|
CT TMJ w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 TC,RT
|
| Hospital Charge Code |
2979989
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,940.56 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,376.19
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241337
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$2,506.56 |
| Rate for Payer: Aetna Commercial |
$2,506.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,506.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,319.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.09
|
| Rate for Payer: Health EOS Commercial |
$2,401.02
|
| Rate for Payer: HFN Commercial |
$2,506.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.93
|
| Rate for Payer: Quartz Commercial |
$1,503.93
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241337
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$738.77 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Aetna Managed Medicare |
$738.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.39
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,427.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,476.53
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,583.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,715.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,583.09
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630219
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$5,108.95 |
| Rate for Payer: Aetna Commercial |
$5,108.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$198.29
|
| Rate for Payer: Anthem Medicare Advantage |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.29
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$5,108.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,688.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.29
|
| Rate for Payer: Health EOS Commercial |
$4,893.83
|
| Rate for Payer: HFN Commercial |
$5,108.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.29
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$297.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,108.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.25
|
| Rate for Payer: Quartz Commercial |
$3,065.37
|
| Rate for Payer: Quartz Medicare Advantage |
$198.29
|
| Rate for Payer: The Alliance Commercial |
$753.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.29
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: WPS Commercial |
$991.43
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
|
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630219
|
| Min. Negotiated Rate |
$2,635.14 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,226.70
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630219
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,495.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,688.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,581.36
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,009.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,495.60
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
|
CT Upper Extremity w/ Contrast Bilat
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241337
|
|
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 Upper Extremity w/ Contrast Left
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241339
|
|
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 Upper Extremity w/ Contrast Left
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630221
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,747.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.43
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,504.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,747.46
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Upper Extremity w/ Contrast Left
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630221
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Upper Extremity w/ Contrast Left
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630221
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$2,553.98 |
| Rate for Payer: Aetna Commercial |
$2,553.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$198.29
|
| Rate for Payer: Anthem Medicare Advantage |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.29
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,553.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,344.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.29
|
| Rate for Payer: Health EOS Commercial |
$2,446.44
|
| Rate for Payer: HFN Commercial |
$2,553.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.29
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$297.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.90
|
| Rate for Payer: Quartz Commercial |
$1,532.39
|
| Rate for Payer: Quartz Medicare Advantage |
$198.29
|
| Rate for Payer: The Alliance Commercial |
$753.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.29
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$991.43
|
|
|
CT Upper Extremity w/ Contrast Left
|
Facility
|
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241339
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$766.73 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,464.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.96
|
| Rate for Payer: Aetna Managed Medicare |
$766.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,451.31
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,519.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,532.41
|
| Rate for Payer: Health EOS Commercial |
$2,437.10
|
| Rate for Payer: HFN Commercial |
$2,519.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,053.74
|
| Rate for Payer: Multiplan Commercial |
$2,190.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,642.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,519.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.78
|
| Rate for Payer: Quartz Commercial |
$1,779.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,642.99
|
| Rate for Payer: The Alliance Commercial |
$1,369.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,506.08
|
| Rate for Payer: WPS Commercial |
$2,028.20
|
|
|
CT Upper Extremity w/ Contrast Left
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241339
|
|
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 Upper Extremity w/ Contrast Right
|
Facility
|
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241341
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$766.73 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,464.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,354.96
|
| Rate for Payer: Aetna Managed Medicare |
$766.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,451.31
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cash Price |
$789.90
|
| Rate for Payer: Cigna Commercial |
$2,519.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,532.41
|
| Rate for Payer: Health EOS Commercial |
$2,437.10
|
| Rate for Payer: HFN Commercial |
$2,519.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,053.74
|
| Rate for Payer: Multiplan Commercial |
$2,190.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,642.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,519.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.78
|
| Rate for Payer: Quartz Commercial |
$1,779.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,642.99
|
| Rate for Payer: The Alliance Commercial |
$1,369.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,506.08
|
| Rate for Payer: WPS Commercial |
$2,028.20
|
|
|
CT Upper Extremity w/ Contrast Right
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980017
|
|
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 Upper Extremity w/ Contrast Right
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630235
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$2,553.98 |
| Rate for Payer: Aetna Commercial |
$2,553.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$198.29
|
| Rate for Payer: Anthem Medicare Advantage |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.29
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,553.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,344.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.29
|
| Rate for Payer: Health EOS Commercial |
$2,446.44
|
| Rate for Payer: HFN Commercial |
$2,553.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.29
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$297.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.90
|
| Rate for Payer: Quartz Commercial |
$1,532.39
|
| Rate for Payer: Quartz Medicare Advantage |
$198.29
|
| Rate for Payer: The Alliance Commercial |
$753.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.29
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$991.43
|
|
|
CT Upper Extremity w/ Contrast Right
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630235
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,747.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.43
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,504.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,747.46
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Upper Extremity w/ Contrast Right
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$738.77 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Aetna Managed Medicare |
$738.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.39
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,427.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,476.53
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,583.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,715.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,583.09
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Upper Extremity w/ Contrast Right
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630235
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
CT Upper Extremity w/ Contrast Right
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241341
|
|
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 Upper Extremity w/ Contrast Right
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241341
|
|
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 Upper Extremity w/ Contrast Right
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980017
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$2,506.56 |
| Rate for Payer: Aetna Commercial |
$2,506.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,506.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,319.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.09
|
| Rate for Payer: Health EOS Commercial |
$2,401.02
|
| Rate for Payer: HFN Commercial |
$2,506.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.93
|
| Rate for Payer: Quartz Commercial |
$1,503.93
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Upper Extremity w/o Contrast Bilat
|
Professional
|
Both
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241349
|
|
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 Upper Extremity w/o Contrast Bilat
|
Facility
|
IP
|
$5,281.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
630239
|
| 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 Upper Extremity w/o Contrast Bilat
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241349
|
|
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
|
|
