|
CT Head/Brain Combined
|
Facility
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
3072654
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,764.98 |
| Max. Negotiated Rate |
$3,313.84 |
| Rate for Payer: Aetna Commercial |
$3,241.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,909.06
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,313.84
|
| Rate for Payer: Health EOS Commercial |
$3,205.78
|
| Rate for Payer: HFN Commercial |
$3,313.84
|
| Rate for Payer: Multiplan Commercial |
$2,881.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,161.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,313.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,764.98
|
| Rate for Payer: Quartz Commercial |
$2,161.20
|
| Rate for Payer: WEA Trust Commercial |
$1,981.10
|
| Rate for Payer: WPS Commercial |
$2,668.00
|
|
|
CT Head/Brain Unenhanced
|
Facility
IP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
2950237
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,326.92 |
| Max. Negotiated Rate |
$2,491.36 |
| Rate for Payer: Aetna Commercial |
$2,437.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,435.24
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,491.36
|
| Rate for Payer: Health EOS Commercial |
$2,410.12
|
| Rate for Payer: HFN Commercial |
$2,491.36
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.92
|
| Rate for Payer: Quartz Commercial |
$1,624.80
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$2,005.82
|
|
|
CT Head/Brain Unenhanced
|
Facility
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
2950237
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$469.49 |
| Max. Negotiated Rate |
$10,832.00 |
| Rate for Payer: Aetna Commercial |
$2,437.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.88
|
| Rate for Payer: Aetna Managed Medicare |
$758.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,435.24
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,491.36
|
| Rate for Payer: Health EOS Commercial |
$2,410.12
|
| Rate for Payer: HFN Commercial |
$2,491.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,031.00
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.92
|
| Rate for Payer: Quartz Commercial |
$1,760.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.80
|
| Rate for Payer: The Alliance Commercial |
$10,832.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$469.49
|
|
|
CT Head/Brain Unenhanced
|
Professional
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
2950237
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$67.07 |
| Max. Negotiated Rate |
$2,572.60 |
| Rate for Payer: Aetna Commercial |
$2,572.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.88
|
| Rate for Payer: Aetna Managed Medicare |
$67.07
|
| Rate for Payer: Anthem Medicare Advantage |
$67.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.07
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,572.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,354.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.07
|
| Rate for Payer: Health EOS Commercial |
$2,464.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.07
|
| Rate for Payer: Multiplan Commercial |
$2,166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,572.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,191.52
|
| Rate for Payer: Quartz Commercial |
$1,543.56
|
| Rate for Payer: Quartz Medicare Advantage |
$67.07
|
| Rate for Payer: The Alliance Commercial |
$254.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.07
|
| Rate for Payer: WEA Trust Commercial |
$1,489.40
|
| Rate for Payer: WPS Commercial |
$335.35
|
|
|
CT Head or Brain w/ Contrast
|
Facility
OP
|
$3,060.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
629962
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$9,019.28 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,989.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,468.80
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| 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 |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,989.00
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$9,019.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
CT Head or Brain w/ Contrast
|
Facility
IP
|
$3,060.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
629962
|
| Min. Negotiated Rate |
$1,499.40 |
| Max. Negotiated Rate |
$2,815.20 |
| Rate for Payer: Aetna Commercial |
$2,754.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,621.80
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,815.20
|
| Rate for Payer: Health EOS Commercial |
$2,723.40
|
| Rate for Payer: HFN Commercial |
$2,815.20
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,836.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,815.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,499.40
|
| Rate for Payer: Quartz Commercial |
$1,836.00
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$2,266.54
|
|
|
CT Head or Brain w/ Contrast
|
Professional
|
$3,060.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
629962
|
| Min. Negotiated Rate |
$148.17 |
| Max. Negotiated Rate |
$2,907.00 |
| Rate for Payer: Aetna Commercial |
$2,907.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,631.60
|
| Rate for Payer: Aetna Managed Medicare |
$148.17
|
| Rate for Payer: Anthem Medicare Advantage |
$148.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.17
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,907.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,530.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.17
|
| Rate for Payer: Health EOS Commercial |
$2,784.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$546.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.17
|
| Rate for Payer: Multiplan Commercial |
$2,448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,907.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.40
|
| Rate for Payer: Quartz Commercial |
$1,744.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.17
|
| Rate for Payer: The Alliance Commercial |
$563.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.17
|
| Rate for Payer: WEA Trust Commercial |
$1,683.00
|
| Rate for Payer: WPS Commercial |
$740.85
|
|
|
CT Head or Brain w/o Contrast
|
Facility
IP
|
$2,362.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
629966
|
| Min. Negotiated Rate |
$1,157.38 |
| Max. Negotiated Rate |
$2,173.04 |
| Rate for Payer: Aetna Commercial |
$2,125.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.86
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,173.04
|
| Rate for Payer: Health EOS Commercial |
$2,102.18
|
| Rate for Payer: HFN Commercial |
$2,173.04
|
| Rate for Payer: Multiplan Commercial |
$1,889.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,417.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,157.38
|
| Rate for Payer: Quartz Commercial |
$1,417.20
|
| Rate for Payer: WEA Trust Commercial |
$1,299.10
