|
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
|
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 |
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
|
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
|
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
|
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
|
|
|
CT Abdomen w/ + w/o Contrast, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3072682
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,840.86 |
| 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 w/ + w/o Contrast, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3072682
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 w/ + w/o, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240803
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 w/ + w/o, Pelvis w/ Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240803
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 w/ + w/o, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
1240803
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,840.86 |
| 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 Abd, Pel, Spine Reformats w/ Con
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
5551882
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,439.80 |
| 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 Abd, Pel, Spine Reformats w/ Con
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
5551882
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Abd, Pel, Spine Reformats w/ Con
|
Professional
|
Both
|
$6,750.00
|
|
|
Service Code
|
CPT 74177 TC
|
| Hospital Charge Code |
5551882
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Abd, Pel, Spine Reformats w/o Con
|
Professional
|
Both
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5551885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Abd, Pel, Spine Reformats w/o Con
|
Facility
|
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5551885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Abd, Pel, Spine Reformats w/o Con
|
Facility
|
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5551885
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Adrenal w + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724130
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,308.49 |
| 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 Adrenal w + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724130
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Adrenal w + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724130
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Adrenal w + w/o, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724133
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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 Adrenal w + w/o, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724133
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,840.86 |
| 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 Adrenal w + w/o, Pelvis w/ Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724133
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$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
|
|
