|
CT Upper Extremity w/+w/o Contrast Left
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241345
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| 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 |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Left
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630211
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Upper Extremity w/+w/o Contrast Left
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630211
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Upper Extremity w/+w/o Contrast Left
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241345
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Left
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 LT,TC
|
| Hospital Charge Code |
1241345
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241347
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241347
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630213
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980024
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630213
|
| Min. Negotiated Rate |
$244.96 |
| Max. Negotiated Rate |
$4,130.83 |
| Rate for Payer: Aetna Commercial |
$4,130.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$244.96
|
| Rate for Payer: Anthem Medicare Advantage |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.96
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,130.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.96
|
| Rate for Payer: Health EOS Commercial |
$3,956.90
|
| Rate for Payer: HFN Commercial |
$4,130.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.96
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$367.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,913.23
|
| Rate for Payer: Quartz Commercial |
$2,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$244.96
|
| Rate for Payer: The Alliance Commercial |
$930.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.96
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$1,224.81
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630213
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980024
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| 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 |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980024
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Upper Extremity w/+w/o Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241347
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| 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 |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Wrist w/ Contrast Bilateral
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241361
|
|
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 Wrist w/ Contrast Bilateral
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630253
|
| 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 Wrist w/ Contrast Bilateral
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630253
|
| 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 Wrist w/ Contrast Bilateral
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241361
|
|
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 Wrist w/ Contrast Bilateral
|
Facility
|
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630253
|
| 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 Wrist w/ Contrast Bilateral
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241361
|
|
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 Wrist w/ Contrast Left
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630255
|
| 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 Wrist w/ Contrast Left
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241363
|
|
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 Wrist w/ Contrast Left
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241363
|
|
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 Wrist w/ Contrast Left
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630255
|
| 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 Wrist w/ Contrast Left
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241363
|
|
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
|
|
