|
CT Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629888
|
| 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 GUIDANCE
|
Facility
|
OP
|
$138.89
|
|
|
Service Code
|
EAPG 00473
|
| Min. Negotiated Rate |
$133.55 |
| Max. Negotiated Rate |
$138.89 |
| Rate for Payer: Anthem Medicaid |
$133.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$133.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.55
|
| Rate for Payer: Dean Health Medicaid |
$133.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$133.55
|
| Rate for Payer: Managed Health Services Medicaid |
$138.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$133.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$133.55
|
| Rate for Payer: United Healthcare Medicaid |
$133.55
|
|
|
CT Guidance for Injection
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629910
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,990.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,531.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,470.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Guidance for Injection
|
Facility
|
IP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1241092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,750.48 |
| Max. Negotiated Rate |
$3,286.61 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,893.37
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,286.61
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,143.44
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$2,645.98
|
|
|
CT Guidance for Injection
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629910
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Guidance for Injection
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
629910
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$2,909.66 |
| Rate for Payer: Aetna Commercial |
$2,909.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,909.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,531.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$2,787.15
|
| Rate for Payer: HFN Commercial |
$2,909.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,909.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.63
|
| Rate for Payer: Quartz Commercial |
$1,745.80
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Guidance for Injection
|
Professional
|
Both
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1241092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$122.34 |
| Max. Negotiated Rate |
$3,393.78 |
| Rate for Payer: Aetna Commercial |
$3,393.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$122.34
|
| Rate for Payer: Anthem Medicare Advantage |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.34
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,393.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,786.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.34
|
| Rate for Payer: Health EOS Commercial |
$3,250.88
|
| Rate for Payer: HFN Commercial |
$3,393.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$525.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.34
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$183.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,571.86
|
| Rate for Payer: Quartz Commercial |
$2,036.27
|
| Rate for Payer: Quartz Medicare Advantage |
$122.34
|
| Rate for Payer: The Alliance Commercial |
$464.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.34
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$611.68
|
|
|
CT Guidance for Injection
|
Facility
|
OP
|
$3,435.00
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1241092
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,215.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,072.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,000.27
|
| 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 |
$1,893.37
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cash Price |
$1,030.50
|
| Rate for Payer: Cigna Commercial |
$3,286.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,999.17
|
| Rate for Payer: Health EOS Commercial |
$3,179.44
|
| Rate for Payer: HFN Commercial |
$3,286.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,679.30
|
| Rate for Payer: Multiplan Commercial |
$2,857.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,143.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,286.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.48
|
| Rate for Payer: Quartz Commercial |
$2,322.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,143.44
|
| Rate for Payer: The Alliance Commercial |
$489.34
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,964.82
|
| Rate for Payer: WPS Commercial |
$856.35
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
|
OP
|
$2,229.00
|
|
|
Service Code
|
CPT 77014 TC
|
| Hospital Charge Code |
1241094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$649.08 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,086.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.62
|
| Rate for Payer: Aetna Managed Medicare |
$649.08
|
| 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 |
$1,228.62
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna Commercial |
$2,132.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.28
|
| Rate for Payer: Health EOS Commercial |
$2,063.16
|
| Rate for Payer: HFN Commercial |
$2,132.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,738.62
|
| Rate for Payer: Multiplan Commercial |
$1,854.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,390.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.90
|
| Rate for Payer: Quartz Commercial |
$1,506.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,390.90
|
| Rate for Payer: The Alliance Commercial |
$1,159.08
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,274.99
|
| Rate for Payer: WPS Commercial |
