|
CT Abdomen, Pelvis w/ Contrast
|
Professional
|
Both
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
2950239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$6,669.00 |
| Rate for Payer: Aetna Commercial |
$6,669.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,037.20
|
| Rate for Payer: Aetna Managed Medicare |
$215.19
|
| Rate for Payer: Anthem Medicare Advantage |
$215.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$215.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$215.19
|
| 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 |
$6,669.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,510.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.19
|
| Rate for Payer: Health EOS Commercial |
$6,388.20
|
| Rate for Payer: HFN Commercial |
$6,669.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$861.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$215.19
|
| Rate for Payer: Multiplan Commercial |
$5,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$322.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,669.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,088.80
|
| Rate for Payer: Quartz Commercial |
$4,001.40
|
| Rate for Payer: Quartz Medicare Advantage |
$215.19
|
| Rate for Payer: The Alliance Commercial |
$817.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$215.19
|
| Rate for Payer: WEA Trust Commercial |
$3,861.00
|
| Rate for Payer: WPS Commercial |
$1,075.93
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
2950239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$860.75 |
| Max. Negotiated Rate |
$6,458.40 |
| Rate for Payer: Aetna Commercial |
$6,318.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,037.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,965.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,720.60
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,458.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,928.50
|
| Rate for Payer: Health EOS Commercial |
$6,247.80
|
| Rate for Payer: HFN Commercial |
$6,458.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,265.00
|
| Rate for Payer: Multiplan Commercial |
$5,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,458.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,439.80
|
| Rate for Payer: Quartz Commercial |
$4,563.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,212.00
|
| Rate for Payer: The Alliance Commercial |
$860.75
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,861.00
|
| Rate for Payer: WPS Commercial |
$1,506.30
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Professional
|
Both
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
1240813
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$215.19 |
| Max. Negotiated Rate |
$6,669.00 |
| Rate for Payer: Aetna Commercial |
$6,669.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,037.20
|
| Rate for Payer: Aetna Managed Medicare |
$215.19
|
| Rate for Payer: Anthem Medicare Advantage |
$215.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$215.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$215.19
|
| 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 |
$6,669.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,510.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.19
|
| Rate for Payer: Health EOS Commercial |
$6,388.20
|
| Rate for Payer: HFN Commercial |
$6,669.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$861.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$215.19
|
| Rate for Payer: Multiplan Commercial |
$5,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$322.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,669.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,088.80
|
| Rate for Payer: Quartz Commercial |
$4,001.40
|
| Rate for Payer: Quartz Medicare Advantage |
$215.19
|
| Rate for Payer: The Alliance Commercial |
$817.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$215.19
|
| Rate for Payer: WEA Trust Commercial |
$3,861.00
|
| Rate for Payer: WPS Commercial |
$1,075.93
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
2950239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,439.80 |
| Max. Negotiated Rate |
$6,458.40 |
| Rate for Payer: Aetna Commercial |
$6,318.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,037.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,720.60
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,458.40
|
| Rate for Payer: Health EOS Commercial |
$6,247.80
|
| Rate for Payer: HFN Commercial |
$6,458.40
|
| Rate for Payer: Multiplan Commercial |
$5,616.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,458.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,439.80
|
| Rate for Payer: Quartz Commercial |
$4,212.00
|
| Rate for Payer: WEA Trust Commercial |
$3,861.00
|
| Rate for Payer: WPS Commercial |
$5,199.52
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
|
IP
|
$6,089.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
1220807
|
| Min. Negotiated Rate |
$3,102.95 |
| Max. Negotiated Rate |
$5,825.96 |
| Rate for Payer: Aetna Commercial |
$5,699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,356.26
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$5,825.96
|
| Rate for Payer: Health EOS Commercial |
$5,635.98
|
| Rate for Payer: HFN Commercial |
$5,825.96
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,825.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.95
|
| Rate for Payer: Quartz Commercial |
$3,799.54
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$4,690.36
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
1240813
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$860.75 |
| Max. Negotiated Rate |
$6,458.40 |
| Rate for Payer: Aetna Commercial |
$6,318.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,037.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,965.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,720.60
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cash Price |
$2,025.00
|
| Rate for Payer: Cigna Commercial |
$6,458.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,928.50
|
| Rate for Payer: Health EOS Commercial |
$6,247.80
|
| Rate for Payer: HFN Commercial |
$6,458.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,265.00
|
| Rate for Payer: Multiplan Commercial |
$5,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,458.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,439.80
|
| Rate for Payer: Quartz Commercial |
$4,563.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4,212.00
