|
CT Forearm w/o Contrast Right
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
2980006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,554.28 |
| Max. Negotiated Rate |
$2,918.24 |
| Rate for Payer: Aetna Commercial |
$2,854.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,681.16
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,918.24
|
| Rate for Payer: Health EOS Commercial |
$2,823.08
|
| Rate for Payer: HFN Commercial |
$2,918.24
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,918.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.28
|
| Rate for Payer: Quartz Commercial |
$1,903.20
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.41
|
|
|
CT Forearm w/o Contrast Right
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$629.94 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Aetna Commercial |
$3,013.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$3,013.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,586.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,903.20
|
| Rate for Payer: Health EOS Commercial |
$2,886.52
|
| Rate for Payer: HFN Commercial |
$3,013.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$629.94
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,013.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.68
|
| Rate for Payer: Quartz Commercial |
$1,808.04
|
| Rate for Payer: The Alliance Commercial |
$1,586.00
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.41
|
|
|
CT Forearm w/o Contrast Right
|
Facility
|
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629906
|
| Min. Negotiated Rate |
$1,345.85 |
| Max. Negotiated Rate |
$2,526.91 |
| Rate for Payer: Aetna Commercial |
$2,471.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.72
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,526.91
|
| Rate for Payer: Health EOS Commercial |
$2,444.51
|
| Rate for Payer: HFN Commercial |
$2,526.91
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,526.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,345.85
|
| Rate for Payer: Quartz Commercial |
$1,647.98
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: WPS Commercial |
$2,034.36
|
|
|
CT Forearm w/o Contrast Right
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
2980006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$629.94 |
| Max. Negotiated Rate |
$3,013.40 |
| Rate for Payer: Aetna Commercial |
$3,013.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$3,013.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,586.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,903.20
|
| Rate for Payer: Health EOS Commercial |
$2,886.52
|
| Rate for Payer: HFN Commercial |
$3,013.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$629.94
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,013.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.68
|
| Rate for Payer: Quartz Commercial |
$1,808.04
|
| Rate for Payer: The Alliance Commercial |
$1,586.00
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.41
|
|
|
CT Forearm w/o Contrast Right
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
2980006
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$888.16 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,854.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.92
|
| Rate for Payer: Aetna Managed Medicare |
$888.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,681.16
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,918.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,775.10
|
| Rate for Payer: Health EOS Commercial |
$2,823.08
|
| Rate for Payer: HFN Commercial |
$2,918.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,379.00
|
| Rate for Payer: Multiplan Commercial |
$2,537.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,918.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.28
|
| Rate for Payer: Quartz Commercial |
$2,061.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,903.20
|
| Rate for Payer: The Alliance Commercial |
$1,586.00
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,744.60
|
| Rate for Payer: WPS Commercial |
$2,349.41
|
|
|
CT Forearm w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629884
|
| Min. Negotiated Rate |
$4,260.26 |
| Max. Negotiated Rate |
$7,998.85 |
| Rate for Payer: Aetna Commercial |
$7,824.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.03
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,998.85
|
| Rate for Payer: Health EOS Commercial |
$7,738.02
|
| Rate for Payer: HFN Commercial |
$7,998.85
|
| Rate for Payer: Multiplan Commercial |
$6,955.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,998.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.26
|
| Rate for Payer: Quartz Commercial |
$5,216.64
|
| Rate for Payer: WEA Trust Commercial |
$4,781.92
|
| Rate for Payer: WPS Commercial |
$6,439.71
|
|
|
CT Forearm w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241074
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241074
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| 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 |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241074
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| 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 |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629884
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$7,998.85 |
| Rate for Payer: Aetna Commercial |
$7,824.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.18
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,651.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,347.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,173.31
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,608.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,998.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,865.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$7,738.02
|
| Rate for Payer: HFN Commercial |
$7,998.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$6,955.52
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,998.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,260.26
|
| Rate for Payer: Quartz Commercial |
$5,651.36
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$4,781.92
