|
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
|
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/o Contrast
|
Professional
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
1240816
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$5,662.95 |
| Rate for Payer: Aetna Commercial |
$5,662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$102.91
|
| Rate for Payer: Anthem Medicare Advantage |
$102.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.91
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,980.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.91
|
| Rate for Payer: Health EOS Commercial |
$5,424.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.91
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,662.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,622.84
|
| Rate for Payer: Quartz Commercial |
$3,397.77
|
| Rate for Payer: Quartz Medicare Advantage |
$102.91
|
| Rate for Payer: The Alliance Commercial |
$391.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.91
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$514.55
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
1240816
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,669.08
|
| 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 |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,470.75
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,874.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,576.60
|
| Rate for Payer: The Alliance Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$720.37
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Professional
|
$5,204.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1220806
|
| Min. Negotiated Rate |
$183.22 |
| Max. Negotiated Rate |
$4,943.80 |
| Rate for Payer: Aetna Commercial |
$4,943.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,475.44
|
| Rate for Payer: Aetna Managed Medicare |
$183.22
|
| Rate for Payer: Anthem Medicare Advantage |
$183.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$183.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$183.22
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cigna Commercial |
$4,943.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,602.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.22
|
| Rate for Payer: Health EOS Commercial |
$4,735.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$671.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$183.22
|
| Rate for Payer: Multiplan Commercial |
$4,163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,943.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.76
|
| Rate for Payer: Quartz Commercial |
$2,966.28
|
| Rate for Payer: Quartz Medicare Advantage |
$183.22
|
| Rate for Payer: The Alliance Commercial |
$696.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.22
|
| Rate for Payer: WEA Trust Commercial |
$2,862.20
|
| Rate for Payer: WPS Commercial |
$916.10
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
3072641
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,920.89 |
| Max. Negotiated Rate |
$5,484.12 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,576.60
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$4,415.31
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
3072641
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,669.08
|
| 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 |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,470.75
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,874.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,576.60
|
| Rate for Payer: The Alliance Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$720.37
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Professional
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
3072641
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$5,662.95 |
| Rate for Payer: Aetna Commercial |
$5,662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$102.91
|
| Rate for Payer: Anthem Medicare Advantage |
$102.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.91
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,980.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.91
|
| Rate for Payer: Health EOS Commercial |
$5,424.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.91
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,662.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,622.84
|
| Rate for Payer: Quartz Commercial |
$3,397.77
|
| Rate for Payer: Quartz Medicare Advantage |
$102.91
|
| Rate for Payer: The Alliance Commercial |
$391.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.91
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$514.55
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
OP
|
$5,204.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1220806
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$4,787.68 |
| Rate for Payer: Aetna Commercial |
$4,683.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,475.44
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,382.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,602.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,497.92
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,758.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cigna Commercial |
$4,787.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,631.56
|
| Rate for Payer: HFN Commercial |
$4,787.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$4,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,787.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,549.96
|
| Rate for Payer: Quartz Commercial |
$3,382.60
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: WEA Trust Commercial |
$2,862.20
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,854.60
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
IP
|
$5,204.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1220806
|
| Min. Negotiated Rate |
$2,549.96 |
| Max. Negotiated Rate |
$4,787.68 |
| Rate for Payer: Aetna Commercial |
$4,683.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,758.12
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cigna Commercial |
$4,787.68
|
| Rate for Payer: Health EOS Commercial |
$4,631.56
|
| Rate for Payer: HFN Commercial |
$4,787.68
|
| Rate for Payer: Multiplan Commercial |
$4,163.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,787.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,549.96
|
| Rate for Payer: Quartz Commercial |
$3,122.40
|
| Rate for Payer: WEA Trust Commercial |
