|
CT Guidance for Injection
|
Professional
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629910
|
| Min. Negotiated Rate |
$136.67 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Aetna Commercial |
$2,797.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$136.67
|
| Rate for Payer: Anthem Medicare Advantage |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.67
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,797.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.67
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$505.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.67
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,797.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.80
|
| Rate for Payer: Quartz Commercial |
$1,678.65
|
| Rate for Payer: Quartz Medicare Advantage |
$136.67
|
| Rate for Payer: The Alliance Commercial |
$519.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.67
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$683.35
|
|
|
CT Guidance for Injection
|
Facility
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1241092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,683.15 |
| Max. Negotiated Rate |
$3,160.20 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,061.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$2,544.30
|
|
|
CT Guidance for Injection
|
Facility
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1241092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,091.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,954.10
|
| Rate for Payer: Aetna Managed Medicare |
$961.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.55
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,160.20
|
| Rate for Payer: Health EOS Commercial |
$3,057.15
|
| Rate for Payer: HFN Commercial |
$3,160.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,576.25
|
| Rate for Payer: Multiplan Commercial |
$2,748.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,061.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,160.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.15
|
| Rate for Payer: Quartz Commercial |
$2,232.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,061.00
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,889.25
|
| Rate for Payer: WPS Commercial |
$956.69
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
IP
|
$1,836.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
629914
|
| Min. Negotiated Rate |
$899.64 |
| Max. Negotiated Rate |
$1,689.12 |
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$973.08
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$1,689.12
|
| Rate for Payer: Health EOS Commercial |
$1,634.04
|
| Rate for Payer: HFN Commercial |
$1,689.12
|
| Rate for Payer: Multiplan Commercial |
$1,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,101.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,689.12
|
| Rate for Payer: Quartz Beloit One Network |
$899.64
|
| Rate for Payer: Quartz Commercial |
$1,101.60
|
| Rate for Payer: WEA Trust Commercial |
$1,009.80
|
| Rate for Payer: WPS Commercial |
$1,359.93
|
|
|
CT Guidance Marking Radiation Therapy
|
Professional
|
$1,836.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
629914
|
| Min. Negotiated Rate |
$116.58 |
| Max. Negotiated Rate |
$1,744.20 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,578.96
|
| Rate for Payer: Aetna Managed Medicare |
$116.58
|
| Rate for Payer: Anthem Medicare Advantage |
$116.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.58
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$1,744.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$918.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.58
|
| Rate for Payer: Health EOS Commercial |
$1,670.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.58
|
| Rate for Payer: Multiplan Commercial |
$1,468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,744.20
|
| Rate for Payer: Quartz Beloit One Network |
$807.84
|
| Rate for Payer: Quartz Commercial |
$1,046.52
|
| Rate for Payer: Quartz Medicare Advantage |
$116.58
|
| Rate for Payer: The Alliance Commercial |
$443.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.58
|
| Rate for Payer: WEA Trust Commercial |
$1,009.80
|
| Rate for Payer: WPS Commercial |
$582.90
|
|
|
CT Guidance Marking Radiation Therapy
|
Professional
|
$2,229.00
|
|
|
Service Code
|
CPT 77014 TC
|
| Hospital Charge Code |
1241094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$2,117.55 |
| Rate for Payer: Aetna Commercial |
$2,117.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,916.94
|
| Rate for Payer: Aetna Managed Medicare |
$73.18
|
| Rate for Payer: Anthem Medicare Advantage |
$73.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.18
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna Commercial |
$2,117.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,114.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.18
|
| Rate for Payer: Health EOS Commercial |
$2,028.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$268.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.18
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,117.55
|
| Rate for Payer: Quartz Beloit One Network |
$980.76
|
| Rate for Payer: Quartz Commercial |
$1,270.53
|
| Rate for Payer: Quartz Medicare Advantage |
$73.18
|
| Rate for Payer: The Alliance Commercial |
$278.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.18
|
| Rate for Payer: WEA Trust Commercial |
$1,225.95
|
| Rate for Payer: WPS Commercial |
$365.90
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 77014 TC
|
| Hospital Charge Code |
1241094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$512.26 |
| Max. Negotiated Rate |
$8,916.00 |
| Rate for Payer: Aetna Commercial |
$2,006.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,916.94
|
| Rate for Payer: Aetna Managed Medicare |
$624.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,181.37
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna Commercial |
$2,050.68
|
| Rate for Payer: Health EOS Commercial |
$1,983.81
|
| Rate for Payer: HFN Commercial |
$2,050.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,671.75
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,050.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.21
|
| Rate for Payer: Quartz Commercial |
$1,448.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,337.40
|
| Rate for Payer: The Alliance Commercial |
$8,916.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,225.95
|
| Rate for Payer: WPS Commercial |
$512.26
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 77014 TC
|
| Hospital Charge Code |
1241094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,092.21 |
| Max. Negotiated Rate |
$2,050.68 |
| Rate for Payer: Aetna Commercial |
$2,006.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,181.37
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna Commercial |
$2,050.68
|
| Rate for Payer: Health EOS Commercial |
$1,983.81
|
| Rate for Payer: HFN Commercial |
$2,050.68
|
| Rate for Payer: Multiplan Commercial |
$1,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,050.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,092.21
|
| Rate for Payer: Quartz Commercial |
$1,337.40
|
| Rate for Payer: WEA Trust Commercial |
$1,225.95
|
| Rate for Payer: WPS Commercial |
$1,651.02
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
OP
|
$1,836.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
629914
|
| Min. Negotiated Rate |
$514.08 |
| Max. Negotiated Rate |
$1,689.12 |
| Rate for Payer: Aetna Commercial |
$1,652.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,578.96
|
| Rate for Payer: Aetna Managed Medicare |
$514.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,193.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$918.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$881.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$973.08
