|
CT Shoulder w/o Contrast Right
|
Professional
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
2980009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,342.00 |
| Max. Negotiated Rate |
$2,897.50 |
| Rate for Payer: Aetna Commercial |
$2,897.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,623.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,897.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,525.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,830.00
|
| Rate for Payer: Health EOS Commercial |
$2,775.50
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,342.00
|
| Rate for Payer: Quartz Commercial |
$1,738.50
|
| Rate for Payer: The Alliance Commercial |
$1,525.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Shoulder w/o Contrast Right
|
Facility
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
2980009
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,494.50 |
| Max. Negotiated Rate |
$2,806.00 |
| Rate for Payer: Aetna Commercial |
$2,745.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,616.50
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,806.00
|
| Rate for Payer: Health EOS Commercial |
$2,714.50
|
| Rate for Payer: HFN Commercial |
$2,806.00
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,806.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.50
|
| Rate for Payer: Quartz Commercial |
$1,830.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Shoulder w/o Contrast Right
|
Professional
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241228
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,230.68 |
| Max. Negotiated Rate |
$2,657.15 |
| Rate for Payer: Aetna Commercial |
$2,657.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,405.42
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,657.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,398.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,678.20
|
| Rate for Payer: Health EOS Commercial |
$2,545.27
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.68
|
| Rate for Payer: Quartz Commercial |
$1,594.29
|
| Rate for Payer: The Alliance Commercial |
$1,398.50
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Shoulder w/o Contrast Right
|
Facility
IP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241228
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,370.53 |
| Max. Negotiated Rate |
$2,573.24 |
| Rate for Payer: Aetna Commercial |
$2,517.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,482.41
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,573.24
|
| Rate for Payer: Health EOS Commercial |
$2,489.33
|
| Rate for Payer: HFN Commercial |
$2,573.24
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,678.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,573.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,370.53
|
| Rate for Payer: Quartz Commercial |
$1,678.20
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Shoulder w/o Contrast Right
|
Professional
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630152
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$2,508.95 |
| Rate for Payer: Aetna Commercial |
$2,508.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.26
|
| 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 |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,508.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,320.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.55
|
| Rate for Payer: Health EOS Commercial |
$2,403.31
|
| 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 |
$2,112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,508.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,162.04
|
| Rate for Payer: Quartz Commercial |
$1,505.37
|
| 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 |
$1,452.55
|
| Rate for Payer: WPS Commercial |
$812.75
|
|
|
CT Shoulder w/ + w/o Contrast Bilateral
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241212
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Bilateral
|
Facility
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241212
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$16,408.00 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.56
|
| 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 |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,666.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.20
|
| Rate for Payer: The Alliance Commercial |
$16,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Bilateral
|
Facility
OP
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630128
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$7,691.20 |
| Rate for Payer: Aetna Commercial |
$7,524.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,189.60
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,434.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,180.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,012.80
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,430.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,691.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$7,440.40
|
| Rate for Payer: HFN Commercial |
$7,691.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$6,688.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,691.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,096.40
|
| Rate for Payer: Quartz Commercial |
$5,434.00
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$4,598.00
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$6,192.25
|
|
|
CT Shoulder w/ + w/o Contrast Bilateral
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241212
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,009.98 |
| Max. Negotiated Rate |
$3,773.84 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,461.20
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Bilateral
|
Professional
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630128
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$7,942.00 |
| Rate for Payer: Aetna Commercial |
$7,942.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,189.60
|
| Rate for Payer: Aetna Managed Medicare |
$251.13
|
| Rate for Payer: Anthem Medicare Advantage |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.13
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,942.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,180.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.13
|
| Rate for Payer: Health EOS Commercial |
$7,607.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.13
|
| Rate for Payer: Multiplan Commercial |
$6,688.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,942.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,678.40
|
| Rate for Payer: Quartz Commercial |
$4,765.20
|
| Rate for Payer: Quartz Medicare Advantage |
$251.13
|
| Rate for Payer: The Alliance Commercial |
$954.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.13
|
| Rate for Payer: WEA Trust Commercial |
$4,598.00
|
| Rate for Payer: WPS Commercial |
$1,255.65
|
|
|
CT Shoulder w/ + w/o Contrast Bilateral
|
Facility
IP
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630128
|
| Min. Negotiated Rate |
$4,096.40 |
| Max. Negotiated Rate |
$7,691.20 |
| Rate for Payer: Aetna Commercial |
$7,524.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,430.80
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,691.20
|
| Rate for Payer: Health EOS Commercial |
$7,440.40
|
| Rate for Payer: HFN Commercial |
$7,691.20
|
| Rate for Payer: Multiplan Commercial |