$2,862.20
|
| Rate for Payer: WPS Commercial |
$3,854.60
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
1240816
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,920.89 |
| Max. Negotiated Rate |
$5,484.12 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,576.60
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$4,415.31
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Professional
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$251.64 |
| Max. Negotiated Rate |
$7,160.15 |
| Rate for Payer: Aetna Commercial |
$7,160.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$251.64
|
| Rate for Payer: Anthem Medicare Advantage |
$251.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.64
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,160.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,768.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$6,858.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$935.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,160.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.28
|
| Rate for Payer: Quartz Commercial |
$4,296.09
|
| Rate for Payer: Quartz Medicare Advantage |
$251.64
|
| Rate for Payer: The Alliance Commercial |
$956.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.64
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$1,258.20
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
OP
|
$7,893.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1220808
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$7,261.56 |
| Rate for Payer: Aetna Commercial |
$7,103.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,787.98
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,130.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,946.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,788.64
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,183.29
|
| 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 |
$2,367.90
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cigna Commercial |
$7,261.56
|
| 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 |
$7,024.77
|
| Rate for Payer: HFN Commercial |
$7,261.56
|
| 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 |
$6,314.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,261.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,867.57
|
| Rate for Payer: Quartz Commercial |
$5,130.45
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$0.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$4,341.15
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,846.35
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
IP
|
$7,893.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1220808
|
| Min. Negotiated Rate |
$3,867.57 |
| Max. Negotiated Rate |
$7,261.56 |
| Rate for Payer: Aetna Commercial |
$7,103.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,183.29
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cigna Commercial |
$7,261.56
|
| Rate for Payer: Health EOS Commercial |
$7,024.77
|
| Rate for Payer: HFN Commercial |
$7,261.56
|
| Rate for Payer: Multiplan Commercial |
$6,314.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,735.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,261.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,867.57
|
| Rate for Payer: Quartz Commercial |
$4,735.80
|
| Rate for Payer: WEA Trust Commercial |
$4,341.15
|
| Rate for Payer: WPS Commercial |
$5,846.35
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Professional
|
$7,893.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1220808
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$7,498.35 |
| Rate for Payer: Aetna Commercial |
$7,498.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,787.98
|
| Rate for Payer: Aetna Managed Medicare |
$344.00
|
| Rate for Payer: Anthem Medicare Advantage |
$344.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$344.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$344.00
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cigna Commercial |
$7,498.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,946.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.00
|
| Rate for Payer: Health EOS Commercial |
$7,182.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,270.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,270.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$6,314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,472.92
|
| Rate for Payer: Quartz Commercial |
$4,499.01
|
| Rate for Payer: Quartz Medicare Advantage |
$344.00
|
| Rate for Payer: The Alliance Commercial |
$1,307.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$344.00
|
| Rate for Payer: WEA Trust Commercial |
$4,341.15
|
| Rate for Payer: WPS Commercial |
$1,720.00
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,761.48 |
| Max. Negotiated Rate |
$30,148.00 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| 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 |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: The Alliance Commercial |
$30,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$1,761.48
|
|
|
CT Abdomen w/ Contrast
|
Facility
OP
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
3072683
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,054.76 |
| Max. Negotiated Rate |
$15,068.00 |
| Rate for Payer: Aetna Commercial |
$3,390.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,239.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,054.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,996.51
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cigna Commercial |
$3,465.64
|
| Rate for Payer: Health EOS Commercial |
$3,352.63
|
| Rate for Payer: HFN Commercial |
$3,465.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,825.25
|
| Rate for Payer: Multiplan Commercial |
$3,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,260.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,465.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,845.83
|
| Rate for Payer: Quartz Commercial |
$2,448.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,260.20
|
| Rate for Payer: The Alliance Commercial |
$15,068.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,071.85
|
| Rate for Payer: WPS Commercial |
$1,240.89
|
|
|
CT Abdomen w/ Contrast
|
Facility
IP
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
3072683
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,845.83 |
| Max. Negotiated Rate |
$3,465.64 |
| Rate for Payer: Aetna Commercial |