$1,717.00
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
|
IP
|
$2,229.00
|
|
|
Service Code
|
CPT 77014 TC
|
| Hospital Charge Code |
1241094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,135.90 |
| Max. Negotiated Rate |
$2,132.71 |
| Rate for Payer: Aetna Commercial |
$2,086.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,228.62
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna Commercial |
$2,132.71
|
| Rate for Payer: Health EOS Commercial |
$2,063.16
|
| Rate for Payer: HFN Commercial |
$2,132.71
|
| Rate for Payer: Multiplan Commercial |
$1,854.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,132.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,135.90
|
| Rate for Payer: Quartz Commercial |
$1,390.90
|
| Rate for Payer: WEA Trust Commercial |
$1,274.99
|
| Rate for Payer: WPS Commercial |
$1,717.00
|
|
|
CT Guidance Marking Radiation Therapy
|
Professional
|
Both
|
$2,229.00
|
|
|
Service Code
|
CPT 77014 TC
|
| Hospital Charge Code |
1241094
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$279.13 |
| Max. Negotiated Rate |
$2,202.25 |
| Rate for Payer: Aetna Commercial |
$2,202.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,993.62
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cigna Commercial |
$2,202.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,159.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,390.90
|
| Rate for Payer: Health EOS Commercial |
$2,109.53
|
| Rate for Payer: HFN Commercial |
$2,202.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$279.13
|
| Rate for Payer: Multiplan Commercial |
$1,854.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.99
|
| Rate for Payer: Quartz Commercial |
$1,321.35
|
| Rate for Payer: The Alliance Commercial |
$1,159.08
|
| Rate for Payer: WEA Trust Commercial |
$1,274.99
|
| Rate for Payer: WPS Commercial |
$1,717.00
|
|
|
CT Guidance Marking Radiation Therapy
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
629914
|
| Min. Negotiated Rate |
$439.00 |
| Max. Negotiated Rate |
$1,813.97 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,642.12
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$1,813.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$954.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,145.66
|
| Rate for Payer: Health EOS Commercial |
$1,737.59
|
| Rate for Payer: HFN Commercial |
$1,813.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.00
|
| Rate for Payer: Multiplan Commercial |
$1,527.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.97
|
| Rate for Payer: Quartz Beloit One Network |
$840.15
|
| Rate for Payer: Quartz Commercial |
$1,088.38
|
| Rate for Payer: The Alliance Commercial |
$954.72
|
| Rate for Payer: WEA Trust Commercial |
$1,050.19
|
| Rate for Payer: WPS Commercial |
$1,414.27
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
|
IP
|
$1,836.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
629914
|
| Min. Negotiated Rate |
$935.63 |
| Max. Negotiated Rate |
$1,756.68 |
| Rate for Payer: Aetna Commercial |
$1,718.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,642.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,012.00
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$1,756.68
|
| Rate for Payer: Health EOS Commercial |
$1,699.40
|
| Rate for Payer: HFN Commercial |
$1,756.68
|
| Rate for Payer: Multiplan Commercial |
$1,527.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,756.68
|
| Rate for Payer: Quartz Beloit One Network |
$935.63
|
| Rate for Payer: Quartz Commercial |
$1,145.66
|
| Rate for Payer: WEA Trust Commercial |
$1,050.19
|
| Rate for Payer: WPS Commercial |
$1,414.27
|
|
|
CT Guidance Marking Radiation Therapy
|
Facility
|
OP
|
$1,836.00
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
629914
|
| Min. Negotiated Rate |
$534.64 |
| Max. Negotiated Rate |
$1,756.68 |
| Rate for Payer: Aetna Commercial |
$1,718.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,642.12
|
| Rate for Payer: Aetna Managed Medicare |
$534.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,241.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$954.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$916.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,012.00
|
| Rate for Payer: Cash Price |
$550.80
|
| Rate for Payer: Cigna Commercial |
$1,756.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,068.55
|
| Rate for Payer: Health EOS Commercial |
$1,699.40
|
| Rate for Payer: HFN Commercial |
$1,756.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,432.08
|
| Rate for Payer: Multiplan Commercial |
$1,527.55
|
| Rate for Payer: NAPHCARE Commercial |
$1,145.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,756.68
|
| Rate for Payer: Quartz Beloit One Network |
$935.63
|
| Rate for Payer: Quartz Commercial |
$1,241.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,145.66
|
| Rate for Payer: The Alliance Commercial |
$954.72
|
| Rate for Payer: WEA Trust Commercial |
$1,050.19
|
| Rate for Payer: WPS Commercial |
$1,414.27
|
|
|
CT Guide Plcmnt Rad Fields 7701426
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 77014 26
|
| Hospital Charge Code |
5258620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.60 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.18
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$159.88
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,292.86 |
| Max. Negotiated Rate |
$2,427.40 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.39
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,427.40
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,583.09
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Hand w/ Contrast Bilateral
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$2,506.56 |
| Rate for Payer: Aetna Commercial |
