|
CT Wrist w/ Contrast Right
|
Professional
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630257
|
| Min. Negotiated Rate |
$202.41 |
| Max. Negotiated Rate |
$2,455.75 |
| Rate for Payer: Aetna Commercial |
$2,455.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Aetna Managed Medicare |
$202.41
|
| Rate for Payer: Anthem Medicare Advantage |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$202.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$202.41
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,455.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,292.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.41
|
| Rate for Payer: Health EOS Commercial |
$2,352.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$754.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$202.41
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,455.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,137.40
|
| Rate for Payer: Quartz Commercial |
$1,473.45
|
| Rate for Payer: Quartz Medicare Advantage |
$202.41
|
| Rate for Payer: The Alliance Commercial |
$769.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$202.41
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,012.05
|
|
|
CT Wrist w/ Contrast Right
|
Facility
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
1241365
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Wrist w/o Contrast Bilateral
|
Facility
OP
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630259
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$4,858.52 |
| Rate for Payer: Aetna Commercial |
$4,752.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,541.66
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,432.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,640.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,534.88
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,798.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$4,858.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$4,700.09
|
| Rate for Payer: HFN Commercial |
$4,858.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$4,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,858.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.69
|
| Rate for Payer: Quartz Commercial |
$3,432.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$664.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$2,904.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$3,911.64
|
|
|
CT Wrist w/o Contrast Bilateral
|
Facility
IP
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630259
|
| Min. Negotiated Rate |
$2,587.69 |
| Max. Negotiated Rate |
$4,858.52 |
| Rate for Payer: Aetna Commercial |
$4,752.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,798.93
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$4,858.52
|
| Rate for Payer: Health EOS Commercial |
$4,700.09
|
| Rate for Payer: HFN Commercial |
$4,858.52
|
| Rate for Payer: Multiplan Commercial |
$4,224.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,858.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.69
|
| Rate for Payer: Quartz Commercial |
$3,168.60
|
| Rate for Payer: WEA Trust Commercial |
$2,904.55
|
| Rate for Payer: WPS Commercial |
$3,911.64
|
|
|
CT Wrist w/o Contrast Bilateral
|
Facility
OP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241367
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$854.00 |
| Max. Negotiated Rate |
$12,200.00 |
| Rate for Payer: Aetna Commercial |
$2,745.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,623.00
|
| Rate for Payer: Aetna Managed Medicare |
$854.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,616.50
|
| Rate for Payer: Cash Price |
$915.00
|
| 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 |
$2,806.00
|
| Rate for Payer: Health EOS Commercial |
$2,714.50
|
| Rate for Payer: HFN Commercial |
$2,806.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,287.50
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,806.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.50
|
| Rate for Payer: Quartz Commercial |
$1,982.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,830.00
|
| Rate for Payer: The Alliance Commercial |
$12,200.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Wrist w/o Contrast Bilateral
|
Professional
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630259
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$5,016.95 |
| Rate for Payer: Aetna Commercial |
$5,016.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,541.66
|
| Rate for Payer: Aetna Managed Medicare |
$162.55
|
| Rate for Payer: Anthem Medicare Advantage |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.55
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cash Price |
$1,584.30
|
| Rate for Payer: Cigna Commercial |
$5,016.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,640.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.55
|
| Rate for Payer: Health EOS Commercial |
$4,805.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$605.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.55
|
| Rate for Payer: Multiplan Commercial |
$4,224.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,016.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.64
|
| Rate for Payer: Quartz Commercial |
$3,010.17
|
| Rate for Payer: Quartz Medicare Advantage |
$162.55
|
| Rate for Payer: The Alliance Commercial |
$617.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.55
|
| Rate for Payer: WEA Trust Commercial |
$2,904.55
|
| Rate for Payer: WPS Commercial |
$812.75
|
|
|
CT Wrist w/o Contrast Bilateral
|
Professional
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241367
