|
Cryptosporidium Antigen
|
Professional
|
$186.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
5619697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
Crystal Identification By Microscope 89060PP
|
Professional
|
$185.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
3127495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$175.75 |
| Rate for Payer: Aetna Commercial |
$175.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Aetna Managed Medicare |
$7.33
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.33
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$175.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.33
|
| Rate for Payer: Health EOS Commercial |
$168.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: Preferred Network Access Commercial |
$175.75
|
| Rate for Payer: Quartz Beloit One Network |
$81.40
|
| Rate for Payer: Quartz Commercial |
$105.45
|
| Rate for Payer: Quartz Medicare Advantage |
$7.33
|
| Rate for Payer: The Alliance Commercial |
$28.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$32.25
|
|
|
Crystal Identification By Microscope POC
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2580819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$7.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.17
|
| Rate for Payer: Anthem Medicaid |
$7.57
|
| Rate for Payer: Anthem Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.33
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.57
|
| Rate for Payer: Dean Health Medicaid |
$7.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.33
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.33
|
| Rate for Payer: Managed Health Services Medicaid |
$7.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$11.00
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.57
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7.33
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: United Healthcare PPO |
$122.25
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: Wellcare Medicare |
$7.33
|
| Rate for Payer: WMAP Medicaid |
$7.57
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Crystal Identification By Microscope POC
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2580819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Crystal Identification By Microscope POC
|
Professional
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2580819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$7.33
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.33
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.33
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: Quartz Medicare Advantage |
$7.33
|
| Rate for Payer: The Alliance Commercial |
$28.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$32.25
|
|
|
Crystals, Fluid
|
Facility
OP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
979851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$7.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.17
|
| Rate for Payer: Anthem Medicaid |
$7.57
|
| Rate for Payer: Anthem Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.33
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.57
|
| Rate for Payer: Dean Health Medicaid |
$7.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.33
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.33
|
| Rate for Payer: Managed Health Services Medicaid |
$7.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$11.00
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.57
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7.33
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: United Healthcare PPO |
$122.25
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: Wellcare Medicare |
$7.33
|
| Rate for Payer: WMAP Medicaid |
$7.57
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Crystals, Fluid
|
Facility
IP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
979851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Crystals, Fluid
|
Professional
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
979851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$7.33
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.33
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.33
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.33
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: Quartz Medicare Advantage |
$7.33
|
| Rate for Payer: The Alliance Commercial |
$28.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.33
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$32.25
|
|
|
CSF LEAK REPAIR
|
Facility
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2959972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,620.12 |
| Max. Negotiated Rate |
$6,796.96 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,432.80
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
CSF LEAK REPAIR
|
Facility
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2959972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,068.64 |
| Max. Negotiated Rate |
$29,552.00 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,802.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,546.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,134.32
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,541.00
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,802.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,432.80
|
| Rate for Payer: The Alliance Commercial |
$29,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
CT 3D Reconstruction
|
Facility
OP
|
$551.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
615588
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$8.84
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
CT 3D Reconstruction
|
Facility
IP
|
$551.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
615588
|
| Min. Negotiated Rate |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
CT 3D Reconstruction
|
Professional
|
$540.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
1240799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.95
|
| Rate for Payer: Anthem Medicare Advantage |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.95
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.95
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.95
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: Quartz Medicare Advantage |
$13.95
|
| Rate for Payer: The Alliance Commercial |
$53.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.95
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$69.75
|
|
|
CT 3D Reconstruction
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
1240799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
CT 3D Reconstruction
|
Professional
|
$551.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
615588
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$523.45 |
| Rate for Payer: Aetna Commercial |
$523.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$23.09
|
| Rate for Payer: Anthem Medicare Advantage |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.09
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$523.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.09
|
| Rate for Payer: Health EOS Commercial |
$501.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: Preferred Network Access Commercial |
$523.45
|
| Rate for Payer: Quartz Beloit One Network |
$242.44
|
| Rate for Payer: Quartz Commercial |
$314.07
|
| Rate for Payer: Quartz Medicare Advantage |
$23.09
|
| Rate for Payer: The Alliance Commercial |
$87.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$115.45
|
|
|
CT 3D Reconstruction
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
1240799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$151.20
|
| 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 |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| Rate for Payer: Quartz Medicare Advantage |
$324.00
|
| Rate for Payer: The Alliance Commercial |
$2,160.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$97.65
|
|
|
CTA Abdomen
|
Professional
|
$5,579.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
3072661
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$307.83 |
| Max. Negotiated Rate |
$5,300.05 |
| Rate for Payer: Aetna Commercial |
$5,300.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,797.94
