|
CT Abdomen w/ + w/o, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240803
|
|
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, Pelvis w/ Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240803
|
|
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
|
|
|
CT Abdomen w/ + w/o, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240803
|
|
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 Abd, Pel, Spine Reformats w/ Con
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
5551882
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,890.00 |
| Max. Negotiated Rate |
$27,000.00 |
| Rate for Payer: Aetna Commercial |
$6,075.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,890.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,577.50
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,777.30
|
| Rate for Payer: Health EOS Commercial |
$6,007.50
|
| Rate for Payer: HFN Commercial |
$6,210.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,062.50
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,210.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,307.50
|
| Rate for Payer: Quartz Commercial |
$4,387.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,050.00
|
| Rate for Payer: The Alliance Commercial |
$27,000.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$4,999.72
|
|
|
CT Abd, Pel, Spine Reformats w/ Con
|
Professional
|
Both
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
5551882
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Aetna Commercial |
$6,412.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,412.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,375.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,050.00
|
| Rate for Payer: Health EOS Commercial |
$6,142.50
|
| Rate for Payer: HFN Commercial |
$6,412.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$828.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,412.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,970.00
|
| Rate for Payer: Quartz Commercial |
$3,847.50
|
| Rate for Payer: The Alliance Commercial |
$3,375.00
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$4,999.72
|
|
|
CT Abd, Pel, Spine Reformats w/ Con
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
5551882
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,307.50 |
| Max. Negotiated Rate |
$6,210.00 |
| Rate for Payer: Aetna Commercial |
$6,075.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,805.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,577.50
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,210.00
|
| Rate for Payer: Health EOS Commercial |
$6,007.50
|
| Rate for Payer: HFN Commercial |
$6,210.00
|
| Rate for Payer: Multiplan Commercial |
$5,400.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,050.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,210.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,307.50
|
| Rate for Payer: Quartz Commercial |
$4,050.00
|
| Rate for Payer: WEA Trust Commercial |
$3,712.50
|
| Rate for Payer: WPS Commercial |
$4,999.72
|
|
|
CT Abd, Pel, Spine Reformats w/o Con
|
Professional
|
Both
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5551885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$380.96 |
| Max. Negotiated Rate |
$5,662.95 |
| Rate for Payer: Aetna Commercial |
$5,662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,980.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,576.60
|
| Rate for Payer: Health EOS Commercial |
$5,424.51
|
| Rate for Payer: HFN Commercial |
$5,662.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.96
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,662.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,622.84
|
| Rate for Payer: Quartz Commercial |
$3,397.77
|
| Rate for Payer: The Alliance Commercial |
$2,980.50
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$4,415.31
|
|
|
CT Abd, Pel, Spine Reformats w/o Con
|
Facility
|
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5551885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,669.08 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,669.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,335.78
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,470.75
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,874.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,576.60
|
| Rate for Payer: The Alliance Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$4,415.31
|
|
|
CT Abd, Pel, Spine Reformats w/o Con
|
Facility
|
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5551885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,920.89 |
| Max. Negotiated Rate |
$5,484.12 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,576.60
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$4,415.31
|
|
|
CT Adrenal w + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724130
|
|
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 Adrenal w + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724130
|
|
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 Adrenal w + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724130
|
|
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 Adrenal w + w/o, Pelvis w/ Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724133
|
|
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
|
|
|
CT Adrenal w + w/o, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724133
|
|
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 Adrenal w + w/o, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724133
|
|
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 Angiography Abd Aorta + Iliofemoral
|
Professional
|
Both
|
$6,795.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
625588
|
| Min. Negotiated Rate |
$1,510.84 |
| Max. Negotiated Rate |
$6,455.25 |
| Rate for Payer: Aetna Commercial |
$6,455.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,455.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,397.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.00
|
| Rate for Payer: Health EOS Commercial |
$6,183.45
|
| Rate for Payer: HFN Commercial |
$6,455.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,510.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,510.84
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,455.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.80
|
| Rate for Payer: Quartz Commercial |
$3,873.15
|
| Rate for Payer: The Alliance Commercial |
$3,397.50
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
CT Angiography Abd Aorta + Iliofemoral
|
Facility
|
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
625588
|
| Min. Negotiated Rate |
$3,329.55 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,077.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,077.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
CT Angiography Abd Aorta + Iliofemoral
|
Facility
|
IP
|
$6,816.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
1240819
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,339.84 |
| Max. Negotiated Rate |
$6,270.72 |
| Rate for Payer: Aetna Commercial |
$6,134.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,612.48
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,270.72
|
| Rate for Payer: Health EOS Commercial |
$6,066.24
