|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$1,900.81 |
| Max. Negotiated Rate |
$3,568.86 |
| Rate for Payer: Aetna Commercial |
$3,491.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,336.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,055.98
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,568.86
|
| Rate for Payer: Health EOS Commercial |
$3,452.49
|
| Rate for Payer: HFN Commercial |
$3,568.86
|
| Rate for Payer: Multiplan Commercial |
$3,103.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,568.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,900.81
|
| Rate for Payer: Quartz Commercial |
$2,327.52
|
| Rate for Payer: WEA Trust Commercial |
$2,133.56
|
| Rate for Payer: WPS Commercial |
$2,873.22
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,568.86 |
| Rate for Payer: Aetna Commercial |
$3,491.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,336.11
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,521.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,939.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,862.02
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,055.98
|
| 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 |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,568.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,170.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,452.49
|
| Rate for Payer: HFN Commercial |
$3,568.86
|
| 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 |
$3,103.36
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,568.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,900.81
|
| Rate for Payer: Quartz Commercial |
$2,521.48
|
| 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 |
$2,133.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,873.22
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$3,685.24 |
| Rate for Payer: Aetna Commercial |
$3,685.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,336.11
|
| Rate for Payer: Aetna Managed Medicare |
$194.76
|
| Rate for Payer: Anthem Medicare Advantage |
$194.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.76
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,685.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,939.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.76
|
| Rate for Payer: Health EOS Commercial |
$3,530.07
|
| Rate for Payer: HFN Commercial |
$3,685.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$760.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$760.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.76
|
| Rate for Payer: Multiplan Commercial |
$3,103.36
|
| Rate for Payer: NAPHCARE Commercial |
$292.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,685.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,706.85
|
| Rate for Payer: Quartz Commercial |
$2,211.14
|
| Rate for Payer: Quartz Medicare Advantage |
$194.76
|
| Rate for Payer: The Alliance Commercial |
$740.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.76
|
| Rate for Payer: WEA Trust Commercial |
$2,133.56
|
| Rate for Payer: WPS Commercial |
$973.80
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$4,967.66 |
| Rate for Payer: Aetna Commercial |
$4,967.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Aetna Managed Medicare |
$137.32
|
| Rate for Payer: Anthem Medicare Advantage |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.32
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,967.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,614.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.32
|
| Rate for Payer: Health EOS Commercial |
$4,758.50
|
| Rate for Payer: HFN Commercial |
$4,967.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.32
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: NAPHCARE Commercial |
$205.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,300.81
|
| Rate for Payer: Quartz Commercial |
$2,980.60
|
| Rate for Payer: Quartz Medicare Advantage |
$137.32
|
| Rate for Payer: The Alliance Commercial |
$521.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.32
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$686.61
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$3,928.62 |
| Rate for Payer: Aetna Commercial |
$3,843.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.67
|
| 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 |
$2,263.23
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,928.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,389.69
|
| Rate for Payer: Health EOS Commercial |
$3,800.51
|
| Rate for Payer: HFN Commercial |
$3,928.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,202.68
|
| Rate for Payer: Multiplan Commercial |
$3,416.19
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.42
|
| Rate for Payer: Quartz Commercial |
$2,775.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.14
|
| Rate for Payer: The Alliance Commercial |
$549.29
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,348.63
|
| Rate for Payer: WPS Commercial |
$961.25
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,562.27 |
| Max. Negotiated Rate |
$4,810.79 |
| Rate for Payer: Aetna Commercial |
$4,706.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.43
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,810.79
|
| Rate for Payer: Health EOS Commercial |
$4,653.92
|
| Rate for Payer: HFN Commercial |
$4,810.79
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.27
|
| Rate for Payer: Quartz Commercial |
$3,137.47
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$3,873.07
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,092.42 |
| Max. Negotiated Rate |
$3,928.62 |
| Rate for Payer: Aetna Commercial |
$3,843.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.23
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,928.62
|
| Rate for Payer: Health EOS Commercial |
$3,800.51
|
| Rate for Payer: HFN Commercial |
$3,928.62
|
| Rate for Payer: Multiplan Commercial |
$3,416.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.42
|
| Rate for Payer: Quartz Commercial |
$2,562.14
|
| Rate for Payer: WEA Trust Commercial |
$2,348.63
|
| Rate for Payer: WPS Commercial |
$3,162.85
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$4,056.73 |
| Rate for Payer: Aetna Commercial |
$4,056.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.41
|
| Rate for Payer: Aetna Managed Medicare |
$137.32
|
| Rate for Payer: Anthem Medicare Advantage |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.32
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$4,056.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,135.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.32
|
| Rate for Payer: Health EOS Commercial |
$3,885.92
|
| Rate for Payer: HFN Commercial |
$4,056.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.32
|
| Rate for Payer: Multiplan Commercial |
$3,416.19
|
| Rate for Payer: NAPHCARE Commercial |
$205.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,056.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,878.91
|
| Rate for Payer: Quartz Commercial |
$2,434.04
|
| Rate for Payer: Quartz Medicare Advantage |
$137.32
|
| Rate for Payer: The Alliance Commercial |
$521.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.32
|
| Rate for Payer: WEA Trust Commercial |
$2,348.63
|
| Rate for Payer: WPS Commercial |
$686.61
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241296
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,774.30 |