$6,688.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,016.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,691.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,096.40
|
| Rate for Payer: Quartz Commercial |
$5,016.00
|
| Rate for Payer: WEA Trust Commercial |
$4,598.00
|
| Rate for Payer: WPS Commercial |
$6,192.25
|
|
|
CT Shoulder w/ + w/o Contrast Left
|
Facility
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630132
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,717.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,090.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,006.88
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,717.65
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Shoulder w/ + w/o Contrast Left
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241214
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,009.98 |
| Max. Negotiated Rate |
$3,773.84 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,461.20
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Left
|
Facility
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630132
|
| Min. Negotiated Rate |
$2,048.69 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,508.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,508.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Shoulder w/ + w/o Contrast Left
|
Facility
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241214
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$16,408.00 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.56
|
| 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 |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,666.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.20
|
| Rate for Payer: The Alliance Commercial |
$16,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Left
|
Professional
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630132
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$3,971.95 |
| Rate for Payer: Aetna Commercial |
$3,971.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$251.13
|
| Rate for Payer: Anthem Medicare Advantage |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.13
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,971.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,090.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.13
|
| Rate for Payer: Health EOS Commercial |
$3,804.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.13
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,971.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,839.64
|
| Rate for Payer: Quartz Commercial |
$2,383.17
|
| Rate for Payer: Quartz Medicare Advantage |
$251.13
|
| Rate for Payer: The Alliance Commercial |
$954.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.13
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$1,255.65
|
|
|
CT Shoulder w/ + w/o Contrast Left
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241214
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Professional
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630134
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$3,971.95 |
| Rate for Payer: Aetna Commercial |
$3,971.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$251.13
|
| Rate for Payer: Anthem Medicare Advantage |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.13
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,971.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,090.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.13
|
| Rate for Payer: Health EOS Commercial |
$3,804.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.13
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,971.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,839.64
|
| Rate for Payer: Quartz Commercial |
$2,383.17
|
| Rate for Payer: Quartz Medicare Advantage |
$251.13
|
| Rate for Payer: The Alliance Commercial |
$954.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.13
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$1,255.65
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241216
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,192.24 |
| Max. Negotiated Rate |
$17,032.00 |
| Rate for Payer: Aetna Commercial |
$3,832.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,661.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,192.24
|
| 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 |
$2,256.74
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$3,917.36
|
| Rate for Payer: Health EOS Commercial |
$3,789.62
|
| Rate for Payer: HFN Commercial |
$3,917.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,193.50
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,554.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,917.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,086.42
|
| Rate for Payer: Quartz Commercial |
$2,767.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,554.80
|
| Rate for Payer: The Alliance Commercial |
$17,032.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,341.90
|
| Rate for Payer: WPS Commercial |
$3,153.90
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,009.98 |
| Max. Negotiated Rate |
$3,773.84 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,461.20
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
IP
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241216
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,086.42 |
| Max. Negotiated Rate |
$3,917.36 |
| Rate for Payer: Aetna Commercial |
$3,832.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,256.74
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$3,917.36
|
| Rate for Payer: Health EOS Commercial |
$3,789.62
|
| Rate for Payer: HFN Commercial |
$3,917.36
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,554.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,917.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,086.42
|
| Rate for Payer: Quartz Commercial |
$2,554.80
|
| Rate for Payer: WEA Trust Commercial |
$2,341.90
|
| Rate for Payer: WPS Commercial |
$3,153.90
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630134
|
| Min. Negotiated Rate |
$2,048.69 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,508.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,508.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630134
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,717.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,090.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,006.88
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,717.65
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Professional
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241216
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,873.52 |
| Max. Negotiated Rate |
$4,045.10 |
| Rate for Payer: Aetna Commercial |
$4,045.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,661.88
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,045.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,129.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,554.80
|
| Rate for Payer: Health EOS Commercial |
$3,874.78
|
| Rate for Payer: Multiplan Commercial |
$3,406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,045.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,873.52
|
| Rate for Payer: Quartz Commercial |
$2,427.06
|
| Rate for Payer: The Alliance Commercial |
$2,129.00
|
| Rate for Payer: WEA Trust Commercial |
$2,341.90
|
| Rate for Payer: WPS Commercial |
$3,153.90
|
|