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,342.00 |
| Max. Negotiated Rate |
$2,897.50 |
| Rate for Payer: Aetna Commercial |
$2,897.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,623.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,897.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,525.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,830.00
|
| Rate for Payer: Health EOS Commercial |
$2,775.50
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,342.00
|
| Rate for Payer: Quartz Commercial |
$1,738.50
|
| Rate for Payer: The Alliance Commercial |
$1,525.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Wrist w/o Contrast Bilateral
|
Facility
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241367
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,494.50 |
| Max. Negotiated Rate |
$2,806.00 |
| Rate for Payer: Aetna Commercial |
$2,745.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,616.50
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,806.00
|
| Rate for Payer: Health EOS Commercial |
$2,714.50
|
| Rate for Payer: HFN Commercial |
$2,806.00
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,806.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.50
|
| Rate for Payer: Quartz Commercial |
$1,830.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Wrist w/o Contrast Left
|
Facility
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630261
|
| Min. Negotiated Rate |
$1,294.09 |
| Max. Negotiated Rate |
$2,429.72 |
| Rate for Payer: Aetna Commercial |
$2,376.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,399.73
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,429.72
|
| Rate for Payer: Health EOS Commercial |
$2,350.49
|
| Rate for Payer: HFN Commercial |
$2,429.72
|
| Rate for Payer: Multiplan Commercial |
$2,112.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,584.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,429.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.09
|
| Rate for Payer: Quartz Commercial |
$1,584.60
|
| Rate for Payer: WEA Trust Commercial |
$1,452.55
|
| Rate for Payer: WPS Commercial |
$1,956.19
|
|
|
CT Wrist w/o Contrast Left
|
Facility
IP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241369
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,370.53 |
| Max. Negotiated Rate |
$2,573.24 |
| Rate for Payer: Quartz Beloit One Network |
$1,370.53
|
| Rate for Payer: Aetna Commercial |
$2,517.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,482.41
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,573.24
|
| Rate for Payer: Health EOS Commercial |
$2,489.33
|
| Rate for Payer: HFN Commercial |
$2,573.24
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,678.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,573.24
|
| Rate for Payer: Quartz Commercial |
$1,678.20
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Wrist w/o Contrast Left
|
Facility
OP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241369
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$783.16 |
| Max. Negotiated Rate |
$11,188.00 |
| Rate for Payer: Aetna Commercial |
$2,517.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,405.42
|
| Rate for Payer: Aetna Managed Medicare |
$783.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,482.41
|
| Rate for Payer: Cash Price |
$839.10
|
| 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 |
$2,573.24
|
| Rate for Payer: Health EOS Commercial |
$2,489.33
|
| Rate for Payer: HFN Commercial |
$2,573.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,097.75
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,678.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,573.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,370.53
|
| Rate for Payer: Quartz Commercial |
$1,818.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,678.20
|
| Rate for Payer: The Alliance Commercial |
$11,188.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Wrist w/o Contrast Left
|
Facility
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630261
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,429.72 |
| Rate for Payer: Aetna Commercial |
$2,376.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.26
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,716.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,320.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,267.68
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,399.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,429.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,350.49
|
| Rate for Payer: HFN Commercial |
$2,429.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,112.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,429.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.09
|
| Rate for Payer: Quartz Commercial |
$1,716.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$664.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,452.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,956.19
|
|
|
CT Wrist w/o Contrast Left
|
Professional
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630261
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$2,508.95 |
| Rate for Payer: Aetna Commercial |
$2,508.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.26
|
| Rate for Payer: Aetna Managed Medicare |
$162.55
|
| Rate for Payer: Anthem Medicare Advantage |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.55
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,508.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,320.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.55
|
