|
CT Brain w/o Contrast
|
Facility
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
1240940
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$469.49 |
| Max. Negotiated Rate |
$10,832.00 |
| Rate for Payer: Aetna Commercial |
$2,437.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.88
|
| Rate for Payer: Aetna Managed Medicare |
$758.24
|
| 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 |
$1,435.24
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,491.36
|
| Rate for Payer: Health EOS Commercial |
$2,410.12
|
| Rate for Payer: HFN Commercial |
$2,491.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,031.00
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.92
|
| Rate for Payer: Quartz Commercial |
$1,760.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.80
|
| Rate for Payer: The Alliance Commercial |
$10,832.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$469.49
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
IP
|
$3,740.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240936
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,832.60 |
| Max. Negotiated Rate |
$3,440.80 |
| Rate for Payer: Aetna Commercial |
$3,366.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,982.20
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: Health EOS Commercial |
$3,328.60
|
| Rate for Payer: HFN Commercial |
$3,440.80
|
| Rate for Payer: Multiplan Commercial |
$2,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,832.60
|
| Rate for Payer: Quartz Commercial |
$2,244.00
|
| Rate for Payer: WEA Trust Commercial |
$2,057.00
|
| Rate for Payer: WPS Commercial |
$2,770.22
|
|
|
CT Brain w/ + w/o Contrast
|
Professional
|
$3,362.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
629958
|
| Min. Negotiated Rate |
$174.05 |
| Max. Negotiated Rate |
$3,193.90 |
| Rate for Payer: Aetna Commercial |
$3,193.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,891.32
|
| Rate for Payer: Aetna Managed Medicare |
$174.05
|
| Rate for Payer: Anthem Medicare Advantage |
$174.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$174.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$174.05
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cigna Commercial |
$3,193.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,681.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.05
|
| Rate for Payer: Health EOS Commercial |
$3,059.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$642.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$174.05
|
| Rate for Payer: Multiplan Commercial |
$2,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.28
|
| Rate for Payer: Quartz Commercial |
$1,916.34
|
| Rate for Payer: Quartz Medicare Advantage |
$174.05
|
| Rate for Payer: The Alliance Commercial |
$661.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.05
|
| Rate for Payer: WEA Trust Commercial |
$1,849.10
|
| Rate for Payer: WPS Commercial |
$870.25
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
IP
|
$3,362.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
629958
|
| Min. Negotiated Rate |
$1,647.38 |
| Max. Negotiated Rate |
$3,093.04 |
| Rate for Payer: Aetna Commercial |
$3,025.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,781.86
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cigna Commercial |
$3,093.04
|
| Rate for Payer: Health EOS Commercial |
$2,992.18
|
| Rate for Payer: HFN Commercial |
$3,093.04
|
| Rate for Payer: Multiplan Commercial |
$2,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,017.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,093.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,647.38
|
| Rate for Payer: Quartz Commercial |
$2,017.20
|
| Rate for Payer: WEA Trust Commercial |
$1,849.10
|
| Rate for Payer: WPS Commercial |
$2,490.23
|
|
|
CT Brain w/ + w/o Contrast
|
Professional
|
$3,740.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240936
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$3,553.00 |
| Rate for Payer: Aetna Commercial |
$3,553.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,216.40
|
| Rate for Payer: Aetna Managed Medicare |
$115.46
|
| Rate for Payer: Anthem Medicare Advantage |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.46
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$3,553.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,870.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.46
|
| Rate for Payer: Health EOS Commercial |
$3,403.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.46
|
| Rate for Payer: Multiplan Commercial |
$2,992.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,645.60
|
| Rate for Payer: Quartz Commercial |
$2,131.80
|
| Rate for Payer: Quartz Medicare Advantage |
$115.46
|
| Rate for Payer: The Alliance Commercial |
$438.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.46
|
| Rate for Payer: WEA Trust Commercial |
$2,057.00
|
| Rate for Payer: WPS Commercial |
$577.30
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
OP
|
$3,740.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240936
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$808.22 |
| Max. Negotiated Rate |
$14,960.00 |
| Rate for Payer: Aetna Commercial |
$3,366.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,216.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,047.20
|
| 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 |
$1,982.20
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$3,440.80
|
| Rate for Payer: Health EOS Commercial |
$3,328.60
|
| Rate for Payer: HFN Commercial |
$3,440.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,805.00
|
| Rate for Payer: Multiplan Commercial |
$2,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,832.60
|
| Rate for Payer: Quartz Commercial |
$2,431.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,244.00
|
| Rate for Payer: The Alliance Commercial |
$14,960.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,057.00
|
| Rate for Payer: WPS Commercial |
$808.22
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
629958
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,093.04 |
| Rate for Payer: Aetna Commercial |
$3,025.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,891.32
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,185.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,681.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,613.76
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,781.86
|
| 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 |
$1,008.60
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cigna Commercial |
$3,093.04
|
| 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 |
