|
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
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,156.48 |
| Rate for Payer: Aetna Commercial |
$3,087.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,950.63
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,230.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,715.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,646.86
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,818.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cigna Commercial |
$3,156.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,920.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,053.55
|
| Rate for Payer: HFN Commercial |
$3,156.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$2,744.77
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,156.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,681.17
|
| Rate for Payer: Quartz Commercial |
$2,230.12
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$1,887.03
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,541.22
|
|
|
CT Abdomen w/ Contrast
|
Professional
|
Both
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$229.06 |
| Max. Negotiated Rate |
$3,259.41 |
| Rate for Payer: Aetna Commercial |
$3,259.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,950.63
|
| Rate for Payer: Aetna Managed Medicare |
$229.06
|
| Rate for Payer: Anthem Medicare Advantage |
$229.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.06
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cigna Commercial |
$3,259.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,715.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.06
|
| Rate for Payer: Health EOS Commercial |
$3,122.17
|
| Rate for Payer: HFN Commercial |
$3,259.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$897.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$897.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.06
|
| Rate for Payer: Multiplan Commercial |
$2,744.77
|
| Rate for Payer: NAPHCARE Commercial |
$343.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,259.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,509.62
|
| Rate for Payer: Quartz Commercial |
$1,955.65
|
| Rate for Payer: Quartz Medicare Advantage |
$229.06
|
| Rate for Payer: The Alliance Commercial |
$870.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.06
|
| Rate for Payer: WEA Trust Commercial |
$1,887.03
|
| Rate for Payer: WPS Commercial |
$1,145.30
|
|
|
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 |
$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
|
|
|
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
|
|
|
CT Abdomen w/ Contrast
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
625598
|
| Min. Negotiated Rate |
$1,681.17 |
| Max. Negotiated Rate |
$3,156.48 |
| Rate for Payer: Aetna Commercial |
$3,087.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,950.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,818.41
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cigna Commercial |
$3,156.48
|
| Rate for Payer: Health EOS Commercial |
$3,053.55
|
| Rate for Payer: HFN Commercial |
$3,156.48
|
| Rate for Payer: Multiplan Commercial |
$2,744.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,156.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,681.17
|
| Rate for Payer: Quartz Commercial |
$2,058.58
|
| Rate for Payer: WEA Trust Commercial |
$1,887.03
|
| Rate for Payer: WPS Commercial |
$2,541.22
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
625600
|
| Min. Negotiated Rate |
$1,333.11 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,632.38
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
CT Abdomen w/o Contrast
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
625600
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,768.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,360.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.91
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,768.42
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
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 |
$80.97 |
| Max. Negotiated Rate |
$3,063.79 |
| Rate for Payer: Aetna Commercial |
$3,063.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,773.53
|
| Rate for Payer: Aetna Managed Medicare |
$80.97
|
| Rate for Payer: Anthem Medicare Advantage |
$80.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.97
|
| 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 |
$3,063.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,612.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.97
|
| Rate for Payer: Health EOS Commercial |
$2,934.79
|
| Rate for Payer: HFN Commercial |
$3,063.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$316.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.97
|
| Rate for Payer: Multiplan Commercial |
$2,580.03
|
| Rate for Payer: NAPHCARE Commercial |
$121.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,063.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.02
|
| Rate for Payer: Quartz Commercial |
$1,838.27
|
| Rate for Payer: Quartz Medicare Advantage |
$80.97
|
| Rate for Payer: The Alliance Commercial |
$307.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.97
|
| Rate for Payer: WEA Trust Commercial |
$1,773.77
|
| Rate for Payer: WPS Commercial |
$404.87
|
|
|
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 |
$80.97 |
| Max. Negotiated Rate |
$3,063.79 |
| Rate for Payer: Aetna Commercial |
$3,063.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,773.53
|
| Rate for Payer: Aetna Managed Medicare |
$80.97
|
| Rate for Payer: Anthem Medicare Advantage |
$80.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.97
|
| 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 |
$3,063.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,612.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.97
|
| Rate for Payer: Health EOS Commercial |
$2,934.79
|
| Rate for Payer: HFN Commercial |
$3,063.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$316.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.97
|
| Rate for Payer: Multiplan Commercial |
$2,580.03
|
| Rate for Payer: NAPHCARE Commercial |
$121.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,063.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.02
|
| Rate for Payer: Quartz Commercial |
$1,838.27
|
| Rate for Payer: Quartz Medicare Advantage |
$80.97
|
| Rate for Payer: The Alliance Commercial |
$307.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.97
|
| Rate for Payer: WEA Trust Commercial |
$1,773.77
|
| Rate for Payer: WPS Commercial |
$404.87
|
|
|
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 |
$1,580.27 |
| Max. Negotiated Rate |
$2,967.04 |
| Rate for Payer: Aetna Commercial |
$2,902.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,773.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,709.27
