|
CT Brain w/ Contrast
|
Professional
|
Both
|
$3,117.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
1240938
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$3,079.60 |
| Rate for Payer: Aetna Commercial |
$3,079.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,787.84
|
| Rate for Payer: Aetna Managed Medicare |
$95.39
|
| Rate for Payer: Anthem Medicare Advantage |
$95.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.39
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$3,079.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,620.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.39
|
| Rate for Payer: Health EOS Commercial |
$2,949.93
|
| Rate for Payer: HFN Commercial |
$3,079.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$372.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.39
|
| Rate for Payer: Multiplan Commercial |
$2,593.34
|
| Rate for Payer: NAPHCARE Commercial |
$143.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,079.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,426.34
|
| Rate for Payer: Quartz Commercial |
$1,847.76
|
| Rate for Payer: Quartz Medicare Advantage |
$95.39
|
| Rate for Payer: The Alliance Commercial |
$362.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.39
|
| Rate for Payer: WEA Trust Commercial |
$1,782.92
|
| Rate for Payer: WPS Commercial |
$476.94
|
|
|
CT Brain w/ Contrast
|
Facility
|
OP
|
$3,117.00
|
|
|
Service Code
|
CPT 70460 TC
|
| Hospital Charge Code |
1240938
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$381.56 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,917.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,787.84
|
| Rate for Payer: Aetna Managed Medicare |
$907.67
|
| 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 |
$1,718.09
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$2,982.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,814.09
|
| Rate for Payer: Health EOS Commercial |
$2,885.10
|
| Rate for Payer: HFN Commercial |
$2,982.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,431.26
|
| Rate for Payer: Multiplan Commercial |
$2,593.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,945.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,982.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,588.42
|
| Rate for Payer: Quartz Commercial |
$2,107.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,945.01
|
| Rate for Payer: The Alliance Commercial |
$381.56
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,782.92
|
| Rate for Payer: WPS Commercial |
$667.72
|
|
|
CT Brain w/o Contrast
|
Facility
|
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
1240940
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$266.66 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,534.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.04
|
| Rate for Payer: Aetna Managed Medicare |
$788.57
|
| 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 |
$1,492.65
|
| 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 |
$2,591.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,576.06
|
| Rate for Payer: Health EOS Commercial |
$2,506.52
|
| Rate for Payer: HFN Commercial |
$2,591.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,112.24
|
| Rate for Payer: Multiplan Commercial |
$2,253.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,689.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.00
|
| Rate for Payer: Quartz Commercial |
$1,830.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,689.79
|
| Rate for Payer: The Alliance Commercial |
$266.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,548.98
|
| Rate for Payer: WPS Commercial |
$466.65
|
|
|
CT Brain w/o Contrast
|
Professional
|
Both
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
1240940
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$66.66 |
| Max. Negotiated Rate |
$2,675.50 |
| Rate for Payer: Aetna Commercial |
$2,675.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.04
|
| Rate for Payer: Aetna Managed Medicare |
$66.66
|
| Rate for Payer: Anthem Medicare Advantage |
$66.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.66
|
| 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 |
$2,675.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,408.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.66
|
| Rate for Payer: Health EOS Commercial |
$2,562.85
|
| Rate for Payer: HFN Commercial |
$2,675.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.66
|
| Rate for Payer: Multiplan Commercial |
$2,253.06
|
| Rate for Payer: NAPHCARE Commercial |
$100.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,675.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,239.18
|
| Rate for Payer: Quartz Commercial |
$1,605.30
|
| Rate for Payer: Quartz Medicare Advantage |
$66.66
|
| Rate for Payer: The Alliance Commercial |
$253.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.66
|
| Rate for Payer: WEA Trust Commercial |
$1,548.98
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
CT Brain w/o Contrast
|
Facility
|
IP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
1240940
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,380.00 |
| Max. Negotiated Rate |
$2,591.01 |
| Rate for Payer: Aetna Commercial |
$2,534.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,422.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,492.65
|
| Rate for Payer: Cash Price |
$812.40
|
| Rate for Payer: Cigna Commercial |
$2,591.01
|
| Rate for Payer: Health EOS Commercial |
$2,506.52
|
| Rate for Payer: HFN Commercial |
$2,591.01
|
| Rate for Payer: Multiplan Commercial |
$2,253.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,591.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,380.00
|
| Rate for Payer: Quartz Commercial |
$1,689.79
|
| Rate for Payer: WEA Trust Commercial |
$1,548.98
|
| Rate for Payer: WPS Commercial |
$2,085.97
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
|
IP
|
$3,362.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
629958
|
| Min. Negotiated Rate |
$1,713.28 |
| Max. Negotiated Rate |
$3,216.76 |
| Rate for Payer: Aetna Commercial |
$3,146.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,853.13
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cigna Commercial |
$3,216.76
|
| Rate for Payer: Health EOS Commercial |
$3,111.87
|
| Rate for Payer: HFN Commercial |
$3,216.76
|
| Rate for Payer: Multiplan Commercial |
$2,797.18
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.28
|
| Rate for Payer: Quartz Commercial |
