|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,239.62
|
| 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
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$181.60 |
| 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 DHI/DHP/ASO |
$1,846.12
|
| 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 |
$726.40
|
| 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
|
Both
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
1240806
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$651.29 |
| 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: 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 |
$2,260.20
|
| Rate for Payer: Health EOS Commercial |
$3,427.97
|
| Rate for Payer: HFN Commercial |
$3,578.65
|
| 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: 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: The Alliance Commercial |
$1,883.50
|
| Rate for Payer: WEA Trust Commercial |
$2,071.85
|
| Rate for Payer: WPS Commercial |
$2,790.22
|
|
|
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: Cigna Commercial |
$3,465.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,108.01
|
| 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 |
$2,790.22
|
|
|
CT Abdomen w/o Contrast
|
Professional
|
Both
|
$2,616.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
625600
|
| Min. Negotiated Rate |
$502.64 |
| Max. Negotiated Rate |
$2,485.20 |
| Rate for Payer: Aetna Commercial |
$2,485.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,485.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,569.60
|
| Rate for Payer: Health EOS Commercial |
$2,380.56
|
| Rate for Payer: HFN Commercial |
$2,485.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$502.64
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,151.04
|
| Rate for Payer: Quartz Commercial |
$1,491.12
|
| Rate for Payer: The Alliance Commercial |
$1,308.00
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
IP
|
$3,101.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
3072684
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,519.49 |
| Max. Negotiated Rate |
$2,852.92 |
| Rate for Payer: Aetna Commercial |
$2,790.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,643.53
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,852.92
|
| Rate for Payer: Health EOS Commercial |
$2,759.89
|
| Rate for Payer: HFN Commercial |
$2,852.92
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.49
|
| Rate for Payer: Quartz Commercial |
$1,860.60
|
| Rate for Payer: WEA Trust Commercial |
$1,705.55
|
| Rate for Payer: WPS Commercial |
$2,296.91
|
|
|
CT Abdomen w/o Contrast
|
Professional
|
Both
|
$3,101.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
3072684
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$304.36 |
| Max. Negotiated Rate |
$2,945.95 |
| Rate for Payer: Aetna Commercial |
$2,945.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.86
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,945.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,550.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,860.60
|
| Rate for Payer: Health EOS Commercial |
$2,821.91
|
| Rate for Payer: HFN Commercial |
$2,945.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$304.36
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,945.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,364.44
|
| Rate for Payer: Quartz Commercial |
$1,767.57
|
| Rate for Payer: The Alliance Commercial |
$1,550.50
|
| Rate for Payer: WEA Trust Commercial |
$1,705.55
|
| Rate for Payer: WPS Commercial |
$2,296.91
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
IP
|
$3,101.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
1240808
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,519.49 |
| Max. Negotiated Rate |
$2,852.92 |
| Rate for Payer: Aetna Commercial |
$2,790.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,643.53
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,852.92
|
| Rate for Payer: Health EOS Commercial |
$2,759.89
|
| Rate for Payer: HFN Commercial |
$2,852.92
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.49
|
| Rate for Payer: Quartz Commercial |
$1,860.60
|
| Rate for Payer: WEA Trust Commercial |
$1,705.55
|
| Rate for Payer: WPS Commercial |
$2,296.91
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
625600
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,406.72 |
| Rate for Payer: Aetna Commercial |
$2,354.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,700.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.68
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,328.24
|
| Rate for Payer: HFN Commercial |
$2,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.84
|
| Rate for Payer: Quartz Commercial |
$1,700.40
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
OP
|
$3,101.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
3072684
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$868.28 |
| Max. Negotiated Rate |
$12,404.00 |
| Rate for Payer: Aetna Commercial |
$2,790.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.86
|
| Rate for Payer: Aetna Managed Medicare |
$868.28
|
| 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 |
$1,643.53
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,852.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,735.32
|
| Rate for Payer: Health EOS Commercial |
$2,759.89
|
| Rate for Payer: HFN Commercial |
$2,852.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,325.75
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.49
|
| Rate for Payer: Quartz Commercial |
$2,015.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,860.60
|
| Rate for Payer: The Alliance Commercial |
$12,404.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,705.55
|
| Rate for Payer: WPS Commercial |
$2,296.91
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
625600
|
| Min. Negotiated Rate |
$1,281.84 |
| Max. Negotiated Rate |
$2,406.72 |
| Rate for Payer: Aetna Commercial |
$2,354.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.48
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,406.72
|
| Rate for Payer: Health EOS Commercial |
$2,328.24
|
| Rate for Payer: HFN Commercial |
$2,406.72
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.84
|
| Rate for Payer: Quartz Commercial |
$1,569.60
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
CT Abdomen w/o Contrast
|
Professional
|
Both
|
$3,101.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
1240808
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$304.36 |
| Max. Negotiated Rate |
$2,945.95 |
| Rate for Payer: Aetna Commercial |
$2,945.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.86
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,945.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,550.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,860.60
|
| Rate for Payer: Health EOS Commercial |
$2,821.91
|
| Rate for Payer: HFN Commercial |
$2,945.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$304.36
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,945.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,364.44
|
| Rate for Payer: Quartz Commercial |
$1,767.57
|
| Rate for Payer: The Alliance Commercial |
$1,550.50
|
| Rate for Payer: WEA Trust Commercial |
$1,705.55
|
| Rate for Payer: WPS Commercial |
$2,296.91
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
OP
|
$3,101.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
1240808
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$868.28 |
| Max. Negotiated Rate |
$12,404.00 |
| Rate for Payer: Aetna Commercial |
$2,790.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,666.86
|
| Rate for Payer: Aetna Managed Medicare |
$868.28
|
| 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 |
$1,643.53
