6,024.01
|
| 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 |
$5,238.27
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$6,024.01
|
| Rate for Payer: Quartz Beloit One Network |
$3,208.44
|
| Rate for Payer: Quartz Commercial |
$4,256.10
|
| 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 |
$3,601.31
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$4,849.81
|
|
|
CT TMJ w/ Contrast Bilateral
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 70487 LT,TC
|
| Hospital Charge Code |
1241317
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$899.52 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Aetna Managed Medicare |
$899.52
|
| 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 |
$1,702.66
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,955.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,797.80
|
| Rate for Payer: Health EOS Commercial |
$2,859.18
|
| Rate for Payer: HFN Commercial |
$2,955.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,409.42
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,927.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.15
|
| Rate for Payer: Quartz Commercial |
$2,088.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,927.54
|
| Rate for Payer: The Alliance Commercial |
$1,606.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
CT TMJ w/ Contrast Left
|
Facility
|
OP
|
$3,089.00
|
|
|
Service Code
|
CPT 70487 LT,TC
|
| Hospital Charge Code |
1241320
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$899.52 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Aetna Managed Medicare |
$899.52
|
| 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 |
$1,702.66
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,955.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,797.80
|
| Rate for Payer: Health EOS Commercial |
$2,859.18
|
| Rate for Payer: HFN Commercial |
$2,955.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,409.42
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,927.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.15
|
| Rate for Payer: Quartz Commercial |
$2,088.16
|
| Rate for Payer: Quartz Medicare Advantage |
$1,927.54
|
| Rate for Payer: The Alliance Commercial |
$1,606.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
CT TMJ w/ Contrast Left
|
Facility
|
OP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
711754
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,012.01 |
| Rate for Payer: Aetna Commercial |
$2,946.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,636.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,571.48
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.18
|
| 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 |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,012.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,832.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,913.79
|
| Rate for Payer: HFN Commercial |
$3,012.01
|
| 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 |
$2,619.14
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.22
|
| Rate for Payer: Quartz Commercial |
$2,128.05
|
| 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 |
$1,800.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,424.90
|
|
|
CT TMJ w/ Contrast Left
|
Facility
|
IP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
711754
|
| Min. Negotiated Rate |
$1,604.22 |
| Max. Negotiated Rate |
$3,012.01 |
| Rate for Payer: Aetna Commercial |
$2,946.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.18
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,012.01
|
| Rate for Payer: Health EOS Commercial |
$2,913.79
|
| Rate for Payer: HFN Commercial |
$3,012.01
|
| Rate for Payer: Multiplan Commercial |
$2,619.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.22
|
| Rate for Payer: Quartz Commercial |
$1,964.35
|
| Rate for Payer: WEA Trust Commercial |
$1,800.66
|
| Rate for Payer: WPS Commercial |
$2,424.90
|
|
|
CT TMJ w/ Contrast Left
|
Professional
|
Both
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
711754
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$3,110.22 |
| Rate for Payer: Aetna Commercial |
$3,110.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Aetna Managed Medicare |
$150.65
|
| Rate for Payer: Anthem Medicare Advantage |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.65
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,110.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,636.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.65
|
| Rate for Payer: Health EOS Commercial |
$2,979.27
|
| Rate for Payer: HFN Commercial |
$3,110.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.65
|
| Rate for Payer: Multiplan Commercial |
$2,619.14
|
| Rate for Payer: NAPHCARE Commercial |
$225.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,110.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,440.52
|
| Rate for Payer: Quartz Commercial |
$1,866.13
|
| Rate for Payer: Quartz Medicare Advantage |
$150.65
|
| Rate for Payer: The Alliance Commercial |
$572.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.65
|
| Rate for Payer: WEA Trust Commercial |
$1,800.66
|
| Rate for Payer: WPS Commercial |
$753.27
|
|
|
CT TMJ w/ Contrast Left
|
Professional
|
Both
|
$3,089.00
|
|
|
Service Code
|
CPT 70487 LT,TC
|
| Hospital Charge Code |
1241320
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$583.87 |
| Max. Negotiated Rate |
$3,051.93 |
| Rate for Payer: Aetna Commercial |
$3,051.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$3,051.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,606.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,927.54
|
| Rate for Payer: Health EOS Commercial |
$2,923.43
|
| Rate for Payer: HFN Commercial |
$3,051.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.87
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: Preferred Network Access Commercial |
$3,051.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,413.53
|
| Rate for Payer: Quartz Commercial |
$1,831.16
|
| Rate for Payer: The Alliance Commercial |
$1,606.28
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
|
CT TMJ w/ Contrast Left
|
Facility
|
IP
|
$3,089.00
|
|
|
Service Code
|
CPT 70487 LT,TC
|
| Hospital Charge Code |
1241320
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,574.15 |
| Max. Negotiated Rate |
$2,955.56 |
| Rate for Payer: Aetna Commercial |
$2,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,762.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,702.66
|
| Rate for Payer: Cash Price |
$926.70
|
| Rate for Payer: Cigna Commercial |
$2,955.56
|
| Rate for Payer: Health EOS Commercial |
$2,859.18
|
| Rate for Payer: HFN Commercial |
$2,955.56
|
| Rate for Payer: Multiplan Commercial |
$2,570.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,955.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,574.15
|
| Rate for Payer: Quartz Commercial |
$1,927.54
|
| Rate for Payer: WEA Trust Commercial |
$1,766.91
|
| Rate for Payer: WPS Commercial |
$2,379.46
|
|
