|
CT Humerus w/ Contrast Right
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241148
|
|
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 Humerus w/ Contrast Right
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,292.86 |
| 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 Humerus w/ Contrast Right
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241148
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,341.78 |
| 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 Humerus w/o Contrast Bilateral
|
Professional
|
Both
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630020
|
| Min. Negotiated Rate |
$159.69 |
| Max. Negotiated Rate |
$5,217.63 |
| Rate for Payer: Aetna Commercial |
$5,217.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,723.33
|
| Rate for Payer: Aetna Managed Medicare |
$159.69
|
| Rate for Payer: Anthem Medicare Advantage |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.69
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$5,217.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,746.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.69
|
| Rate for Payer: Health EOS Commercial |
$4,997.94
|
| Rate for Payer: HFN Commercial |
$5,217.63
|
| 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: Independent Care Health Plan Medicare |
$159.69
|
| Rate for Payer: Multiplan Commercial |
$4,393.79
|
| Rate for Payer: NAPHCARE Commercial |
$239.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,416.59
|
| Rate for Payer: Quartz Commercial |
$3,130.58
|
| Rate for Payer: Quartz Medicare Advantage |
$159.69
|
| Rate for Payer: The Alliance Commercial |
$606.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.69
|
| Rate for Payer: WEA Trust Commercial |
$3,020.73
|
| Rate for Payer: WPS Commercial |
$798.46
|
|
|
CT Humerus w/o Contrast Bilateral
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,LT
|
| Hospital Charge Code |
1241150
|
|
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 Humerus w/o Contrast Bilateral
|
Facility
|
OP
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630020
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$5,052.86 |
| Rate for Payer: Aetna Commercial |
$4,943.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,723.33
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,569.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,746.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,636.28
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,910.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$5,052.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,073.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$4,888.09
|
| Rate for Payer: HFN Commercial |
$5,052.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$4,393.79
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$5,052.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,691.20
|
| Rate for Payer: Quartz Commercial |
$3,569.96
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$3,020.73
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$4,067.95
|
|
|
CT Humerus w/o Contrast Bilateral
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,LT
|
| Hospital Charge Code |
1241150
|
|
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 Humerus w/o Contrast Bilateral
|
Facility
|
IP
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630020
|
| Min. Negotiated Rate |
$2,691.20 |
| Max. Negotiated Rate |
$5,052.86 |
| Rate for Payer: Aetna Commercial |
$4,943.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,723.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,910.89
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$5,052.86
|
| Rate for Payer: Health EOS Commercial |
$4,888.09
|
| Rate for Payer: HFN Commercial |
$5,052.86
|
| Rate for Payer: Multiplan Commercial |
$4,393.79
|
| Rate for Payer: Preferred Network Access Commercial |
$5,052.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,691.20
|
| Rate for Payer: Quartz Commercial |
$3,295.34
|
| Rate for Payer: WEA Trust Commercial |
$3,020.73
|
| Rate for Payer: WPS Commercial |
$4,067.95
|
|
|
CT Humerus w/o Contrast Bilateral
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,LT
|
| Hospital Charge Code |
1241150
|
|
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 Humerus w/o Contrast Left
|
Facility
|
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
635588
|
| Min. Negotiated Rate |
$110.02 |
| 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: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.39
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,526.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,444.51
|
| Rate for Payer: HFN Commercial |
$2,526.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| 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 |
$1,785.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,034.36
|
|
|
CT Humerus w/o Contrast Left
|
Facility
|
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
635588
|
| 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 Humerus w/o Contrast Left
|
Facility
|
OP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241152
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$814.49 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,617.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,501.64
|
| Rate for Payer: Aetna Managed Medicare |
$814.49
|
| 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 |
$1,541.71
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,676.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,627.85
|
| Rate for Payer: Health EOS Commercial |
$2,588.90
|
| Rate for Payer: HFN Commercial |
$2,676.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,181.66
|
| Rate for Payer: Multiplan Commercial |
$2,327.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,745.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,676.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,425.35
|
| Rate for Payer: Quartz Commercial |
$1,890.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,745.33
|
| Rate for Payer: The Alliance Commercial |
$1,454.44
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,599.88
|
| Rate for Payer: WPS Commercial |
$2,154.53
|
|
|
CT Humerus w/o Contrast Left
|
Professional
|
Both