$2,097.89
|
| Rate for Payer: WEA Trust Commercial |
$1,923.06
|
| Rate for Payer: WPS Commercial |
$2,589.75
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
629958
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,216.76 |
| Rate for Payer: Aetna Commercial |
$3,146.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,272.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,748.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,678.31
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,853.13
|
| 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 |
$1,008.60
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cigna Commercial |
$3,216.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,956.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,111.87
|
| Rate for Payer: HFN Commercial |
$3,216.76
|
| 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 |
$2,797.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,216.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,713.28
|
| Rate for Payer: Quartz Commercial |
$2,272.71
|
| 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 |
$1,923.06
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,589.75
|
|
|
CT Brain w/ + w/o Contrast
|
Professional
|
Both
|
$3,362.00
|
|
|
Service Code
|
CPT 70470
|
| Hospital Charge Code |
629958
|
| Min. Negotiated Rate |
$172.16 |
| Max. Negotiated Rate |
$3,321.66 |
| Rate for Payer: Aetna Commercial |
$3,321.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,006.97
|
| Rate for Payer: Aetna Managed Medicare |
$172.16
|
| Rate for Payer: Anthem Medicare Advantage |
$172.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$172.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$172.16
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cash Price |
$1,008.60
|
| Rate for Payer: Cigna Commercial |
$3,321.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,748.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.16
|
| Rate for Payer: Health EOS Commercial |
$3,181.80
|
| Rate for Payer: HFN Commercial |
$3,321.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$668.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$668.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$2,797.18
|
| Rate for Payer: NAPHCARE Commercial |
$258.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,321.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,538.45
|
| Rate for Payer: Quartz Commercial |
$1,992.99
|
| Rate for Payer: Quartz Medicare Advantage |
$172.16
|
| Rate for Payer: The Alliance Commercial |
$654.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.16
|
| Rate for Payer: WEA Trust Commercial |
$1,923.06
|
| Rate for Payer: WPS Commercial |
$860.81
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240936
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.77 |
| Max. Negotiated Rate |
$3,578.43 |
| Rate for Payer: Aetna Commercial |
$3,500.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,345.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,089.09
|
| 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 |
$2,061.49
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$3,578.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,176.68
|
| Rate for Payer: Health EOS Commercial |
$3,461.74
|
| Rate for Payer: HFN Commercial |
$3,578.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,917.20
|
| Rate for Payer: Multiplan Commercial |
$3,111.68
|
| Rate for Payer: NAPHCARE Commercial |
$2,333.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,578.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.90
|
| Rate for Payer: Quartz Commercial |
$2,528.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,333.76
|
| Rate for Payer: The Alliance Commercial |
$454.77
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,139.28
|
| Rate for Payer: WPS Commercial |
$795.85
|
|
|
CT Brain w/ + w/o Contrast
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240936
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,905.90 |
| Max. Negotiated Rate |
$3,578.43 |
| Rate for Payer: Aetna Commercial |
$3,500.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,345.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,061.49
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$3,578.43
|
| Rate for Payer: Health EOS Commercial |
$3,461.74
|
| Rate for Payer: HFN Commercial |
$3,578.43
|
| Rate for Payer: Multiplan Commercial |
$3,111.68
|
| Rate for Payer: Preferred Network Access Commercial |
$3,578.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,905.90
|
| Rate for Payer: Quartz Commercial |
$2,333.76
|
| Rate for Payer: WEA Trust Commercial |
$2,139.28
|
| Rate for Payer: WPS Commercial |
$2,880.92
|
|
|
CT Brain w/ + w/o Contrast
|
Professional
|
Both
|
$3,740.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240936
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$3,695.12 |
| Rate for Payer: Aetna Commercial |
$3,695.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,345.06
|
| Rate for Payer: Aetna Managed Medicare |
$113.69
|
| Rate for Payer: Anthem Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.69
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cash Price |
$1,122.00
|
| Rate for Payer: Cigna Commercial |
$3,695.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,944.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.69
|
| Rate for Payer: Health EOS Commercial |
$3,539.54
|
| Rate for Payer: HFN Commercial |
$3,695.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$448.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.69
|
| Rate for Payer: Multiplan Commercial |
$3,111.68
|
| Rate for Payer: NAPHCARE Commercial |
$170.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,695.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,711.42
|
| Rate for Payer: Quartz Commercial |
$2,217.07
|
| Rate for Payer: Quartz Medicare Advantage |
$113.69
|
| Rate for Payer: The Alliance Commercial |
$432.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.69
|
| Rate for Payer: WEA Trust Commercial |
$2,139.28
|
| Rate for Payer: WPS Commercial |
$568.46
|
|
|
CT Brain w + w/o Contrast, Sinus LTD w/o
|
Facility
|
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240924
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,835.58 |
| Max. Negotiated Rate |
$3,446.39 |
| Rate for Payer: Aetna Commercial |
$3,371.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,221.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.42
