|
CT Wrist w/ + w/o Contrast Bilateral
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241355
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Bilateral
|
Facility
OP
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630247
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$7,691.20 |
| Rate for Payer: Aetna Commercial |
$7,524.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,189.60
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,434.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,180.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,012.80
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,430.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,691.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$7,440.40
|
| Rate for Payer: HFN Commercial |
$7,691.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$6,688.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,691.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,096.40
|
| Rate for Payer: Quartz Commercial |
$5,434.00
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$4,598.00
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$6,192.25
|
|
|
CT Wrist w/ + w/o Contrast Bilateral
|
Facility
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241355
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$16,408.00 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,666.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.20
|
| Rate for Payer: The Alliance Commercial |
$16,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Bilateral
|
Professional
|
$8,360.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630247
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$7,942.00 |
| Rate for Payer: Aetna Commercial |
$7,942.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,189.60
|
| Rate for Payer: Aetna Managed Medicare |
$251.13
|
| Rate for Payer: Anthem Medicare Advantage |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.13
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cash Price |
$2,508.00
|
| Rate for Payer: Cigna Commercial |
$7,942.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,180.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.13
|
| Rate for Payer: Health EOS Commercial |
$7,607.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.13
|
| Rate for Payer: Multiplan Commercial |
$6,688.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,942.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,678.40
|
| Rate for Payer: Quartz Commercial |
$4,765.20
|
| Rate for Payer: Quartz Medicare Advantage |
$251.13
|
| Rate for Payer: The Alliance Commercial |
$954.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.13
|
| Rate for Payer: WEA Trust Commercial |
$4,598.00
|
| Rate for Payer: WPS Commercial |
$1,255.65
|
|
|
CT Wrist w/ + w/o Contrast Left
|
Facility
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241357
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$16,408.00 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,666.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.20
|
| Rate for Payer: The Alliance Commercial |
$16,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Left
|
Facility
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630249
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,717.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,090.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,006.88
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,717.65
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Wrist w/ + w/o Contrast Left
|
Facility
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630249
|
| Min. Negotiated Rate |
$2,048.69 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,508.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,508.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Wrist w/ + w/o Contrast Left
|
Professional
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630249
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$3,971.95 |
| Rate for Payer: Aetna Commercial |
$3,971.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$251.13
|
| Rate for Payer: Anthem Medicare Advantage |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.13
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,971.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,090.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.13
|
| Rate for Payer: Health EOS Commercial |
$3,804.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.13
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,971.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,839.64
|
| Rate for Payer: Quartz Commercial |
$2,383.17
|
| Rate for Payer: Quartz Medicare Advantage |
$251.13
|
| Rate for Payer: The Alliance Commercial |
$954.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.13
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$1,255.65
|
|
|
CT Wrist w/ + w/o Contrast Left
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241357
|
|
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 Left
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241357
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Facility
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630251
|
| Min. Negotiated Rate |
$2,048.69 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,508.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,508.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Facility
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630251
|
| Min. Negotiated Rate |
$79.76 |
| Max. Negotiated Rate |
$3,846.52 |
| Rate for Payer: Aetna Commercial |
$3,762.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,717.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,090.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,006.88
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,215.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,846.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,721.09
|
| Rate for Payer: HFN Commercial |
$3,846.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,846.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,048.69
|
| Rate for Payer: Quartz Commercial |
$2,717.65
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$79.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,096.87
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Professional
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630251
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$3,971.95 |
| Rate for Payer: Aetna Commercial |
$3,971.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,595.66
|
| Rate for Payer: Aetna Managed Medicare |
$251.13
|
| Rate for Payer: Anthem Medicare Advantage |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.13
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$3,971.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,090.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.13
|
| Rate for Payer: Health EOS Commercial |
$3,804.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.13
|
| Rate for Payer: Multiplan Commercial |
$3,344.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,971.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,839.64
|
| Rate for Payer: Quartz Commercial |
$2,383.17
|
| Rate for Payer: Quartz Medicare Advantage |
$251.13
|
| Rate for Payer: The Alliance Commercial |
$954.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.13
|
| Rate for Payer: WEA Trust Commercial |
$2,299.55
|
| Rate for Payer: WPS Commercial |
$1,255.65
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980025
|
|
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 Right
|
Facility
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241359
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$16,408.00 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,666.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.20
|
| Rate for Payer: The Alliance Commercial |
$16,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Facility
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241359
|
|
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 Right
|
Professional
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241359
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,804.88 |
| Max. Negotiated Rate |
$3,896.90 |
| Rate for Payer: Aetna Commercial |
$3,896.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,896.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,051.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,461.20
|
| Rate for Payer: Health EOS Commercial |
$3,732.82
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,896.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,804.88
|
| Rate for Payer: Quartz Commercial |
$2,338.14
|
| Rate for Payer: The Alliance Commercial |
$2,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CT Wrist w/ + w/o Contrast Right
|
Facility
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980025
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,148.56 |
| Max. Negotiated Rate |
$16,408.00 |
| Rate for Payer: Aetna Commercial |
$3,691.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,174.06
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,773.84
|
| Rate for Payer: Health EOS Commercial |
$3,650.78
|
| Rate for Payer: HFN Commercial |
$3,773.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.50
|
| Rate for Payer: Multiplan Commercial |
$3,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.98
|
| Rate for Payer: Quartz Commercial |
$2,666.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.20
|
| Rate for Payer: The Alliance Commercial |
$16,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,256.10
|
| Rate for Payer: WPS Commercial |
$3,038.35
|
|
|
CUBITAL TUNNEL
|
Facility
IP
|
$1,337.00
|
|
| Hospital Charge Code |
5130616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
CUBITAL TUNNEL
|
Facility
OP
|
$1,337.00
|
|
| Hospital Charge Code |
5130616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
CUFF ADAPTER UNIVERSAL 22mm #1421
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
2969677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
CUFF ADAPTER UNIVERSAL 22mm #1421
|
Facility
IP
|
$10.00
|
|
| Hospital Charge Code |
2969677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
CUFF BLOOD PRESSURE DISP ADULT LONG VSOFT-11L
|
Facility
OP
|
$72.00
|
|
| Hospital Charge Code |
4509021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
CUFF BLOOD PRESSURE DISP ADULT LONG VSOFT-11L
|
Facility
IP
|
$72.00
|
|
| Hospital Charge Code |
4509021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