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
635588
|
| Min. Negotiated Rate |
$159.69 |
| Max. Negotiated Rate |
$2,609.31 |
| Rate for Payer: Aetna Commercial |
$2,609.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.11
|
| Rate for Payer: Aetna Managed Medicare |
$159.69
|
| Rate for Payer: Anthem Medicare Advantage |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.69
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,609.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,373.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.69
|
| Rate for Payer: Health EOS Commercial |
$2,499.44
|
| Rate for Payer: HFN Commercial |
$2,609.31
|
| 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: Independent Care Health Plan Medicare |
$159.69
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: NAPHCARE Commercial |
$239.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,609.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,208.52
|
| Rate for Payer: Quartz Commercial |
$1,565.58
|
| Rate for Payer: Quartz Medicare Advantage |
$159.69
|
| Rate for Payer: The Alliance Commercial |
$606.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.69
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: WPS Commercial |
$798.46
|
|
|
CT Humerus w/o Contrast Left
|
Professional
|
Both
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241152
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$629.94 |
| Max. Negotiated Rate |
$2,763.44 |
| Rate for Payer: Aetna Commercial |
$2,763.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,501.64
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,763.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,454.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,745.33
|
| Rate for Payer: Health EOS Commercial |
$2,647.08
|
| Rate for Payer: HFN Commercial |
$2,763.44
|
| 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 |
$2,327.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,763.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.91
|
| Rate for Payer: Quartz Commercial |
$1,658.06
|
| Rate for Payer: The Alliance Commercial |
$1,454.44
|
| Rate for Payer: WEA Trust Commercial |
$1,599.88
|
| Rate for Payer: WPS Commercial |
$2,154.53
|
|
|
CT Humerus w/o Contrast Left
|
Facility
|
IP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241152
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,425.35 |
| Max. Negotiated Rate |
$2,676.17 |
| Rate for Payer: Aetna Commercial |
$2,617.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,501.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,541.71
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,676.17
|
| Rate for Payer: Health EOS Commercial |
$2,588.90
|
| Rate for Payer: HFN Commercial |
$2,676.17
|
| Rate for Payer: Multiplan Commercial |
$2,327.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,676.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,425.35
|
| Rate for Payer: Quartz Commercial |
$1,745.33
|
| Rate for Payer: WEA Trust Commercial |
$1,599.88
|
| Rate for Payer: WPS Commercial |
$2,154.53
|
|
|
CT Humerus w/o Contrast Right
|
Facility
|
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630024
|
| 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 Humerus w/o Contrast Right
|
Facility
|
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630024
|
| Min. Negotiated Rate |
$110.02 |
| 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: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.39
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,526.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,444.51
|
| Rate for Payer: HFN Commercial |
$2,526.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| 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 |
$1,785.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,034.36
|
|
|
CT Humerus w/o Contrast Right
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241154
|
|
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 Humerus w/o Contrast Right
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241154
|
|
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 Humerus w/o Contrast Right
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,RT
|
| Hospital Charge Code |
2980008
|
|
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 Humerus w/o Contrast Right
|
Professional
|
Both
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630024
|
| Min. Negotiated Rate |
$159.69 |
| Max. Negotiated Rate |
$2,609.31 |
| Rate for Payer: Aetna Commercial |
$2,609.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.11
|
| Rate for Payer: Aetna Managed Medicare |
$159.69
|
| Rate for Payer: Anthem Medicare Advantage |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.69
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,609.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,373.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.69
|
| Rate for Payer: Health EOS Commercial |
$2,499.44
|
| Rate for Payer: HFN Commercial |
$2,609.31
|
| 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: Independent Care Health Plan Medicare |
$159.69
|
| Rate for Payer: Multiplan Commercial |
$2,197.31
|
| Rate for Payer: NAPHCARE Commercial |
$239.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,609.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,208.52
|
| Rate for Payer: Quartz Commercial |
$1,565.58
|
| Rate for Payer: Quartz Medicare Advantage |
$159.69
|
| Rate for Payer: The Alliance Commercial |
$606.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.69
|
| Rate for Payer: WEA Trust Commercial |
$1,510.65
|
| Rate for Payer: WPS Commercial |
$798.46
|
|
|
CT Humerus w/o Contrast Right
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241154
|
|
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 Humerus w/o Contrast Right
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,RT
|
| Hospital Charge Code |
2980008
|
|
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 Humerus w/o Contrast Right
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,RT
|
| Hospital Charge Code |
2980008
|
|
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 Humerus w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241138
|
|
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
|
|