$3,390.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,996.51
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cigna Commercial |
$3,465.64
|
| Rate for Payer: Health EOS Commercial |
$3,352.63
|
| Rate for Payer: HFN Commercial |
$3,465.64
|
| Rate for Payer: Multiplan Commercial |
$3,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,260.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,465.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,845.83
|
| Rate for Payer: Quartz Commercial |
$2,260.20
|
| Rate for Payer: WEA Trust Commercial |
$2,071.85
|
| Rate for Payer: WPS Commercial |
$2,790.22
|
|
|
CT Abdomen w/ Contrast
|
Facility
IP
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$1,616.51 |
| Max. Negotiated Rate |
$3,035.08 |
| Rate for Payer: Aetna Commercial |
$2,969.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.47
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cigna Commercial |
$3,035.08
|
| Rate for Payer: Health EOS Commercial |
$2,936.11
|
| Rate for Payer: HFN Commercial |
$3,035.08
|
| Rate for Payer: Multiplan Commercial |
$2,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,979.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,035.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.51
|
| Rate for Payer: Quartz Commercial |
$1,979.40
|
| Rate for Payer: WEA Trust Commercial |
$1,814.45
|
| Rate for Payer: WPS Commercial |
$2,443.57
|
|
|
CT Abdomen w/ Contrast
|
Professional
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$235.86 |
| Max. Negotiated Rate |
$3,134.05 |
| Rate for Payer: Aetna Commercial |
$3,134.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.14
|
| Rate for Payer: Aetna Managed Medicare |
$235.86
|
| Rate for Payer: Anthem Medicare Advantage |
$235.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$235.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$235.86
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cigna Commercial |
$3,134.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,649.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.86
|
| Rate for Payer: Health EOS Commercial |
$3,002.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$862.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$862.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$235.86
|
| Rate for Payer: Multiplan Commercial |
$2,639.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,134.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,451.56
|
| Rate for Payer: Quartz Commercial |
$1,880.43
|
| Rate for Payer: Quartz Medicare Advantage |
$235.86
|
| Rate for Payer: The Alliance Commercial |
$896.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$235.86
|
| Rate for Payer: WEA Trust Commercial |
$1,814.45
|
| Rate for Payer: WPS Commercial |
$1,179.30
|
|
|
CT Abdomen w/ Contrast
|
Professional
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
3072683
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$177.27 |
| Max. Negotiated Rate |
$3,578.65 |
| Rate for Payer: Aetna Commercial |
$3,578.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,239.62
|
| Rate for Payer: Aetna Managed Medicare |
$177.27
|
| Rate for Payer: Anthem Medicare Advantage |
$177.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.27
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cigna Commercial |
$3,578.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,883.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.27
|
| Rate for Payer: Health EOS Commercial |
$3,427.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$651.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.27
|
| Rate for Payer: Multiplan Commercial |
$3,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,578.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,657.48
|
| Rate for Payer: Quartz Commercial |
$2,147.19
|
| Rate for Payer: Quartz Medicare Advantage |
$177.27
|
| Rate for Payer: The Alliance Commercial |
$673.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.27
|
| Rate for Payer: WEA Trust Commercial |
$2,071.85
|
| Rate for Payer: WPS Commercial |
$886.35
|
|
|
CT Abdomen w/ Contrast
|
Facility
OP
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3,035.08 |
| Rate for Payer: Aetna Commercial |
$2,969.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.14
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,144.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,649.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,583.52
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.47
|
| 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 |
$989.70
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cigna Commercial |
$3,035.08
|
| 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 |
$2,936.11
|
| Rate for Payer: HFN Commercial |
$3,035.08
|
| 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 |
$2,639.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,035.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.51
|
| Rate for Payer: Quartz Commercial |
$2,144.35
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$1.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$1,814.45
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,443.57
|
|
|
CT Abdomen w/ Contrast
|
Professional
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
1240806
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$177.27 |
| Max. Negotiated Rate |
$3,578.65 |
| Rate for Payer: Aetna Commercial |
$3,578.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,239.62
|
| Rate for Payer: Aetna Managed Medicare |
$177.27
|
| Rate for Payer: Anthem Medicare Advantage |
$177.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.27
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cigna Commercial |
$3,578.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,883.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.27
|
| Rate for Payer: Health EOS Commercial |
$3,427.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$651.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.27
|
| Rate for Payer: Multiplan Commercial |
$3,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,578.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,657.48
|
| Rate for Payer: Quartz Commercial |
$2,147.19
|
| Rate for Payer: Quartz Medicare Advantage |
$177.27
|
| Rate for Payer: The Alliance Commercial |
$673.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.27
|
| Rate for Payer: WEA Trust Commercial |
$2,071.85
|
| Rate for Payer: WPS Commercial |
$886.35
|
|