|
| Rate for Payer: The Alliance Commercial |
$860.75
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,861.00
|
| Rate for Payer: WPS Commercial |
$1,506.30
|
|
|
CT Abdomen, Pelvis w/ Contrast
|
Professional
|
Both
|
$6,089.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
1220807
|
| Min. Negotiated Rate |
$298.81 |
| Max. Negotiated Rate |
$6,015.93 |
| Rate for Payer: Aetna Commercial |
$6,015.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,446.00
|
| Rate for Payer: Aetna Managed Medicare |
$298.81
|
| Rate for Payer: Anthem Medicare Advantage |
$298.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$298.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$298.81
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cash Price |
$1,826.70
|
| Rate for Payer: Cigna Commercial |
$6,015.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,166.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.81
|
| Rate for Payer: Health EOS Commercial |
$5,762.63
|
| Rate for Payer: HFN Commercial |
$6,015.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,177.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,177.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$298.81
|
| Rate for Payer: Multiplan Commercial |
$5,066.05
|
| Rate for Payer: NAPHCARE Commercial |
$448.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,015.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,786.33
|
| Rate for Payer: Quartz Commercial |
$3,609.56
|
| Rate for Payer: Quartz Medicare Advantage |
$298.81
|
| Rate for Payer: The Alliance Commercial |
$1,135.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.81
|
| Rate for Payer: WEA Trust Commercial |
$3,482.91
|
| Rate for Payer: WPS Commercial |
$1,494.06
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Professional
|
Both
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
1240816
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$5,889.47 |
| Rate for Payer: Aetna Commercial |
$5,889.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Aetna Managed Medicare |
$102.38
|
| Rate for Payer: Anthem Medicare Advantage |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.38
|
| 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 |
$5,889.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,099.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$5,641.49
|
| Rate for Payer: HFN Commercial |
$5,889.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: NAPHCARE Commercial |
$153.57
|
| Rate for Payer: Preferred Network Access Commercial |
$5,889.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,727.75
|
| Rate for Payer: Quartz Commercial |
$3,533.68
|
| Rate for Payer: Quartz Medicare Advantage |
$102.38
|
| Rate for Payer: The Alliance Commercial |
$389.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.38
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$511.89
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Professional
|
Both
|
$5,204.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1220806
|
| Min. Negotiated Rate |
$182.36 |
| Max. Negotiated Rate |
$5,141.55 |
| Rate for Payer: Aetna Commercial |
$5,141.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,654.46
|
| Rate for Payer: Aetna Managed Medicare |
$182.36
|
| Rate for Payer: Anthem Medicare Advantage |
$182.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$182.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$182.36
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cigna Commercial |
$5,141.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,706.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.36
|
| Rate for Payer: Health EOS Commercial |
$4,925.07
|
| Rate for Payer: HFN Commercial |
$5,141.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$698.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$182.36
|
| Rate for Payer: Multiplan Commercial |
$4,329.73
|
| Rate for Payer: NAPHCARE Commercial |
$273.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,141.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,381.35
|
| Rate for Payer: Quartz Commercial |
$3,084.93
|
| Rate for Payer: Quartz Medicare Advantage |
$182.36
|
| Rate for Payer: The Alliance Commercial |
$692.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.36
|
| Rate for Payer: WEA Trust Commercial |
$2,976.69
|
| Rate for Payer: WPS Commercial |
$911.82
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
|
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
1240816
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$409.51 |
| Max. Negotiated Rate |
$5,703.48 |
| Rate for Payer: Aetna Commercial |
$5,579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,735.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.70
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,703.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,469.30
|
| Rate for Payer: Health EOS Commercial |
$5,517.50
|
| Rate for Payer: HFN Commercial |
$5,703.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,649.58
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,719.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,703.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.73
|
| Rate for Payer: Quartz Commercial |
$4,029.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,719.66
|
| Rate for Payer: The Alliance Commercial |
$409.51
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$716.64
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
|
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
1240816
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,037.73 |
| Max. Negotiated Rate |
$5,703.48 |
| Rate for Payer: Aetna Commercial |
$5,579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.70
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,703.48
|
| Rate for Payer: Health EOS Commercial |
$5,517.50
|
| Rate for Payer: HFN Commercial |
$5,703.48
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,703.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.73
|
| Rate for Payer: Quartz Commercial |
$3,719.66
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$4,591.76
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
|
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
3072641
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,037.73 |
| Max. Negotiated Rate |
$5,703.48 |
| Rate for Payer: Aetna Commercial |
$5,579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.70
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,703.48
|
| Rate for Payer: Health EOS Commercial |