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$1,689.12
|
| Rate for Payer: Health EOS Commercial |
$1,634.04
|
| Rate for Payer: HFN Commercial |
$1,689.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,377.00
|
| Rate for Payer: Multiplan Commercial |
$1,468.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,101.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,689.12
|
| Rate for Payer: Quartz Beloit One Network |
$899.64
|
| Rate for Payer: Quartz Commercial |
$1,193.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,101.60
|
| Rate for Payer: The Alliance Commercial |
$1,459.48
|
| Rate for Payer: WEA Trust Commercial |
$1,009.80
|
| Rate for Payer: WPS Commercial |
$1,359.93
|
|
|
CT Guide Plcmnt Rad Fields 7701426
|
Professional
|
$316.00
|
|
|
Service Code
|
CPT 77014 26
|
| Hospital Charge Code |
5258620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.39 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$43.39
|
| Rate for Payer: Anthem Medicare Advantage |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.39
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.39
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.39
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: Quartz Medicare Advantage |
$43.39
|
| Rate for Payer: The Alliance Commercial |
$164.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.39
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$216.95
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629934
|
| Min. Negotiated Rate |
$2,533.79 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,102.60
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Hand w/ Contrast Bilateral
|
Professional
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629934
|
| Min. Negotiated Rate |
$202.41 |
| Max. Negotiated Rate |
$4,912.45 |
| Rate for Payer: Aetna Commercial |
$4,912.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Aetna Managed Medicare |
$202.41
|
| Rate for Payer: Anthem Medicare Advantage |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$202.41
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,912.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,585.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.41
|
| Rate for Payer: Health EOS Commercial |
$4,705.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$754.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$202.41
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,912.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,275.24
|
| Rate for Payer: Quartz Commercial |
$2,947.47
|
| Rate for Payer: Quartz Medicare Advantage |
$202.41
|
| Rate for Payer: The Alliance Commercial |
$769.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.41
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$1,012.05
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629934
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,361.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,482.08
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,361.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,897.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Hand w/ Contrast Bilateral
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Hand w/ Contrast Left
|
Facility
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629940
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,680.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.80
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,680.25
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,897.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Hand w/ Contrast Left
|
Facility
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241104
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$737.24 |
| Max. Negotiated Rate |
$10,532.00 |
| Rate for Payer: Aetna Commercial |
$2,369.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,264.38
|
| Rate for Payer: Aetna Managed Medicare |
$737.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,395.49
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,422.36
|
| Rate for Payer: Health EOS Commercial |
$2,343.37
|
| Rate for Payer: HFN Commercial |
$2,422.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,974.75
|
| Rate for Payer: Multiplan Commercial |
$2,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,579.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,422.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,290.17
|
| Rate for Payer: Quartz Commercial |
$1,711.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,579.80
|
| Rate for Payer: The Alliance Commercial |
$10,532.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,448.15
|
| Rate for Payer: WPS Commercial |
$1,950.26
|
|
|
CT Hand w/ Contrast Left
|
Facility
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629940
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
|
CT Hand w/ Contrast Left
|
Facility
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241104
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,290.17 |
| Max. Negotiated Rate |
$2,422.36 |
| Rate for Payer: Aetna Commercial |
$2,369.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,395.49
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,422.36
|
| Rate for Payer: Health EOS Commercial |
$2,343.37
|
| Rate for Payer: HFN Commercial |
$2,422.36
|
| Rate for Payer: Multiplan Commercial |
$2,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,579.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,422.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,290.17
|
| Rate for Payer: Quartz Commercial |
$1,579.80
|
| Rate for Payer: WEA Trust Commercial |
$1,448.15
|
| Rate for Payer: WPS Commercial |
$1,950.26
|
|
|
CT Hand w/ Contrast Left
|
Professional
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241104
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,158.52 |
| Max. Negotiated Rate |
$2,501.35 |
| Rate for Payer: Aetna Commercial |
$2,501.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,264.38
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,501.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,316.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,579.80
|
| Rate for Payer: Health EOS Commercial |
$2,396.03
|
| Rate for Payer: Multiplan Commercial |
$2,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,501.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,158.52
|
| Rate for Payer: Quartz Commercial |
$1,500.81
|
| Rate for Payer: The Alliance Commercial |
$1,316.50
|
| Rate for Payer: WEA Trust Commercial |
$1,448.15
|
| Rate for Payer: WPS Commercial |
$1,950.26
|
|
|
CT Hand w/ Contrast Left
|
Professional
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629940
|
| Min. Negotiated Rate |
$202.41 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$202.41
|
| Rate for Payer: Anthem Medicare Advantage |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$202.41
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.41
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$754.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$202.41
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: Quartz Medicare Advantage |
$202.41
|
| Rate for Payer: The Alliance Commercial |
$769.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.41
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,012.05
|
|
|
CT Hand w/ Contrast Right
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980014
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Hand w/ Contrast Right
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241106
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Hand w/ Contrast Right
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241106
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