|
| Rate for Payer: Aetna Managed Medicare |
$307.83
|
| Rate for Payer: Anthem Medicare Advantage |
$307.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$307.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$307.83
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,300.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,789.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.83
|
| Rate for Payer: Health EOS Commercial |
$5,076.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,119.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$307.83
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,300.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,454.76
|
| Rate for Payer: Quartz Commercial |
$3,180.03
|
| Rate for Payer: Quartz Medicare Advantage |
$307.83
|
| Rate for Payer: The Alliance Commercial |
$1,169.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.83
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: WPS Commercial |
$1,539.15
|
|
|
CTA Abdomen
|
Facility
OP
|
$5,579.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
3072661
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$7,642.76 |
| Rate for Payer: Aetna Commercial |
$5,021.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,797.94
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,956.87
|
| 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 |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,132.68
|
| 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 |
$4,965.31
|
| Rate for Payer: HFN Commercial |
$5,132.68
|
| 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 |
$4,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,132.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,733.71
|
| Rate for Payer: Quartz Commercial |
$3,626.35
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$7,642.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,154.81
|
|
|
CTA Abdomen
|
Facility
IP
|
$5,579.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
3072661
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,733.71 |
| Max. Negotiated Rate |
$5,132.68 |
| Rate for Payer: Aetna Commercial |
$5,021.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,956.87
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,132.68
|
| Rate for Payer: Health EOS Commercial |
$4,965.31
|
| Rate for Payer: HFN Commercial |
$5,132.68
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,132.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,733.71
|
| Rate for Payer: Quartz Commercial |
$3,347.40
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: WPS Commercial |
$4,132.37
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
OP
|
$6,089.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
1220807
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$5,601.88 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,236.54
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,957.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,044.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,922.72
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,957.85
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$0.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Professional
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
2950239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$222.99 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Aetna Commercial |
$6,412.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.00
|
| Rate for Payer: Aetna Managed Medicare |
$222.99
|
| Rate for Payer: Anthem Medicare Advantage |
$222.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$222.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$222.99
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,412.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,375.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.99
|
| Rate for Payer: Health EOS Commercial |
$6,142.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$828.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$222.99
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,412.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.00
|
| Rate for Payer: Quartz Commercial |
$3,847.50
|
| Rate for Payer: Quartz Medicare Advantage |
$222.99
|
| Rate for Payer: The Alliance Commercial |
$847.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.99
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$1,114.95
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
OP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
1240813
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,560.93 |
| Max. Negotiated Rate |
$27,000.00 |
| Rate for Payer: Aetna Commercial |
$6,075.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,890.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,577.50
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,210.00
|
| Rate for Payer: Health EOS Commercial |
$6,007.50
|
| Rate for Payer: HFN Commercial |
$6,210.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,062.50
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,210.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,307.50
|
| Rate for Payer: Quartz Commercial |
$4,387.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,050.00
|
| Rate for Payer: The Alliance Commercial |
$27,000.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$1,560.93
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
IP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
1240813
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,307.50 |
| Max. Negotiated Rate |
$6,210.00 |
| Rate for Payer: Aetna Commercial |
$6,075.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,577.50
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,210.00
|
| Rate for Payer: Health EOS Commercial |
$6,007.50
|
| Rate for Payer: HFN Commercial |
$6,210.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,210.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,307.50
|
| Rate for Payer: Quartz Commercial |
$4,050.00
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$4,999.72
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Professional
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
1240813
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$222.99 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Aetna Commercial |
$6,412.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.00
|
| Rate for Payer: Aetna Managed Medicare |
$222.99
|
| Rate for Payer: Anthem Medicare Advantage |
$222.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$222.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$222.99
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,412.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,375.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.99
|
| Rate for Payer: Health EOS Commercial |
$6,142.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$828.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$222.99
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,412.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.00
|
| Rate for Payer: Quartz Commercial |
$3,847.50
|
| Rate for Payer: Quartz Medicare Advantage |
$222.99
|
| Rate for Payer: The Alliance Commercial |
$847.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$222.99
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$1,114.95
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
IP
|
$6,089.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
1220807
|
| Min. Negotiated Rate |
$2,983.61 |
| Max. Negotiated Rate |
$5,601.88 |
| Rate for Payer: Aetna Commercial |
$5,480.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,227.17
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,601.88
|
| Rate for Payer: Health EOS Commercial |
$5,419.21
|
| Rate for Payer: HFN Commercial |
$5,601.88
|
| Rate for Payer: Multiplan Commercial |
$4,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,653.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,601.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.61
|
| Rate for Payer: Quartz Commercial |
$3,653.40
|
| Rate for Payer: WEA Trust Commercial |
$3,348.95
|
| Rate for Payer: WPS Commercial |
$4,510.12
|
|