$5,517.50
|
| Rate for Payer: HFN Commercial |
$5,703.48
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,703.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.73
|
| Rate for Payer: Quartz Commercial |
$3,719.66
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$4,591.76
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
|
OP
|
$5,204.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1220806
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,979.19 |
| Rate for Payer: Aetna Commercial |
$4,870.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,654.46
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,517.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,706.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,597.84
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,868.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cigna Commercial |
$4,979.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,028.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,816.82
|
| Rate for Payer: HFN Commercial |
$4,979.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$4,329.73
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,979.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,651.96
|
| Rate for Payer: Quartz Commercial |
$3,517.90
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,976.69
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$4,008.64
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
|
IP
|
$5,204.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1220806
|
| Min. Negotiated Rate |
$2,651.96 |
| Max. Negotiated Rate |
$4,979.19 |
| Rate for Payer: Aetna Commercial |
$4,870.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,654.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,868.44
|
| Rate for Payer: Cash Price |
$1,561.20
|
| Rate for Payer: Cigna Commercial |
$4,979.19
|
| Rate for Payer: Health EOS Commercial |
$4,816.82
|
| Rate for Payer: HFN Commercial |
$4,979.19
|
| Rate for Payer: Multiplan Commercial |
$4,329.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,979.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,651.96
|
| Rate for Payer: Quartz Commercial |
$3,247.30
|
| Rate for Payer: WEA Trust Commercial |
$2,976.69
|
| Rate for Payer: WPS Commercial |
$4,008.64
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Facility
|
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
3072641
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$409.51 |
| Max. Negotiated Rate |
$5,703.48 |
| Rate for Payer: Aetna Commercial |
$5,579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,735.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.70
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,703.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,469.30
|
| Rate for Payer: Health EOS Commercial |
$5,517.50
|
| Rate for Payer: HFN Commercial |
$5,703.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,649.58
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,719.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,703.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.73
|
| Rate for Payer: Quartz Commercial |
$4,029.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,719.66
|
| Rate for Payer: The Alliance Commercial |
$409.51
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$716.64
|
|
|
CT Abdomen, Pelvis w/o Contrast
|
Professional
|
Both
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
3072641
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$5,889.47 |
| Rate for Payer: Aetna Commercial |
$5,889.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Aetna Managed Medicare |
$102.38
|
| Rate for Payer: Anthem Medicare Advantage |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.38
|
| 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 |
$5,889.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,099.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$5,641.49
|
| Rate for Payer: HFN Commercial |
$5,889.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: NAPHCARE Commercial |
$153.57
|
| Rate for Payer: Preferred Network Access Commercial |
$5,889.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,727.75
|
| Rate for Payer: Quartz Commercial |
$3,533.68
|
| Rate for Payer: Quartz Medicare Advantage |
$102.38
|
| Rate for Payer: The Alliance Commercial |
$389.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.38
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$511.89
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$7,893.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1220808
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$7,552.02 |
| Rate for Payer: Aetna Commercial |
$7,387.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,059.50
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,335.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,104.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,940.19
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,350.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cigna Commercial |
$7,552.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,593.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$7,305.76
|
| Rate for Payer: HFN Commercial |
$7,552.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$6,566.98
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$7,552.02
|
| Rate for Payer: Quartz Beloit One Network |
$4,022.27
|
| Rate for Payer: Quartz Commercial |
$5,335.67
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$4,514.80
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$6,079.98
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$243.58 |
| Max. Negotiated Rate |
$7,446.56 |
| Rate for Payer: Aetna Commercial |
$7,446.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Aetna Managed Medicare |
$243.58
|
| Rate for Payer: Anthem Medicare Advantage |
$243.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.58
|
| 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 |
$7,446.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,919.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.58
|
| Rate for Payer: Health EOS Commercial |
$7,133.02
|
| Rate for Payer: HFN Commercial |
$7,446.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$973.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$973.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.58
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$365.37
|
| Rate for Payer: Preferred Network Access Commercial |