|
| Rate for Payer: HFN Commercial |
$6,270.72
|
| Rate for Payer: Multiplan Commercial |
$5,452.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,089.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,270.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,339.84
|
| Rate for Payer: Quartz Commercial |
$4,089.60
|
| Rate for Payer: WEA Trust Commercial |
$3,748.80
|
| Rate for Payer: WPS Commercial |
$5,048.61
|
|
|
CT Angiography Abd Aorta + Iliofemoral
|
Professional
|
Both
|
$6,816.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
1240819
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,115.34 |
| Max. Negotiated Rate |
$6,475.20 |
| Rate for Payer: Aetna Commercial |
$6,475.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.76
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,475.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,408.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,089.60
|
| Rate for Payer: Health EOS Commercial |
$6,202.56
|
| Rate for Payer: HFN Commercial |
$6,475.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,115.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,115.34
|
| Rate for Payer: Multiplan Commercial |
$5,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,475.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.04
|
| Rate for Payer: Quartz Commercial |
$3,885.12
|
| Rate for Payer: The Alliance Commercial |
$3,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,748.80
|
| Rate for Payer: WPS Commercial |
$5,048.61
|
|
|
CT Angiography Abd Aorta + Iliofemoral
|
Facility
|
OP
|
$6,816.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
1240819
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,908.48 |
| Max. Negotiated Rate |
$27,264.00 |
| Rate for Payer: Aetna Commercial |
$6,134.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,908.48
|
| 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 |
$3,612.48
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,270.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,814.23
|
| Rate for Payer: Health EOS Commercial |
$6,066.24
|
| Rate for Payer: HFN Commercial |
$6,270.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,112.00
|
| Rate for Payer: Multiplan Commercial |
$5,452.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,089.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,270.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,339.84
|
| Rate for Payer: Quartz Commercial |
$4,430.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,089.60
|
| Rate for Payer: The Alliance Commercial |
$27,264.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,748.80
|
| Rate for Payer: WPS Commercial |
$5,048.61
|
|
|
CT Angiography Abd Aorta + Iliofemoral
|
Facility
|
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
625588
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,416.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,397.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,261.60
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| 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 |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,802.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| 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 |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,416.75
|
| 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 |
$3,737.25
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
CT Angiography Abdomen
|
Professional
|
Both
|
$7,670.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
625596
|
| Min. Negotiated Rate |
$1,119.29 |
| Max. Negotiated Rate |
$7,286.50 |
| Rate for Payer: Aetna Commercial |
$7,286.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,596.20
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cigna Commercial |
$7,286.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,835.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,602.00
|
| Rate for Payer: Health EOS Commercial |
$6,979.70
|
| Rate for Payer: HFN Commercial |
$7,286.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,119.29
|
| Rate for Payer: Multiplan Commercial |
$6,136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,286.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,374.80
|
| Rate for Payer: Quartz Commercial |
$4,371.90
|
| Rate for Payer: The Alliance Commercial |
$3,835.00
|
| Rate for Payer: WEA Trust Commercial |
$4,218.50
|
| Rate for Payer: WPS Commercial |
$5,681.17
|
|
|
CT Angiography Abdomen
|
Facility
|
IP
|
$5,579.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
1240821
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,733.71 |
| Max. Negotiated Rate |
$5,132.68 |
| Rate for Payer: Aetna Commercial |
$5,021.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,797.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,956.87
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,132.68
|
| Rate for Payer: Health EOS Commercial |
$4,965.31
|
| Rate for Payer: HFN Commercial |
$5,132.68
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,132.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,733.71
|
| Rate for Payer: Quartz Commercial |
$3,347.40
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: WPS Commercial |
$4,132.37
|
|
|
CT Angiography Abdomen
|
Facility
|
OP
|
$5,579.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
1240821
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,562.12 |
| Max. Negotiated Rate |
$22,316.00 |
| Rate for Payer: Aetna Commercial |
$5,021.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,797.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,562.12
|
| 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 |
$2,956.87
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,132.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,122.01
|
| Rate for Payer: Health EOS Commercial |
$4,965.31
|
| Rate for Payer: HFN Commercial |
$5,132.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,184.25
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,132.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,733.71
|
| Rate for Payer: Quartz Commercial |
$3,626.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,347.40
|
| Rate for Payer: The Alliance Commercial |
$22,316.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: WPS Commercial |
$4,132.37
|
|
|
CT Angiography Abdomen
|
Facility
|
IP
|
$7,670.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
625596
|
| Min. Negotiated Rate |
$3,758.30 |
| Max. Negotiated Rate |
$7,056.40 |
| Rate for Payer: Aetna Commercial |
$6,903.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,596.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,065.10
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cigna Commercial |
$7,056.40
|
| Rate for Payer: Health EOS Commercial |
$6,826.30
|
| Rate for Payer: HFN Commercial |
$7,056.40
|
| Rate for Payer: Multiplan Commercial |
$6,136.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,602.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,056.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,758.30
|
| Rate for Payer: Quartz Commercial |
$4,602.00
|
| Rate for Payer: WEA Trust Commercial |
$4,218.50
|
| Rate for Payer: WPS Commercial |
$5,681.17
|
|