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,852.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,735.32
|
| Rate for Payer: Health EOS Commercial |
$2,759.89
|
| Rate for Payer: HFN Commercial |
$2,852.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,325.75
|
| Rate for Payer: Multiplan Commercial |
$2,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,852.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,519.49
|
| Rate for Payer: Quartz Commercial |
$2,015.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,860.60
|
| Rate for Payer: The Alliance Commercial |
$12,404.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,705.55
|
| Rate for Payer: WPS Commercial |
$2,296.91
|
|
|
CT Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
1240801
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$737.52 |
| Max. Negotiated Rate |
$4,303.50 |
| Rate for Payer: Aetna Commercial |
$4,303.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,303.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,718.00
|
| Rate for Payer: Health EOS Commercial |
$4,122.30
|
| Rate for Payer: HFN Commercial |
$4,303.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$737.52
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,303.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,993.20
|
| Rate for Payer: Quartz Commercial |
$2,582.10
|
| Rate for Payer: The Alliance Commercial |
$2,265.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
3072677
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,219.70 |
| Max. Negotiated Rate |
$4,167.60 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,718.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
3072677
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,268.40 |
| Max. Negotiated Rate |
$18,120.00 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,268.40
|
| 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 |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.99
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,397.50
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,944.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,718.00
|
| Rate for Payer: The Alliance Commercial |
$18,120.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$4,446.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
615590
|
| Min. Negotiated Rate |
$2,178.54 |
| Max. Negotiated Rate |
$4,090.32 |
| Rate for Payer: Aetna Commercial |
$4,001.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,823.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.38
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,090.32
|
| Rate for Payer: Health EOS Commercial |
$3,956.94
|
| Rate for Payer: HFN Commercial |
$4,090.32
|
| Rate for Payer: Multiplan Commercial |
$3,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,667.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,090.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,178.54
|
| Rate for Payer: Quartz Commercial |
$2,667.60
|
| Rate for Payer: WEA Trust Commercial |
$2,445.30
|
| Rate for Payer: WPS Commercial |
$3,293.15
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
1240801
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,219.70 |
| Max. Negotiated Rate |
$4,167.60 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,718.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$4,446.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
615590
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$4,090.32 |
| Rate for Payer: Aetna Commercial |
$4,001.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,823.56
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,889.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,223.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,134.08
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,356.38
|
| 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 |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,090.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,487.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,956.94
|
| Rate for Payer: HFN Commercial |
$4,090.32
|
| 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 |
$3,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,090.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,178.54
|
| Rate for Payer: Quartz Commercial |
$2,889.90
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,445.30
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,293.15
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
1240801
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,268.40 |
| Max. Negotiated Rate |
$18,120.00 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,268.40
|
| 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 |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.99
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,397.50
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,944.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,718.00
|
| Rate for Payer: The Alliance Commercial |
$18,120.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
3072677
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$737.52 |
| Max. Negotiated Rate |
$4,303.50 |
| Rate for Payer: Aetna Commercial |
$4,303.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,303.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,718.00
|
| Rate for Payer: Health EOS Commercial |
$4,122.30
|
| Rate for Payer: HFN Commercial |
$4,303.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$737.52
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,303.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,993.20
|
| Rate for Payer: Quartz Commercial |
$2,582.10
|
| Rate for Payer: The Alliance Commercial |
$2,265.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$4,446.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
615590
|
| Min. Negotiated Rate |
$970.15 |
| Max. Negotiated Rate |
$4,223.70 |
| Rate for Payer: Aetna Commercial |
$4,223.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,823.56
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,223.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,223.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,667.60
|
| Rate for Payer: Health EOS Commercial |
$4,045.86
|
| Rate for Payer: HFN Commercial |
$4,223.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.15
|
| Rate for Payer: Multiplan Commercial |
$3,556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,223.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,956.24
|
| Rate for Payer: Quartz Commercial |
$2,534.22
|
| Rate for Payer: The Alliance Commercial |
$2,223.00
|
| Rate for Payer: WEA Trust Commercial |
$2,445.30
|
| Rate for Payer: WPS Commercial |
$3,293.15
|
|
|
CT Abdomen w/ + w/o Contrast, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3072682
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,065.00 |
| 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: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| 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 |
$5,582.66
|
|
|
CT Abdomen w/ + w/o Contrast, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3072682
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| 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 w/ + w/o Contrast, Pelvis w/ Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3072682
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$935.91 |
| 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: 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 |
$4,522.20
|
| Rate for Payer: Health EOS Commercial |
$6,858.67
|
| Rate for Payer: HFN Commercial |
$7,160.15
|
| 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: 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: The Alliance Commercial |
$3,768.50
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