|
| Rate for Payer: WPS Commercial |
$1,749.53
|
|
|
CT Head or Brain w/o Contrast
|
Professional
|
$2,362.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
629966
|
| Min. Negotiated Rate |
$106.28 |
| Max. Negotiated Rate |
$2,243.90 |
| Rate for Payer: Aetna Commercial |
$2,243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,031.32
|
| Rate for Payer: Aetna Managed Medicare |
$106.28
|
| Rate for Payer: Anthem Medicare Advantage |
$106.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.28
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,243.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,181.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.28
|
| Rate for Payer: Health EOS Commercial |
$2,149.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$388.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.28
|
| Rate for Payer: Multiplan Commercial |
$1,889.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.28
|
| Rate for Payer: Quartz Commercial |
$1,346.34
|
| Rate for Payer: Quartz Medicare Advantage |
$106.28
|
| Rate for Payer: The Alliance Commercial |
$403.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.28
|
| Rate for Payer: WEA Trust Commercial |
$1,299.10
|
| Rate for Payer: WPS Commercial |
$531.40
|
|
|
CT Head or Brain w/o Contrast
|
Facility
OP
|
$2,362.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
629966
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,173.04 |
| Rate for Payer: Aetna Commercial |
$2,125.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,031.32
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,535.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,181.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,133.76
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,251.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,173.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,102.18
|
| Rate for Payer: HFN Commercial |
$2,173.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,889.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,173.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,157.38
|
| Rate for Payer: Quartz Commercial |
$1,535.30
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$1,358.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,299.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,749.53
|
|
|
CT Heart No Contrast Quant Eval Coronry Calcium 7557126
|
Professional
|
$800.00
|
|
|
Service Code
|
CPT 75571 26
|
| Hospital Charge Code |
5152628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$760.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$26.84
|
| Rate for Payer: Anthem Medicare Advantage |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.84
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$760.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$400.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.84
|
| Rate for Payer: Health EOS Commercial |
$728.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.84
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: Preferred Network Access Commercial |
$760.00
|
| Rate for Payer: Quartz Beloit One Network |
$352.00
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: Quartz Medicare Advantage |
$26.84
|
| Rate for Payer: The Alliance Commercial |
$101.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.84
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$134.20
|
|
|
CT Hemo/ Urogram w + w/o Contrast
|
Facility
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724145
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,761.48 |
| 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: 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: 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 |
$1,761.48
|
|
|
CT Hemo/ Urogram w + w/o Contrast
|
Facility
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724145
|
|
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: 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 Hemo/ Urogram w + w/o Contrast
|
Professional
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724145
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$251.64 |
| 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: Aetna Managed Medicare |
$251.64
|
| Rate for Payer: Anthem Medicare Advantage |
$251.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.64
|
| 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 |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$6,858.67
|
| 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: Independent Care Health Plan Medicare |
$251.64
|
| 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: Quartz Medicare Advantage |
$251.64
|
| Rate for Payer: The Alliance Commercial |
$956.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.64
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$1,258.20
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241126
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,375.92 |
| Max. Negotiated Rate |
$2,583.36 |
| Rate for Payer: Aetna Commercial |
$2,527.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,488.24
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,583.36
|
| Rate for Payer: Health EOS Commercial |
$2,499.12
|
| Rate for Payer: HFN Commercial |
$2,583.36
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,583.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.92
|
| Rate for Payer: Quartz Commercial |
$1,684.80
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Hip w/ Contrast Bilateral
|
Professional
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629978
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$5,450.15 |
| Rate for Payer: Aetna Commercial |
$5,450.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,933.82
|
| Rate for Payer: Aetna Managed Medicare |
$167.00
|
| Rate for Payer: Anthem Medicare Advantage |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.00
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,450.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,868.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.00
|
| Rate for Payer: Health EOS Commercial |
$5,220.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$4,589.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,450.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.28
|
| Rate for Payer: Quartz Commercial |
$3,270.09
|
| Rate for Payer: Quartz Medicare Advantage |
$167.00
|
| Rate for Payer: The Alliance Commercial |
$634.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.00
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: WPS Commercial |
$835.00
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629978
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$5,278.04 |
| Rate for Payer: Aetna Commercial |
$5,163.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,933.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,729.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,868.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,753.76
