|
CT Hip w/ + w/o Contrast Right
|
Facility
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241124
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,848.77 |
| Max. Negotiated Rate |
$3,471.16 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,999.69
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,263.80
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Hip w/ + w/o Contrast Right
|
Facility
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980086
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,056.44 |
| Max. Negotiated Rate |
$15,092.00 |
| Rate for Payer: Aetna Commercial |
$3,395.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,244.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,056.44
|
| 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 |
$1,999.69
|
| 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: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,471.16
|
| Rate for Payer: Health EOS Commercial |
$3,357.97
|
| Rate for Payer: HFN Commercial |
$3,471.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,829.75
|
| Rate for Payer: Multiplan Commercial |
$3,018.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,263.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,471.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,848.77
|
| Rate for Payer: Quartz Commercial |
$2,452.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,263.80
|
| Rate for Payer: The Alliance Commercial |
$15,092.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,075.15
|
| Rate for Payer: WPS Commercial |
$2,794.66
|
|
|
CT Humerus w/ Contrast Bilateral
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241144
|
|
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 Humerus w/ Contrast Bilateral
|
Facility
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630010
|
| 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 Humerus w/ Contrast Bilateral
|
Facility
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630010
|
| 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 Humerus w/ Contrast Bilateral
|
Professional
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630010
|
| 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 Humerus w/ Contrast Bilateral
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241144
|
|
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 Humerus w/ Contrast Bilateral
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241144
|
|
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 Humerus w/ Contrast Left
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241146
|
|
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 Humerus w/ Contrast Left
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241146
|
|
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 Humerus w/ Contrast Left
|
Professional
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630014
|
| 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 Humerus w/ Contrast Left
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241146
|
|
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 Humerus w/ Contrast Left
|
Facility
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630014
|
| 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 Humerus w/ Contrast Left
|
Facility
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630014
|
| 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 Humerus w/ Contrast Right
|
Facility
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980015
|
|
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 Humerus w/ Contrast Right
|
Professional
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241148
|
|
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 Humerus w/ Contrast Right
|
Facility
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241148
|
|
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 Humerus w/ Contrast Right
|
Professional
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630016
|
| 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 Humerus w/ Contrast Right
|
Professional
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980015
|
|
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 Humerus w/ Contrast Right
|
Facility
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630016
|
| 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 Humerus w/ Contrast Right
|
Facility
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630016
|
| 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 Humerus w/ Contrast Right
|
Facility
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241148
|
|
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 Humerus w/ Contrast Right
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980015
|
|
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 Humerus w/o Contrast Bilateral
|
Facility
IP
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630020
|
| Min. Negotiated Rate |
$2,587.69 |
| Max. Negotiated Rate |
$4,858.52 |
| Rate for Payer: Aetna Commercial |
$4,752.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,798.93
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$4,858.52
|
| Rate for Payer: Health EOS Commercial |
$4,700.09
|
| Rate for Payer: HFN Commercial |
$4,858.52
|
| Rate for Payer: Multiplan Commercial |
$4,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,858.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.69
|
| Rate for Payer: Quartz Commercial |
$3,168.60
|
| Rate for Payer: WEA Trust Commercial |
$2,904.55
|
| Rate for Payer: WPS Commercial |
$3,911.64
|
|
|
CT Humerus w/o Contrast Bilateral
|
Professional
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630020
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$5,016.95 |
| Rate for Payer: Aetna Commercial |
$5,016.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,541.66
|
| Rate for Payer: Aetna Managed Medicare |
$162.55
|
| Rate for Payer: Anthem Medicare Advantage |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.55
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$5,016.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,640.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.55
|
| Rate for Payer: Health EOS Commercial |
$4,805.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$605.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.55
|
| Rate for Payer: Multiplan Commercial |
$4,224.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,016.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.64
|
| Rate for Payer: Quartz Commercial |
$3,010.17
|
| Rate for Payer: Quartz Medicare Advantage |
$162.55
|
| Rate for Payer: The Alliance Commercial |
$617.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.55
|
| Rate for Payer: WEA Trust Commercial |
$2,904.55
|
| Rate for Payer: WPS Commercial |
$812.75
|
|