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,446.39
|
| Rate for Payer: Health EOS Commercial |
$3,334.01
|
| Rate for Payer: HFN Commercial |
$3,446.39
|
| Rate for Payer: Multiplan Commercial |
$2,996.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,446.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,835.58
|
| Rate for Payer: Quartz Commercial |
$2,247.65
|
| Rate for Payer: WEA Trust Commercial |
$2,060.34
|
| Rate for Payer: WPS Commercial |
$2,774.62
|
|
|
CT Brain w + w/o Contrast, Sinus LTD w/o
|
Professional
|
Both
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240924
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.69 |
| Max. Negotiated Rate |
$3,558.78 |
| Rate for Payer: Aetna Commercial |
$3,558.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,221.63
|
| Rate for Payer: Aetna Managed Medicare |
$113.69
|
| Rate for Payer: Anthem Medicare Advantage |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.69
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,558.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,873.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.69
|
| Rate for Payer: Health EOS Commercial |
$3,408.93
|
| Rate for Payer: HFN Commercial |
$3,558.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$448.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.69
|
| Rate for Payer: Multiplan Commercial |
$2,996.86
|
| Rate for Payer: NAPHCARE Commercial |
$170.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,648.28
|
| Rate for Payer: Quartz Commercial |
$2,135.27
|
| Rate for Payer: Quartz Medicare Advantage |
$113.69
|
| Rate for Payer: The Alliance Commercial |
$432.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.69
|
| Rate for Payer: WEA Trust Commercial |
$2,060.34
|
| Rate for Payer: WPS Commercial |
$568.46
|
|
|
CT Brain w + w/o Contrast, Sinus LTD w/o
|
Facility
|
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240924
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.77 |
| Max. Negotiated Rate |
$3,446.39 |
| Rate for Payer: Aetna Commercial |
$3,371.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,221.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,048.90
|
| 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 |
$1,985.42
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,446.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,096.36
|
| Rate for Payer: Health EOS Commercial |
$3,334.01
|
| Rate for Payer: HFN Commercial |
$3,446.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,809.56
|
| Rate for Payer: Multiplan Commercial |
$2,996.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,247.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,446.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,835.58
|
| Rate for Payer: Quartz Commercial |
$2,434.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,247.65
|
| Rate for Payer: The Alliance Commercial |
$454.77
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,060.34
|
| Rate for Payer: WPS Commercial |
$795.85
|
|
|
CT Brain w + w/o Contrast, Sinus w/o
|
Facility
|
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240927
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,835.58 |
| Max. Negotiated Rate |
$3,446.39 |
| Rate for Payer: Aetna Commercial |
$3,371.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,221.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,985.42
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,446.39
|
| Rate for Payer: Health EOS Commercial |
$3,334.01
|
| Rate for Payer: HFN Commercial |
$3,446.39
|
| Rate for Payer: Multiplan Commercial |
$2,996.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,446.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,835.58
|
| Rate for Payer: Quartz Commercial |
$2,247.65
|
| Rate for Payer: WEA Trust Commercial |
$2,060.34
|
| Rate for Payer: WPS Commercial |
$2,774.62
|
|
|
CT Brain w + w/o Contrast, Sinus w/o
|
Facility
|
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
1240927
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.77 |
| Max. Negotiated Rate |
$3,446.39 |
| Rate for Payer: Aetna Commercial |
$3,371.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,221.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,048.90
|
| 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 |
$1,985.42
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cash Price |
$1,080.60
|
| Rate for Payer: Cigna Commercial |
$3,446.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,096.36
|
| Rate for Payer: Health EOS Commercial |
$3,334.01
|
| Rate for Payer: HFN Commercial |
$3,446.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,809.56
|
| Rate for Payer: Multiplan Commercial |
$2,996.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,247.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,446.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,835.58
|
| Rate for Payer: Quartz Commercial |
$2,434.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,247.65
|
| Rate for Payer: The Alliance Commercial |
$454.77
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,060.34
|
| Rate for Payer: WPS Commercial |
$795.85
|
|
|
CT Cervical Spine Unenhanced
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
3072649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$334.55 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,130.73
|
| 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 |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,259.91
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,028.74
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,422.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,624.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,422.99
|
| Rate for Payer: The Alliance Commercial |
$334.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$585.46
|
|
|
CT Cervical Spine Unenhanced
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
3072649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,978.78 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,422.99
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT Cervical Spine Unenhanced
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
3072649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.64 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,836.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$83.64
|
| Rate for Payer: Anthem Medicare Advantage |
$83.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.64