| Rate for Payer: Health EOS Commercial |
$2,403.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$605.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.55
|
| Rate for Payer: Multiplan Commercial |
$2,112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,508.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,162.04
|
| Rate for Payer: Quartz Commercial |
$1,505.37
|
| Rate for Payer: Quartz Medicare Advantage |
$162.55
|
| Rate for Payer: The Alliance Commercial |
$617.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.55
|
| Rate for Payer: WEA Trust Commercial |
$1,452.55
|
| Rate for Payer: WPS Commercial |
$812.75
|
|
|
CT Wrist w/o Contrast Left
|
Professional
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241369
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,230.68 |
| Max. Negotiated Rate |
$2,657.15 |
| Rate for Payer: Aetna Commercial |
$2,657.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,405.42
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,657.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,398.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,678.20
|
| Rate for Payer: Health EOS Commercial |
$2,545.27
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.68
|
| Rate for Payer: Quartz Commercial |
$1,594.29
|
| Rate for Payer: The Alliance Commercial |
$1,398.50
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Wrist w/o Contrast Right
|
Professional
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241371
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,230.68 |
| Max. Negotiated Rate |
$2,657.15 |
| Rate for Payer: Aetna Commercial |
$2,657.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,405.42
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,657.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,398.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,678.20
|
| Rate for Payer: Health EOS Commercial |
$2,545.27
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.68
|
| Rate for Payer: Quartz Commercial |
$1,594.29
|
| Rate for Payer: The Alliance Commercial |
$1,398.50
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Wrist w/o Contrast Right
|
Facility
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,RT
|
| Hospital Charge Code |
2980011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,494.50 |
| Max. Negotiated Rate |
$2,806.00 |
| Rate for Payer: Aetna Commercial |
$2,745.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,616.50
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,806.00
|
| Rate for Payer: Health EOS Commercial |
$2,714.50
|
| Rate for Payer: HFN Commercial |
$2,806.00
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,806.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.50
|
| Rate for Payer: Quartz Commercial |
$1,830.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Wrist w/o Contrast Right
|
Facility
IP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241371
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,370.53 |
| Max. Negotiated Rate |
$2,573.24 |
| Rate for Payer: Aetna Commercial |
$2,517.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,482.41
|
| Rate for Payer: Cash Price |
$839.10
|
| Rate for Payer: Cigna Commercial |
$2,573.24
|
| Rate for Payer: Health EOS Commercial |
$2,489.33
|
| Rate for Payer: HFN Commercial |
$2,573.24
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,678.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,573.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,370.53
|
| Rate for Payer: Quartz Commercial |
$1,678.20
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Wrist w/o Contrast Right
|
Facility
OP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630263
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,429.72 |
| Rate for Payer: Aetna Commercial |
$2,376.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.26
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,716.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,320.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,267.68
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,399.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,429.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,350.49
|
| Rate for Payer: HFN Commercial |
$2,429.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,112.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,429.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.09
|
| Rate for Payer: Quartz Commercial |
$1,716.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$664.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,452.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,956.19
|
|
|
CT Wrist w/o Contrast Right
|
Professional
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,RT
|
| Hospital Charge Code |
2980011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,342.00 |
| Max. Negotiated Rate |
$2,897.50 |
| Rate for Payer: Aetna Commercial |
$2,897.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,623.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cash Price |
$915.00
|
| Rate for Payer: Cigna Commercial |
$2,897.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,525.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,830.00
|
| Rate for Payer: Health EOS Commercial |
$2,775.50
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,897.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,342.00
|
| Rate for Payer: Quartz Commercial |
$1,738.50
|
| Rate for Payer: The Alliance Commercial |
$1,525.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Wrist w/o Contrast Right
|
Professional
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630263