$2,992.18
|
| Rate for Payer: HFN Commercial |
$3,093.04
|
| 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 |
$2,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,093.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,647.38
|
| Rate for Payer: Quartz Commercial |
$2,185.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$1,849.10
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,490.23
|
|
|
CT Brain w + w/o Contrast, Sinus LTD w/o
|
Facility
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240924
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$808.22 |
| Max. Negotiated Rate |
$14,408.00 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,097.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,008.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,701.50
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,341.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,161.20
|
| Rate for Payer: The Alliance Commercial |
$14,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$808.22
|
|
|
CT Brain w + w/o Contrast, Sinus LTD w/o
|
Professional
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240924
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$115.46 |
| Max. Negotiated Rate |
$3,421.90 |
| Rate for Payer: Aetna Commercial |
$3,421.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,097.72
|
| Rate for Payer: Aetna Managed Medicare |
$115.46
|
| Rate for Payer: Anthem Medicare Advantage |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.46
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,421.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,801.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.46
|
| Rate for Payer: Health EOS Commercial |
$3,277.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.46
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,421.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,584.88
|
| Rate for Payer: Quartz Commercial |
$2,053.14
|
| Rate for Payer: Quartz Medicare Advantage |
$115.46
|
| Rate for Payer: The Alliance Commercial |
$438.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.46
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$577.30
|
|
|
CT Brain w + w/o Contrast, Sinus LTD w/o
|
Facility
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240924
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,764.98 |
| Max. Negotiated Rate |
$3,313.84 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,161.20
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$2,668.00
|
|
|
CT Brain w + w/o Contrast, Sinus w/o
|
Facility
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240927
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$808.22 |
| Max. Negotiated Rate |
$14,408.00 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,097.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,008.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,701.50
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,341.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,161.20
|
| Rate for Payer: The Alliance Commercial |
$14,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$808.22
|
|
|
CT Brain w + w/o Contrast, Sinus w/o
|
Facility
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240927
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,764.98 |
| Max. Negotiated Rate |
$3,313.84 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,161.20
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$2,668.00
|
|
|
CT Cervical Spine Unenhanced
|
Facility
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
3072649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$588.91 |
| Max. Negotiated Rate |
$15,532.00 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,912.25
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,523.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,329.80
|
| Rate for Payer: The Alliance Commercial |
$15,532.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$588.91
|
|
|
CT Cervical Spine Unenhanced
|
Professional
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
3072649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$84.13 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Aetna Commercial |
$3,688.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.13
|
| Rate for Payer: Anthem Medicare Advantage |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.13
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,688.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,941.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.13
|
| Rate for Payer: Health EOS Commercial |
$3,533.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.13
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,688.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.52
|
| Rate for Payer: Quartz Commercial |
$2,213.31
|
| Rate for Payer: Quartz Medicare Advantage |
$84.13
|
| Rate for Payer: The Alliance Commercial |
$319.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.13
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$420.65
|
|
|
CT Cervical Spine Unenhanced
|
Facility
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
3072649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,902.67 |
| Max. Negotiated Rate |
$3,572.36 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,329.80
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT Chest, Spine Reformats w/ Contrast
|
Professional
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
5551888
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$3,665.10 |
| Rate for Payer: Aetna Commercial |
$3,665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,665.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,929.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,510.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,665.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,697.52
|
| Rate for Payer: Quartz Commercial |
$2,199.06
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$566.05
|
|
|
CT Chest, Spine Reformats w/ Contrast
|
Facility
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
5551888
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,890.42 |
| Max. Negotiated Rate |
$3,549.36 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,314.80
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$2,857.62
|
|
|
CT Chest, Spine Reformats w/ Contrast
|
Facility
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
5551888
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$792.47 |
| Max. Negotiated Rate |
$15,432.00 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,080.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.50