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,019.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.64
|
| Rate for Payer: Health EOS Commercial |
$3,674.87
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.64
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$125.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.86
|
| Rate for Payer: Quartz Commercial |
$2,301.84
|
| Rate for Payer: Quartz Medicare Advantage |
$83.64
|
| Rate for Payer: The Alliance Commercial |
$317.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.64
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$418.18
|
|
|
CT Chest, Spine Reformats w/ Contrast
|
Facility
|
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
5551888
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,966.04 |
| Max. Negotiated Rate |
$3,691.33 |
| Rate for Payer: Aetna Commercial |
$3,611.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,450.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,126.53
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,691.33
|
| Rate for Payer: Health EOS Commercial |
$3,570.96
|
| Rate for Payer: HFN Commercial |
$3,691.33
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,691.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.04
|
| Rate for Payer: Quartz Commercial |
$2,407.39
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$2,971.82
|
|
|
CT Chest, Spine Reformats w/ Contrast
|
Facility
|
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
5551888
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$448.12 |
| Max. Negotiated Rate |
$3,691.33 |
| Rate for Payer: Aetna Commercial |
$3,611.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,450.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,123.45
|
| 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 |
$2,126.53
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,691.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,245.36
|
| Rate for Payer: Health EOS Commercial |
$3,570.96
|
| Rate for Payer: HFN Commercial |
$3,691.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,009.24
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,407.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,691.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.04
|
| Rate for Payer: Quartz Commercial |
$2,608.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,407.39
|
| Rate for Payer: The Alliance Commercial |
$448.12
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$784.20
|
|
|
CT Chest, Spine Reformats w/ Contrast
|
Professional
|
Both
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
5551888
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.03 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$3,811.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,450.60
|
| Rate for Payer: Aetna Managed Medicare |
$112.03
|
| Rate for Payer: Anthem Medicare Advantage |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.03
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,811.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,006.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.03
|
| Rate for Payer: Health EOS Commercial |
$3,651.21
|
| Rate for Payer: HFN Commercial |
$3,811.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.03
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: NAPHCARE Commercial |
$168.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,811.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,765.42
|
| Rate for Payer: Quartz Commercial |
$2,287.02
|
| Rate for Payer: Quartz Medicare Advantage |
$112.03
|
| Rate for Payer: The Alliance Commercial |
$425.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.03
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$560.14
|
|
|
CT Chest, Spine Reformats w/o Contrast
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5551891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,617.47 |
| Max. Negotiated Rate |
$3,036.88 |
| Rate for Payer: Aetna Commercial |
$2,970.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,749.51
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,036.88
|
| Rate for Payer: Health EOS Commercial |
$2,937.85
|
| Rate for Payer: HFN Commercial |
$3,036.88
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,617.47
|
| Rate for Payer: Quartz Commercial |
$1,980.58
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$2,444.93
|
|
|
CT Chest, Spine Reformats w/o Contrast
|
Professional
|
Both
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5551891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$3,135.91 |
| Rate for Payer: Aetna Commercial |
$3,135.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Aetna Managed Medicare |
$82.64
|
| Rate for Payer: Anthem Medicare Advantage |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.64
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,135.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,650.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$3,003.87
|
| Rate for Payer: HFN Commercial |
$3,135.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.64
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: NAPHCARE Commercial |
$123.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,135.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.42
|
| Rate for Payer: Quartz Commercial |
$1,881.55
|
| Rate for Payer: Quartz Medicare Advantage |
$82.64
|
| Rate for Payer: The Alliance Commercial |
$314.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.64
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$413.19
|
|
|
CT Chest, Spine Reformats w/o Contrast
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5551891
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,970.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Aetna Managed Medicare |
$924.27
|
| 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 |
$1,749.51
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,036.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,847.27
|
| Rate for Payer: Health EOS Commercial |
$2,937.85
|
| Rate for Payer: HFN Commercial |
$3,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,475.72
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,980.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,617.47
|
| Rate for Payer: Quartz Commercial |
$2,145.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,980.58
|
| Rate for Payer: The Alliance Commercial |
$330.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$578.47
|
|
