|
CT Chest w, R/O PE
|
Facility
OP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240972
|
|
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
|
Facility
IP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240972
|
|
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, 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
|
|
|
CT Chest w, R/O PE
|
Professional
|
$4,371.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1238801
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$4,152.45 |
| Rate for Payer: Aetna Commercial |
$4,152.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,759.06
|
| Rate for Payer: Aetna Managed Medicare |
$281.75
|
| Rate for Payer: Anthem Medicare Advantage |
$281.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$281.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$281.75
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna Commercial |
$4,152.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.75
|
| Rate for Payer: Health EOS Commercial |
$3,977.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,029.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$281.75
|
| Rate for Payer: Multiplan Commercial |
$3,496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,152.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,923.24
|
| Rate for Payer: Quartz Commercial |
$2,491.47
|
| Rate for Payer: Quartz Medicare Advantage |
$281.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$281.75
|
| Rate for Payer: WEA Trust Commercial |
$2,404.05
|
| Rate for Payer: WPS Commercial |
$1,408.75
|
|
|
CT Chest w, R/O PE
|
Facility
OP
|
$4,371.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1238801
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$4,021.32 |
| Rate for Payer: Aetna Commercial |
$3,933.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,759.06
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,841.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,098.08
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,316.63
|
| 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 |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna Commercial |
$4,021.32
|
| 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 |
$3,890.19
|
| Rate for Payer: HFN Commercial |
$4,021.32
|
| 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 |
$3,496.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,021.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,141.79
|
| Rate for Payer: Quartz Commercial |
$2,841.15
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$711.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,404.05
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,237.60
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Professional
|
$162.00
|
|
|
Service Code
|
CPT 75571 TC
|
| Hospital Charge Code |
1240991
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$71.28 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$72.54
|
| Rate for Payer: Anthem Medicare Advantage |
$72.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.54
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.54
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: Quartz Medicare Advantage |
$72.54
|
| Rate for Payer: The Alliance Commercial |
$275.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$362.70
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
IP
|
$209.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1220813
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$125.40
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT 75571 TC
|
| Hospital Charge Code |
1240991
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$45.36
|
| 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 |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.50
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: Quartz Medicare Advantage |
$97.20
|
| Rate for Payer: The Alliance Commercial |
$648.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$507.78
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
OP
|
$209.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1220813
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$334.13 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.32
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$135.85
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$237.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 75571 TC
|
| Hospital Charge Code |
1240991
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$97.20
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Professional
|
$209.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1220813
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$496.90 |
| Rate for Payer: Aetna Commercial |
$198.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$99.38
|
| Rate for Payer: Anthem Medicare Advantage |
$99.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.38
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$198.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.38
|
| Rate for Payer: Health EOS Commercial |
$190.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.38
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: Preferred Network Access Commercial |
$198.55
|
| Rate for Payer: Quartz Beloit One Network |
$91.96
|
| Rate for Payer: Quartz Commercial |
$119.13
|
| Rate for Payer: Quartz Medicare Advantage |
$99.38
|
| Rate for Payer: The Alliance Commercial |
$377.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.38
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$496.90
|
|
|
CT Drainage Abscess or Cyst
|
Facility
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240994
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,350.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
CT Drainage Abscess or Cyst
|
Professional
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
625642
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,091.90 |
| Rate for Payer: Aetna Commercial |
$2,091.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,091.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,101.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,003.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.90
|
| Rate for Payer: Quartz Beloit One Network |
$968.88
|
| Rate for Payer: Quartz Commercial |
$1,255.14
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
CT Drainage Abscess or Cyst
|
Facility
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240994
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$630.00
|
| 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 |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,462.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.00
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$762.23
|
|
|
CT Drainage Abscess or Cyst
|
Facility
OP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
625642
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Aetna Managed Medicare |
$616.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,651.50
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,431.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.20
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
CT Drainage Abscess or Cyst
|
Facility
IP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
625642
|
| Min. Negotiated Rate |
$1,078.98 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,321.20
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
CT Drainage Abscess or Cyst
|
Professional
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240994
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,137.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,047.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.50
|
| Rate for Payer: Quartz Beloit One Network |
$990.00
|
| Rate for Payer: Quartz Commercial |
$1,282.50
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
CT Drainage Liver
|
Facility
OP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
629798
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Aetna Managed Medicare |
$616.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,651.50
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,431.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.20
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
CT Drainage Liver
|
Facility
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,350.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
CT Drainage Liver
|
Professional
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,137.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,047.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.50
|
| Rate for Payer: Quartz Beloit One Network |
$990.00
|
| Rate for Payer: Quartz Commercial |
$1,282.50
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
CT Drainage Liver
|
Professional
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
629798
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,091.90 |
| Rate for Payer: Aetna Commercial |
$2,091.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,893.72
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,091.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,101.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,003.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,091.90
|
| Rate for Payer: Quartz Beloit One Network |
$968.88
|
| Rate for Payer: Quartz Commercial |
$1,255.14
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
CT Drainage Liver
|
Facility
IP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
629798
|
| Min. Negotiated Rate |
$1,078.98 |
| Max. Negotiated Rate |
$2,025.84 |
| Rate for Payer: Aetna Commercial |
$1,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.06
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,025.84
|
| Rate for Payer: Health EOS Commercial |
$1,959.78
|
| Rate for Payer: HFN Commercial |
$2,025.84
|
| Rate for Payer: Multiplan Commercial |
$1,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,025.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.98
|
| Rate for Payer: Quartz Commercial |
$1,321.20
|
| Rate for Payer: WEA Trust Commercial |
$1,211.10
|
| Rate for Payer: WPS Commercial |
$1,631.02
|
|
|
CT Drainage Liver
|
Facility
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$630.00
|
| 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 |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,462.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.00
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$762.23
|
|
|
CT Drainage Lung Bilateral
|
Professional
|
$2,162.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1240998
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$951.28 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,081.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
CT Drainage Lung Bilateral
|
Professional
|
$4,406.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
629800
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$4,185.70 |
| Rate for Payer: Aetna Commercial |
$4,185.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,789.16
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$1,321.80
|
| Rate for Payer: Cash Price |
$1,321.80
|
| Rate for Payer: Cigna Commercial |
$4,185.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,203.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$4,009.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$3,524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,185.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,938.64
|
| Rate for Payer: Quartz Commercial |
$2,511.42
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$2,423.30
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