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,967.04
|
| Rate for Payer: Health EOS Commercial |
$2,870.29
|
| Rate for Payer: HFN Commercial |
$2,967.04
|
| Rate for Payer: Multiplan Commercial |
$2,580.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,967.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,580.27
|
| Rate for Payer: Quartz Commercial |
$1,935.02
|
| Rate for Payer: WEA Trust Commercial |
$1,773.77
|
| Rate for Payer: WPS Commercial |
$2,388.70
|
|
|
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 |
$1,580.27 |
| Max. Negotiated Rate |
$2,967.04 |
| Rate for Payer: Aetna Commercial |
$2,902.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,773.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,709.27
|
| Rate for Payer: Cash Price |
$930.30
|
| Rate for Payer: Cigna Commercial |
$2,967.04
|
| Rate for Payer: Health EOS Commercial |
$2,870.29
|
| Rate for Payer: HFN Commercial |
$2,967.04
|
| Rate for Payer: Multiplan Commercial |
$2,580.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,967.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,580.27
|
| Rate for Payer: Quartz Commercial |
$1,935.02
|
| Rate for Payer: WEA Trust Commercial |
$1,773.77
|
| Rate for Payer: WPS Commercial |
$2,388.70
|
|
|
CT Abdomen w/o Contrast
|
Professional
|
Both
|
$2,616.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
625600
|
| Min. Negotiated Rate |
$135.66 |
| Max. Negotiated Rate |
$2,584.61 |
| Rate for Payer: Aetna Commercial |
$2,584.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Aetna Managed Medicare |
$135.66
|
| Rate for Payer: Anthem Medicare Advantage |
$135.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.66
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,584.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,360.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.66
|
| Rate for Payer: Health EOS Commercial |
$2,475.78
|
| Rate for Payer: HFN Commercial |
$2,584.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$522.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.66
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: NAPHCARE Commercial |
$203.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,584.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.08
|
| Rate for Payer: Quartz Commercial |
$1,550.76
|
| Rate for Payer: Quartz Medicare Advantage |
$135.66
|
| Rate for Payer: The Alliance Commercial |
$515.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.66
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$678.29
|
|
|
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 |
$323.90 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,902.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,773.53
|
| Rate for Payer: Aetna Managed Medicare |
$903.01
|
| 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 |
$1,709.27
|
| Rate for Payer: Cash Price |
$930.30
|
| 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 |
$2,967.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,804.78
|
| Rate for Payer: Health EOS Commercial |
$2,870.29
|
| Rate for Payer: HFN Commercial |
$2,967.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,418.78
|
| Rate for Payer: Multiplan Commercial |
$2,580.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,935.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,967.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,580.27
|
| Rate for Payer: Quartz Commercial |
$2,096.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,935.02
|
| Rate for Payer: The Alliance Commercial |
$323.90
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,773.77
|
| Rate for Payer: WPS Commercial |
$566.82
|
|
|
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 |
$323.90 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,902.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,773.53
|
| Rate for Payer: Aetna Managed Medicare |
$903.01
|
| 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 |
$1,709.27
|
| Rate for Payer: Cash Price |
$930.30
|
| 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 |
$2,967.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,804.78
|
| Rate for Payer: Health EOS Commercial |
$2,870.29
|
| Rate for Payer: HFN Commercial |
$2,967.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,418.78
|
| Rate for Payer: Multiplan Commercial |
$2,580.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,935.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,967.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,580.27
|
| Rate for Payer: Quartz Commercial |
$2,096.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,935.02
|
| Rate for Payer: The Alliance Commercial |
$323.90
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,773.77
|
| Rate for Payer: WPS Commercial |
$566.82
|
|
|
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 |
$2,308.49 |
| Max. Negotiated Rate |
$4,334.30 |
| Rate for Payer: Aetna Commercial |
$4,240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,496.94
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,334.30
|
| Rate for Payer: Health EOS Commercial |
$4,192.97
|
| Rate for Payer: HFN Commercial |
$4,334.30
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.49
|
| Rate for Payer: Quartz Commercial |
$2,826.72
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$3,489.46
|
|
|
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 |
$774.22 |
| Max. Negotiated Rate |
$4,334.30 |
| Rate for Payer: Aetna Commercial |
$4,240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,319.14
|
| 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 |
$2,496.94
|
| 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: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,334.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,636.46
|
| Rate for Payer: Health EOS Commercial |
$4,192.97
|
| Rate for Payer: HFN Commercial |
$4,334.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,533.40
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: NAPHCARE Commercial |
$2,826.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.49
|
| Rate for Payer: Quartz Commercial |
$3,062.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,826.72
|
| Rate for Payer: The Alliance Commercial |
$774.22
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$1,354.88
|
|
|
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 |
$193.55 |
| Max. Negotiated Rate |
$4,475.64 |
| Rate for Payer: Aetna Commercial |
$4,475.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Aetna Managed Medicare |
$193.55
|
| Rate for Payer: Anthem Medicare Advantage |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.55
|
| 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 |
$4,475.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,355.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.55