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$6,439.71
|
|
|
CT Forearm w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629884
|
| Min. Negotiated Rate |
$244.96 |
| Max. Negotiated Rate |
$8,259.68 |
| Rate for Payer: Aetna Commercial |
$8,259.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,477.18
|
| Rate for Payer: Aetna Managed Medicare |
$244.96
|
| Rate for Payer: Anthem Medicare Advantage |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.96
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$8,259.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,347.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.96
|
| Rate for Payer: Health EOS Commercial |
$7,911.90
|
| Rate for Payer: HFN Commercial |
$8,259.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.96
|
| Rate for Payer: Multiplan Commercial |
$6,955.52
|
| Rate for Payer: NAPHCARE Commercial |
$367.44
|
| Rate for Payer: Preferred Network Access Commercial |
$8,259.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,825.54
|
| Rate for Payer: Quartz Commercial |
$4,955.81
|
| Rate for Payer: Quartz Medicare Advantage |
$244.96
|
| Rate for Payer: The Alliance Commercial |
$930.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.96
|
| Rate for Payer: WEA Trust Commercial |
$4,781.92
|
| Rate for Payer: WPS Commercial |
$1,224.81
|
|
|
CT Forearm w/ + w/o Contrast Left
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| 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 |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Left
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629886
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Forearm w/ + w/o Contrast Left
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| 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 |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Left
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Left
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629886
|
| Min. Negotiated Rate |
$244.96 |
| Max. Negotiated Rate |
$4,130.83 |
| Rate for Payer: Aetna Commercial |
$4,130.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$244.96
|
| Rate for Payer: Anthem Medicare Advantage |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.96
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,130.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.96
|
| Rate for Payer: Health EOS Commercial |
$3,956.90
|
| Rate for Payer: HFN Commercial |
$4,130.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.96
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$367.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,913.23
|
| Rate for Payer: Quartz Commercial |
$2,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$244.96
|
| Rate for Payer: The Alliance Commercial |
$930.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.96
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$1,224.81
|
|
|
CT Forearm w/ + w/o Contrast Left
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629886
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,239.93 |
| Max. Negotiated Rate |
$4,074.05 |
| Rate for Payer: Aetna Commercial |
$3,985.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.01
|
| 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 |
$4,074.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,478.16
|
| Rate for Payer: Health EOS Commercial |
$3,941.20
|
| Rate for Payer: HFN Commercial |
$4,074.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,321.24
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.88
|
| Rate for Payer: Quartz Commercial |
$2,878.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,656.99
|
| Rate for Payer: The Alliance Commercial |
$2,214.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| 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 |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| 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 |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,169.88 |
| Max. Negotiated Rate |
$4,074.05 |
| Rate for Payer: Aetna Commercial |
$3,985.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.01
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,074.05
|
| Rate for Payer: Health EOS Commercial |
$3,941.20
|
| Rate for Payer: HFN Commercial |
$4,074.05
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.88
|
| Rate for Payer: Quartz Commercial |
$2,656.99
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980020
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629888
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629888
|
| Min. Negotiated Rate |
$244.96 |
| Max. Negotiated Rate |
$4,130.83 |
| Rate for Payer: Aetna Commercial |
$4,130.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$244.96
|
| Rate for Payer: Anthem Medicare Advantage |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.96
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,130.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.96
|
| Rate for Payer: Health EOS Commercial |
$3,956.90
|
| Rate for Payer: HFN Commercial |
$4,130.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.96
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$367.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,913.23
|
| Rate for Payer: Quartz Commercial |
$2,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$244.96
|
| Rate for Payer: The Alliance Commercial |
$930.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.96
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$1,224.81
|
|
|
CT Forearm w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,206.90 |
| Rate for Payer: Aetna Commercial |
$4,206.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| 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 |
$4,206.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,214.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,656.99
|
| Rate for Payer: Health EOS Commercial |
$4,029.77
|
| Rate for Payer: HFN Commercial |
$4,206.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.46
|
| Rate for Payer: Quartz Commercial |
$2,524.14
|
| Rate for Payer: The Alliance Commercial |
$2,214.16
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