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,278.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$5,105.93
|
| Rate for Payer: HFN Commercial |
$5,278.04
|
| 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 |
$4,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,278.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,811.13
|
| Rate for Payer: Quartz Commercial |
$3,729.05
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$283.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$4,249.40
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629978
|
| Min. Negotiated Rate |
$2,811.13 |
| Max. Negotiated Rate |
$5,278.04 |
| Rate for Payer: Aetna Commercial |
$5,163.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.61
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,278.04
|
| Rate for Payer: Health EOS Commercial |
$5,105.93
|
| Rate for Payer: HFN Commercial |
$5,278.04
|
| Rate for Payer: Multiplan Commercial |
$4,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,442.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,278.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,811.13
|
| Rate for Payer: Quartz Commercial |
$3,442.20
|
| Rate for Payer: WEA Trust Commercial |
$3,155.35
|
| Rate for Payer: WPS Commercial |
$4,249.40
|
|
|
CT Hip w/ Contrast Bilateral
|
Professional
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241126
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,235.52 |
| Max. Negotiated Rate |
$2,667.60 |
| Rate for Payer: Aetna Commercial |
$2,667.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,667.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,404.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,684.80
|
| Rate for Payer: Health EOS Commercial |
$2,555.28
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.52
|
| Rate for Payer: Quartz Commercial |
$1,600.56
|
| Rate for Payer: The Alliance Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241126
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$11,232.00 |
| Rate for Payer: Aetna Commercial |
$2,527.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Aetna Managed Medicare |
$786.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,488.24
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,583.36
|
| Rate for Payer: Health EOS Commercial |
$2,499.12
|
| Rate for Payer: HFN Commercial |
$2,583.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,106.00
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,583.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.92
|
| Rate for Payer: Quartz Commercial |
$1,825.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.80
|
| Rate for Payer: The Alliance Commercial |
$11,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Hip w/ Contrast Left
|
Facility
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241128
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$816.48 |
| Max. Negotiated Rate |
$11,664.00 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.76
|
| Rate for Payer: Aetna Managed Medicare |
$816.48
|
| 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 |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,187.00
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,895.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,749.60
|
| Rate for Payer: The Alliance Commercial |
$11,664.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Hip w/ Contrast Left
|
Facility
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241128
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,428.84 |
| Max. Negotiated Rate |
$2,682.72 |
| Rate for Payer: Aetna Commercial |
$2,624.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.48
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,682.72
|
| Rate for Payer: Health EOS Commercial |
$2,595.24
|
| Rate for Payer: HFN Commercial |
$2,682.72
|
| Rate for Payer: Multiplan Commercial |
$2,332.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.84
|
| Rate for Payer: Quartz Commercial |
$1,749.60
|
| Rate for Payer: WEA Trust Commercial |
$1,603.80
|
| Rate for Payer: WPS Commercial |
$2,159.88
|
|
|
CT Hip w/ Contrast Left
|
Facility
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629984
|
| Min. Negotiated Rate |
$1,405.32 |
| Max. Negotiated Rate |
$2,638.56 |
| Rate for Payer: Aetna Commercial |
$2,581.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.04
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,638.56
|
| Rate for Payer: Health EOS Commercial |
$2,552.52
|
| Rate for Payer: HFN Commercial |
$2,638.56
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.32
|
| Rate for Payer: Quartz Commercial |
$1,720.80
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
|
CT Hip w/ Contrast Left
|
Professional
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629984
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$2,724.60 |
| Rate for Payer: Aetna Commercial |
$2,724.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.48
|
| Rate for Payer: Aetna Managed Medicare |
$167.00
|
| Rate for Payer: Anthem Medicare Advantage |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.00
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,724.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,434.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.00
|
| Rate for Payer: Health EOS Commercial |
$2,609.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$616.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,724.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.92
|
| Rate for Payer: Quartz Commercial |
$1,634.76
|
| Rate for Payer: Quartz Medicare Advantage |
$167.00
|
| Rate for Payer: The Alliance Commercial |
$634.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.00
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: WPS Commercial |
$835.00
|
|
|
CT Hip w/ Contrast Left
|
Facility
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629984
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$2,638.56 |
| Rate for Payer: Aetna Commercial |
$2,581.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,466.48
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,864.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,376.64
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,520.04
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,638.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$2,552.52
|
| Rate for Payer: HFN Commercial |
$2,638.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$2,294.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,638.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,405.32
|
| Rate for Payer: Quartz Commercial |
$1,864.20
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$283.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$1,577.40
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,124.33
|
|