| Rate for Payer: Aetna Commercial |
$2,774.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,774.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,460.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.19
|
| Rate for Payer: Health EOS Commercial |
$2,657.49
|
| Rate for Payer: HFN Commercial |
$2,774.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.94
|
| Rate for Payer: Quartz Commercial |
$1,664.58
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241296
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.69
|
| 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 |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,634.26
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,190.24
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,898.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,752.19
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630190
|
| Min. Negotiated Rate |
$2,923.58 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| 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 |
$3,579.89
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630190
|
| 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
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241296
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,430.96 |
| Max. Negotiated Rate |
$2,686.69 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Professional
|
Both
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630190
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$5,668.16 |
| Rate for Payer: Aetna Commercial |
$5,668.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,668.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,983.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$5,429.50
|
| Rate for Payer: HFN Commercial |
$5,668.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,668.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.25
|
| Rate for Payer: Quartz Commercial |
$3,400.89
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Tibia/Fibula w/ Contrast Left
|
Facility
|
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630194
|
| Min. Negotiated Rate |
$1,461.53 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Commercial |
$1,789.63
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Tibia/Fibula w/ Contrast Left
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241298
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,881.01 |
| Rate for Payer: Aetna Commercial |
$2,881.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,881.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,516.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,819.58
|
| Rate for Payer: Health EOS Commercial |
$2,759.70
|
| Rate for Payer: HFN Commercial |
$2,881.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.36
|
| Rate for Payer: Quartz Commercial |
$1,728.60
|
| Rate for Payer: The Alliance Commercial |
$1,516.32
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Tibia/Fibula w/ Contrast Left
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630194
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,938.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,431.71
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| 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 |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,938.77
|
| 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 |
$1,640.50
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Tibia/Fibula w/ Contrast Left
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630194
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$2,833.58 |
| Rate for Payer: Aetna Commercial |
$2,833.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,833.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$2,714.28
|
| Rate for Payer: HFN Commercial |
$2,833.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,833.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,312.40
|
| Rate for Payer: Quartz Commercial |
$1,700.15
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Tibia/Fibula w/ Contrast Left
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241298
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$849.14 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Aetna Managed Medicare |
$849.14
|
| 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 |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,697.11
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,274.48
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,819.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,971.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,819.58
|
| Rate for Payer: The Alliance Commercial |
$1,516.32
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Tibia/Fibula w/ Contrast Left
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241298
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,790.03 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,819.58
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Tibia/Fibula w/ Contrast Right
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630198
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,938.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,431.71
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| 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 |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,938.77
|
| 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 |
$1,640.50
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Tibia/Fibula w/ Contrast Right
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630198
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$2,833.58 |
| Rate for Payer: Aetna Commercial |
$2,833.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,833.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$2,714.28
|
| Rate for Payer: HFN Commercial |
$2,833.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,833.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,312.40
|
| Rate for Payer: Quartz Commercial |
$1,700.15
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Tibia/Fibula w/ Contrast Right
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241300
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,790.03 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,819.58
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Tibia/Fibula w/ Contrast Right
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980082
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,774.30 |
| Rate for Payer: Aetna Commercial |
$2,774.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,774.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,460.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.19
|
| Rate for Payer: Health EOS Commercial |
$2,657.49
|
| Rate for Payer: HFN Commercial |
$2,774.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.94
|
| Rate for Payer: Quartz Commercial |
$1,664.58
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Tibia/Fibula w/ Contrast Right
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980082
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.69
|
| 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 |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,634.26
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,190.24
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,898.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,752.19
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