$7,446.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.93
|
| Rate for Payer: Quartz Commercial |
$4,467.93
|
| Rate for Payer: Quartz Medicare Advantage |
$243.58
|
| Rate for Payer: The Alliance Commercial |
$925.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.58
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$1,217.89
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$7,893.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1220808
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$7,798.28 |
| Rate for Payer: Aetna Commercial |
$7,798.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,059.50
|
| Rate for Payer: Aetna Managed Medicare |
$336.24
|
| Rate for Payer: Anthem Medicare Advantage |
$336.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$336.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$336.24
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cigna Commercial |
$7,798.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,104.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.24
|
| Rate for Payer: Health EOS Commercial |
$7,469.94
|
| Rate for Payer: HFN Commercial |
$7,798.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,321.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$336.24
|
| Rate for Payer: Multiplan Commercial |
$6,566.98
|
| Rate for Payer: NAPHCARE Commercial |
$504.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,798.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,611.84
|
| Rate for Payer: Quartz Commercial |
$4,678.97
|
| Rate for Payer: Quartz Medicare Advantage |
$336.24
|
| Rate for Payer: The Alliance Commercial |
$1,277.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.24
|
| Rate for Payer: WEA Trust Commercial |
$4,514.80
|
| Rate for Payer: WPS Commercial |
$1,681.21
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,840.86 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$4,703.09
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240810
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$974.31 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Aetna Managed Medicare |
$2,194.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.53
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,878.86
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,703.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$5,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,703.09
|
| Rate for Payer: The Alliance Commercial |
$974.31
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$1,705.05
|
|
|
CT Abdomen, Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$7,893.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1220808
|
| Min. Negotiated Rate |
$4,022.27 |
| Max. Negotiated Rate |
$7,552.02 |
| Rate for Payer: Aetna Commercial |
$7,387.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,059.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,350.62
|
| Rate for Payer: Cash Price |
$2,367.90
|
| Rate for Payer: Cigna Commercial |
$7,552.02
|
| Rate for Payer: Health EOS Commercial |
$7,305.76
|
| Rate for Payer: HFN Commercial |
$7,552.02
|
| Rate for Payer: Multiplan Commercial |
$6,566.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,552.02
|
| Rate for Payer: Quartz Beloit One Network |
$4,022.27
|
| Rate for Payer: Quartz Commercial |
$4,925.23
|
| Rate for Payer: WEA Trust Commercial |
$4,514.80
|
| Rate for Payer: WPS Commercial |
$6,079.98
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
IP
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
1240806
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,919.66 |
| Max. Negotiated Rate |
$3,604.27 |
| Rate for Payer: Aetna Commercial |
$3,525.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,369.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.37
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cigna Commercial |
$3,604.27
|
| Rate for Payer: Health EOS Commercial |
$3,486.74
|
| Rate for Payer: HFN Commercial |
$3,604.27
|
| Rate for Payer: Multiplan Commercial |
$3,134.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,604.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.66
|
| Rate for Payer: Quartz Commercial |
$2,350.61
|
| Rate for Payer: WEA Trust Commercial |
$2,154.72
|
| Rate for Payer: WPS Commercial |
$2,901.72
|
|
|
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 |
$1,919.66 |
| Max. Negotiated Rate |
$3,604.27 |
| Rate for Payer: Aetna Commercial |
$3,525.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,369.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.37
|
| Rate for Payer: Cash Price |
$1,130.10
|
| Rate for Payer: Cigna Commercial |
$3,604.27
|
| Rate for Payer: Health EOS Commercial |
$3,486.74
|
| Rate for Payer: HFN Commercial |
$3,604.27
|
| Rate for Payer: Multiplan Commercial |
$3,134.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,604.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.66
|
| Rate for Payer: Quartz Commercial |
$2,350.61
|
| Rate for Payer: WEA Trust Commercial |
$2,154.72
|
| Rate for Payer: WPS Commercial |
$2,901.72
|
|
|
CT Abdomen w/ Contrast
|
Professional
|
Both
|
$3,767.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
3072683
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$170.60 |
| Max. Negotiated Rate |
$3,721.80 |
| Rate for Payer: Aetna Commercial |
$3,721.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,369.20
|
| Rate for Payer: Aetna Managed Medicare |
$170.60
|
| Rate for Payer: Anthem Medicare Advantage |
$170.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.60
|
| 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 |
$3,721.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,958.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.60
|
| Rate for Payer: Health EOS Commercial |
$3,565.09
|
| Rate for Payer: HFN Commercial |
$3,721.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$677.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$677.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.60
|
| Rate for Payer: Multiplan Commercial |
$3,134.14
|
| Rate for Payer: NAPHCARE Commercial |
$255.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,721.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.78
|
| Rate for Payer: Quartz Commercial |
$2,233.08
|
| Rate for Payer: Quartz Medicare Advantage |
$170.60
|
| Rate for Payer: The Alliance Commercial |
$648.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.60
|
| Rate for Payer: WEA Trust Commercial |
$2,154.72
|
| Rate for Payer: WPS Commercial |
$853.01
|
|