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,507.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,314.80
|
| Rate for Payer: The Alliance Commercial |
$15,432.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$792.47
|
|
|
CT Chest, Spine Reformats w/o Contrast
|
Facility
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5551891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,555.26 |
| Max. Negotiated Rate |
$2,920.08 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$1,904.40
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$2,350.98
|
|
|
CT Chest, Spine Reformats w/o Contrast
|
Facility
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5551891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$584.43 |
| Max. Negotiated Rate |
$12,696.00 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Aetna Managed Medicare |
$888.72
|
| 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 |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,380.50
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$2,063.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,904.40
|
| Rate for Payer: The Alliance Commercial |
$12,696.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$584.43
|
|
|
CT Chest, Spine Reformats w/o Contrast
|
Professional
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5551891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$3,015.30 |
| Rate for Payer: Aetna Commercial |
$3,015.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Aetna Managed Medicare |
$83.49
|
| Rate for Payer: Anthem Medicare Advantage |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.49
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,015.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.49
|
| Rate for Payer: Health EOS Commercial |
$2,888.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.56
|
| Rate for Payer: Quartz Commercial |
$1,809.18
|
| Rate for Payer: Quartz Medicare Advantage |
$83.49
|
| Rate for Payer: The Alliance Commercial |
$317.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.49
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$417.45
|
|
|
CT Chest w/ Contrast R/O PE
|
Facility
IP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
3072660
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,382.87 |
| Max. Negotiated Rate |
$4,473.96 |
| Rate for Payer: Aetna Commercial |
$4,376.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,577.39
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,473.96
|
| Rate for Payer: Health EOS Commercial |
$4,328.07
|
| Rate for Payer: HFN Commercial |
$4,473.96
|
| Rate for Payer: Multiplan Commercial |
$3,890.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,917.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,473.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,382.87
|
| Rate for Payer: Quartz Commercial |
$2,917.80
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: WPS Commercial |
$3,602.02
|
|
|
CT Chest w/ Contrast R/O PE
|
Professional
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
3072660
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$4,619.85 |
| Rate for Payer: Aetna Commercial |
$4,619.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,182.18
|
| Rate for Payer: Aetna Managed Medicare |
$198.09
|
| Rate for Payer: Anthem Medicare Advantage |
$198.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.09
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,619.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,431.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.09
|
| Rate for Payer: Health EOS Commercial |
$4,425.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$727.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$727.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.09
|
| Rate for Payer: Multiplan Commercial |
$3,890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,619.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.72
|
| Rate for Payer: Quartz Commercial |
$2,771.91
|
| Rate for Payer: Quartz Medicare Advantage |
$198.09
|
| Rate for Payer: The Alliance Commercial |
$752.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.09
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: WPS Commercial |
$990.45
|
|
|
CT Chest w/ Contrast R/O PE
|
Facility
OP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
3072660
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,361.64 |
| Max. Negotiated Rate |
$19,452.00 |
| Rate for Payer: Aetna Commercial |
$4,376.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,182.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,361.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,577.39
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,473.96
|
| Rate for Payer: Health EOS Commercial |
$4,328.07
|
| Rate for Payer: HFN Commercial |
$4,473.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,647.25
|
| Rate for Payer: Multiplan Commercial |
$3,890.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,917.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,473.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,382.87
|
| Rate for Payer: Quartz Commercial |
$3,160.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,917.80
|
| Rate for Payer: The Alliance Commercial |
$19,452.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: WPS Commercial |
$1,386.63
|
|
|
CT Chest w, R/O PE
|
Professional
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240972
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$4,619.85 |
| Rate for Payer: Aetna Commercial |
$4,619.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,182.18
|
| Rate for Payer: Aetna Managed Medicare |
$198.09
|
| Rate for Payer: Anthem Medicare Advantage |
$198.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.09
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,619.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,431.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.09
|
| Rate for Payer: Health EOS Commercial |
$4,425.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$727.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$727.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.09
|
| Rate for Payer: Multiplan Commercial |
$3,890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,619.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.72
|
| Rate for Payer: Quartz Commercial |
$2,771.91
|
| Rate for Payer: Quartz Medicare Advantage |
$198.09
|
| Rate for Payer: The Alliance Commercial |
$752.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.09
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: WPS Commercial |
$990.45
|
|