|
| Min. Negotiated Rate |
$162.55 |
| Max. Negotiated Rate |
$2,508.95 |
| Rate for Payer: Aetna Commercial |
$2,508.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,271.26
|
| Rate for Payer: Aetna Managed Medicare |
$162.55
|
| Rate for Payer: Anthem Medicare Advantage |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.55
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,508.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,320.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.55
|
| Rate for Payer: Health EOS Commercial |
$2,403.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$605.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$605.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.55
|
| Rate for Payer: Multiplan Commercial |
$2,112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,508.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,162.04
|
| Rate for Payer: Quartz Commercial |
$1,505.37
|
| Rate for Payer: Quartz Medicare Advantage |
$162.55
|
| Rate for Payer: The Alliance Commercial |
$617.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.55
|
| Rate for Payer: WEA Trust Commercial |
$1,452.55
|
| Rate for Payer: WPS Commercial |
$812.75
|
|
|
CT Wrist w/o Contrast Right
|
Facility
IP
|
$2,641.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630263
|
| Min. Negotiated Rate |
$1,294.09 |
| Max. Negotiated Rate |
$2,429.72 |
| Rate for Payer: Aetna Commercial |
$2,376.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,399.73
|
| Rate for Payer: Cash Price |
$792.30
|
| Rate for Payer: Cigna Commercial |
$2,429.72
|
| Rate for Payer: Health EOS Commercial |
$2,350.49
|
| Rate for Payer: HFN Commercial |
$2,429.72
|
| Rate for Payer: Multiplan Commercial |
$2,112.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,584.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,429.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.09
|
| Rate for Payer: Quartz Commercial |
$1,584.60
|
| Rate for Payer: WEA Trust Commercial |
$1,452.55
|
| Rate for Payer: WPS Commercial |
$1,956.19
|
|
|
CT Wrist w/o Contrast Right
|
Facility
OP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 TC,RT
|
| Hospital Charge Code |
2980011
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$854.00 |
| Max. Negotiated Rate |
$12,200.00 |
| Rate for Payer: Aetna Commercial |
$2,745.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,623.00
|
| Rate for Payer: Aetna Managed Medicare |
$854.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,616.50
|
| Rate for Payer: Cash Price |
$915.00
|
| 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 |
$2,806.00
|
| Rate for Payer: Health EOS Commercial |
$2,714.50
|
| Rate for Payer: HFN Commercial |
$2,806.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,287.50
|
| Rate for Payer: Multiplan Commercial |
$2,440.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,830.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,806.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.50
|
| Rate for Payer: Quartz Commercial |
$1,982.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,830.00
|
| Rate for Payer: The Alliance Commercial |
$12,200.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,677.50
|
| Rate for Payer: WPS Commercial |
$2,259.14
|
|
|
CT Wrist w/o Contrast Right
|
Facility
OP
|
$2,797.00
|
|
|
Service Code
|
CPT 73200 RT,TC
|
| Hospital Charge Code |
1241371
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$783.16 |
| Max. Negotiated Rate |
$11,188.00 |
| Rate for Payer: Aetna Commercial |
$2,517.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,405.42
|
| Rate for Payer: Aetna Managed Medicare |
$783.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,482.41
|
| Rate for Payer: Cash Price |
$839.10
|
| 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 |
$2,573.24
|
| Rate for Payer: Health EOS Commercial |
$2,489.33
|
| Rate for Payer: HFN Commercial |
$2,573.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,097.75
|
| Rate for Payer: Multiplan Commercial |
$2,237.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,678.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,573.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,370.53
|
| Rate for Payer: Quartz Commercial |
$1,818.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,678.20
|
| Rate for Payer: The Alliance Commercial |
$11,188.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,538.35
|
| Rate for Payer: WPS Commercial |
$2,071.74
|
|
|
CT Wrist w/ + w/o Contrast Bilateral
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241355
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,009.98 |
| Max. Negotiated Rate |
$3,773.84 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,461.20
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Bilateral
|
Facility
IP
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630247
|
| Min. Negotiated Rate |
$4,096.40 |
| Max. Negotiated Rate |
$7,691.20 |
| Rate for Payer: Aetna Commercial |
$7,524.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,430.80
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,691.20
|
| Rate for Payer: Health EOS Commercial |
$7,440.40
|
| Rate for Payer: HFN Commercial |
$7,691.20
|
| Rate for Payer: Multiplan Commercial |
$6,688.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,016.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,691.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,096.40
|
| Rate for Payer: Quartz Commercial |
$5,016.00
|
| Rate for Payer: WEA Trust Commercial |
$4,598.00
|
| Rate for Payer: WPS Commercial |
$6,192.25
|
|