$2,506.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| 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 |
$2,506.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,319.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.09
|
| Rate for Payer: Health EOS Commercial |
$2,401.02
|
| Rate for Payer: HFN Commercial |
$2,506.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.93
|
| Rate for Payer: Quartz Commercial |
$1,503.93
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241102
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$738.77 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Aetna Managed Medicare |
$738.77
|
| 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 |
$1,398.39
|
| 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 |
$2,427.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,476.53
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,583.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,715.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,583.09
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629934
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,495.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,688.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,581.36
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,009.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,495.60
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
|
CT Hand w/ Contrast Bilateral
|
Facility
|
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629934
|
| Min. Negotiated Rate |
$2,635.14 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,226.70
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
|
CT Hand w/ Contrast Bilateral
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629934
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$5,108.95 |
| Rate for Payer: Aetna Commercial |
$5,108.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$198.29
|
| Rate for Payer: Anthem Medicare Advantage |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.29
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$5,108.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,688.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.29
|
| Rate for Payer: Health EOS Commercial |
$4,893.83
|
| Rate for Payer: HFN Commercial |
$5,108.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.29
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$297.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,108.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.25
|
| Rate for Payer: Quartz Commercial |
$3,065.37
|
| Rate for Payer: Quartz Medicare Advantage |
$198.29
|
| Rate for Payer: The Alliance Commercial |
$753.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.29
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: WPS Commercial |
$991.43
|
|
|
CT Hand w/ Contrast Left
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241104
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$2,601.40 |
| Rate for Payer: Aetna Commercial |
$2,601.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.96
|
| 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 |
$2,601.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,369.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,642.99
|
| Rate for Payer: Health EOS Commercial |
$2,491.87
|
| Rate for Payer: HFN Commercial |
$2,601.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$2,190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,601.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,204.86
|
| Rate for Payer: Quartz Commercial |
$1,560.84
|
| Rate for Payer: The Alliance Commercial |
$1,369.16
|
| Rate for Payer: WEA Trust Commercial |
$1,506.08
|
| Rate for Payer: WPS Commercial |
$2,028.20
|
|
|
CT Hand w/ Contrast Left
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241104
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,341.78 |
| Max. Negotiated Rate |
$2,519.25 |
| Rate for Payer: Aetna Commercial |
$2,464.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,451.31
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,519.25
|
| Rate for Payer: Health EOS Commercial |
$2,437.10
|
| Rate for Payer: HFN Commercial |
$2,519.25
|
| Rate for Payer: Multiplan Commercial |
$2,190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,519.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.78
|
| Rate for Payer: Quartz Commercial |
$1,642.99
|
| Rate for Payer: WEA Trust Commercial |
$1,506.08
|
| Rate for Payer: WPS Commercial |
$2,028.20
|
|
|
CT Hand w/ Contrast Left
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629940
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Hand w/ Contrast Left
|
Facility
|
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241104
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$766.73 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,464.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.96
|
| Rate for Payer: Aetna Managed Medicare |
$766.73
|
| 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 |
$1,451.31
|
| 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 |
$2,519.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,532.41
|
| Rate for Payer: Health EOS Commercial |
$2,437.10
|
| Rate for Payer: HFN Commercial |
$2,519.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,053.74
|
| Rate for Payer: Multiplan Commercial |
$2,190.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,642.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,519.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.78
|
| Rate for Payer: Quartz Commercial |
$1,779.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,642.99
|
| Rate for Payer: The Alliance Commercial |
$1,369.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,506.08
|
| Rate for Payer: WPS Commercial |
$2,028.20
|
|