|
| Rate for Payer: Health EOS Commercial |
$4,287.19
|
| Rate for Payer: HFN Commercial |
$4,475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$767.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.55
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: NAPHCARE Commercial |
$290.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,072.93
|
| Rate for Payer: Quartz Commercial |
$2,685.38
|
| Rate for Payer: Quartz Medicare Advantage |
$193.55
|
| Rate for Payer: The Alliance Commercial |
$735.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.55
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$967.77
|
|
|
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 |
$774.22 |
| Max. Negotiated Rate |
$4,334.30 |
| Rate for Payer: Aetna Commercial |
$4,240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,319.14
|
| 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 |
$2,496.94
|
| 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: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,334.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,636.46
|
| Rate for Payer: Health EOS Commercial |
$4,192.97
|
| Rate for Payer: HFN Commercial |
$4,334.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,533.40
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: NAPHCARE Commercial |
$2,826.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.49
|
| Rate for Payer: Quartz Commercial |
$3,062.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,826.72
|
| Rate for Payer: The Alliance Commercial |
$774.22
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$1,354.88
|
|
|
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 |
$193.55 |
| Max. Negotiated Rate |
$4,475.64 |
| Rate for Payer: Aetna Commercial |
$4,475.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Aetna Managed Medicare |
$193.55
|
| Rate for Payer: Anthem Medicare Advantage |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.55
|
| 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 |
$4,475.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,355.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.55
|
| Rate for Payer: Health EOS Commercial |
$4,287.19
|
| Rate for Payer: HFN Commercial |
$4,475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$767.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.55
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: NAPHCARE Commercial |
$290.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,072.93
|
| Rate for Payer: Quartz Commercial |
$2,685.38
|
| Rate for Payer: Quartz Medicare Advantage |
$193.55
|
| Rate for Payer: The Alliance Commercial |
$735.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.55
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$967.77
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$4,446.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
615590
|
| Min. Negotiated Rate |
$2,265.68 |
| Max. Negotiated Rate |
$4,253.93 |
| Rate for Payer: Aetna Commercial |
$4,161.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,976.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,450.64
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,253.93
|
| Rate for Payer: Health EOS Commercial |
$4,115.22
|
| Rate for Payer: HFN Commercial |
$4,253.93
|
| Rate for Payer: Multiplan Commercial |
$3,699.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,253.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,265.68
|
| Rate for Payer: Quartz Commercial |
$2,774.30
|
| Rate for Payer: WEA Trust Commercial |
$2,543.11
|
| Rate for Payer: WPS Commercial |
$3,424.75
|
|
|
CT Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$4,446.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
615590
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,253.93 |
| Rate for Payer: Aetna Commercial |
$4,161.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,976.50
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,005.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,311.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,219.44
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,450.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,253.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,587.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$4,115.22
|
| Rate for Payer: HFN Commercial |
$4,253.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$3,699.07
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,253.93
|
| Rate for Payer: Quartz Beloit One Network |
$2,265.68
|
| Rate for Payer: Quartz Commercial |
$3,005.50
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,543.11
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,424.75
|
|
|
CT Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$4,446.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
615590
|
| Min. Negotiated Rate |
$257.87 |
| Max. Negotiated Rate |
$4,392.65 |
| Rate for Payer: Aetna Commercial |
$4,392.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,976.50
|
| Rate for Payer: Aetna Managed Medicare |
$257.87
|
| Rate for Payer: Anthem Medicare Advantage |
$257.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$257.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$257.87
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cash Price |
$1,333.80
|
| Rate for Payer: Cigna Commercial |
$4,392.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,311.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.87
|
| Rate for Payer: Health EOS Commercial |
$4,207.69
|
| Rate for Payer: HFN Commercial |
$4,392.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$257.87
|
| Rate for Payer: Multiplan Commercial |
$3,699.07
|
| Rate for Payer: NAPHCARE Commercial |
$386.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,392.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,034.49
|
| Rate for Payer: Quartz Commercial |
$2,635.59
|
| Rate for Payer: Quartz Medicare Advantage |
$257.87
|
| Rate for Payer: The Alliance Commercial |
$979.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.87
|
| Rate for Payer: WEA Trust Commercial |
$2,543.11
|
| Rate for Payer: WPS Commercial |
$1,289.34
|
|
|
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 |
$2,308.49 |
| Max. Negotiated Rate |
$4,334.30 |
| Rate for Payer: Aetna Commercial |
$4,240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,496.94
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,334.30
|
| Rate for Payer: Health EOS Commercial |
$4,192.97
|
| Rate for Payer: HFN Commercial |
$4,334.30
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.49
|
| Rate for Payer: Quartz Commercial |
$2,826.72
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$3,489.46
|
|
|
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 |
$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
|
|
