|
CT Chest w/ Contrast R/O PE
|
Professional
|
Both
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
3072660
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.67 |
| Max. Negotiated Rate |
$4,804.64 |
| Rate for Payer: Aetna Commercial |
$4,804.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,804.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,528.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$4,602.34
|
| Rate for Payer: HFN Commercial |
$4,804.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,804.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,225.31
|
| Rate for Payer: Quartz Commercial |
$2,882.79
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
CT Chest w/ Contrast R/O PE
|
Facility
|
IP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
3072660
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,478.18 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,034.51
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$3,745.97
|
|
|
CT Chest w/ Contrast R/O PE
|
Facility
|
OP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
3072660
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$782.66 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,416.11
|
| 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 |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,830.27
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,793.14
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,034.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,287.39
|
| Rate for Payer: Quartz Medicare Advantage |
$3,034.51
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
|
CT Chest w, R/O PE
|
Facility
|
IP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240972
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,478.18 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,034.51
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$3,745.97
|
|
|
CT Chest w, R/O PE
|
Professional
|
Both
|
$4,371.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1238801
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$4,318.55 |
| Rate for Payer: Aetna Commercial |
$4,318.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,909.42
|
| Rate for Payer: Aetna Managed Medicare |
$278.96
|
| Rate for Payer: Anthem Medicare Advantage |
$278.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$278.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$278.96
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna Commercial |
$4,318.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,272.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.96
|
| Rate for Payer: Health EOS Commercial |
$4,136.71
|
| Rate for Payer: HFN Commercial |
$4,318.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,071.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$278.96
|
| Rate for Payer: Multiplan Commercial |
$3,636.67
|
| Rate for Payer: NAPHCARE Commercial |
$418.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,318.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,000.17
|
| Rate for Payer: Quartz Commercial |
$2,591.13
|
| Rate for Payer: Quartz Medicare Advantage |
$278.96
|
| Rate for Payer: The Alliance Commercial |
$1,060.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$278.96
|
| Rate for Payer: WEA Trust Commercial |
$2,500.21
|
| Rate for Payer: WPS Commercial |
$1,394.80
|
|
|
CT Chest w, R/O PE
|
Facility
|
OP
|
$4,371.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1238801
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,182.17 |
| Rate for Payer: Aetna Commercial |
$4,091.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,909.42
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,954.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,272.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,182.00
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,409.30
|
| 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 |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna Commercial |
$4,182.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,543.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$4,045.80
|
| Rate for Payer: HFN Commercial |
$4,182.17
|
| 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 |
$3,636.67
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,182.17
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.46
|
| Rate for Payer: Quartz Commercial |
$2,954.80
|
| 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 |
$2,500.21
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,366.98
|
|
|
CT Chest w, R/O PE
|
Facility
|
IP
|
$4,371.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1238801
|
| Min. Negotiated Rate |
$2,227.46 |
| Max. Negotiated Rate |
$4,182.17 |
| Rate for Payer: Aetna Commercial |
$4,091.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,909.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,409.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna Commercial |
$4,182.17
|
| Rate for Payer: Health EOS Commercial |
$4,045.80
|
| Rate for Payer: HFN Commercial |
$4,182.17
|
| Rate for Payer: Multiplan Commercial |
$3,636.67
|
| Rate for Payer: Preferred Network Access Commercial |
$4,182.17
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.46
|
| Rate for Payer: Quartz Commercial |
$2,727.50
|
| Rate for Payer: WEA Trust Commercial |
$2,500.21
|
| Rate for Payer: WPS Commercial |
$3,366.98
|
|
|
CT Chest w, R/O PE
|
Professional
|
Both
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240972
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.67 |
| Max. Negotiated Rate |
$4,804.64 |
| Rate for Payer: Aetna Commercial |
$4,804.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,804.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,528.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$4,602.34
|
| Rate for Payer: HFN Commercial |
$4,804.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,804.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,225.31
|
| Rate for Payer: Quartz Commercial |
$2,882.79
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
CT Chest w, R/O PE
|
Facility
|
OP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240972
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$782.66 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,416.11
|
| 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 |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,830.27
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,793.14
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,034.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,287.39
|
| Rate for Payer: Quartz Medicare Advantage |
$3,034.51
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1220813
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$366.33 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.33
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$141.28
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 75571 TC
|
| Hospital Charge Code |
1240991
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1220813
|
| Min. Negotiated Rate |
$106.51 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 75571 TC
|
| Hospital Charge Code |
1240991
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$47.17 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$47.17
|
| 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 |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.28
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.36
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$101.09
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: Quartz Medicare Advantage |
$101.09
|
| Rate for Payer: The Alliance Commercial |
$288.37
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$504.65
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 75571 TC
|
| Hospital Charge Code |
1240991
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$72.09 |
| Max. Negotiated Rate |
$360.46 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$72.09
|
| Rate for Payer: Anthem Medicare Advantage |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.09
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.09
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.09
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$108.14
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$72.09
|
| Rate for Payer: The Alliance Commercial |
$273.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$360.46
|
|
|
CT Coronary Calcium Scoring w/o Contrast
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 75571
|
| Hospital Charge Code |
1220813
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$494.36 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$98.87
|
| Rate for Payer: Anthem Medicare Advantage |
$98.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.87
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$206.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.87
|
| Rate for Payer: Health EOS Commercial |
$197.80
|
| Rate for Payer: HFN Commercial |
$206.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$373.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.87
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$148.31
|
| Rate for Payer: Preferred Network Access Commercial |
$206.49
|
| Rate for Payer: Quartz Beloit One Network |
$95.64
|
| Rate for Payer: Quartz Commercial |
$123.90
|
| Rate for Payer: Quartz Medicare Advantage |
$98.87
|
| Rate for Payer: The Alliance Commercial |
$375.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.87
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$494.36
|
|
|
CT Drainage Abscess or Cyst
|
Facility
|
OP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
625642
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$2,106.87 |
| Rate for Payer: Aetna Commercial |
$2,061.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Aetna Managed Medicare |
$641.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,488.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,145.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,099.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.74
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,106.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,281.56
|
| Rate for Payer: Health EOS Commercial |
$2,038.17
|
| Rate for Payer: HFN Commercial |
$2,106.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,717.56
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,106.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.14
|
| Rate for Payer: Quartz Commercial |
$1,488.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,374.05
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$1,696.20
|
|
|
CT Drainage Abscess or Cyst
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240994
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,146.60 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
CT Drainage Abscess or Cyst
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240994
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,223.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,129.40
|
| Rate for Payer: HFN Commercial |
$2,223.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.60
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
CT Drainage Abscess or Cyst
|
Facility
|
IP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
625642
|
| Min. Negotiated Rate |
$1,122.14 |
| Max. Negotiated Rate |
$2,106.87 |
| Rate for Payer: Aetna Commercial |
$2,061.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.74
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,106.87
|
| Rate for Payer: Health EOS Commercial |
$2,038.17
|
| Rate for Payer: HFN Commercial |
$2,106.87
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,106.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.14
|
| Rate for Payer: Quartz Commercial |
$1,374.05
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$1,696.20
|
|
|
CT Drainage Abscess or Cyst
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240994
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$655.20
|
| 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 |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.50
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,521.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.00
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$782.67
|
|
|
CT Drainage Abscess or Cyst
|
Professional
|
Both
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
625642
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,175.58 |
| Rate for Payer: Aetna Commercial |
$2,175.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,175.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,145.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,083.97
|
| Rate for Payer: HFN Commercial |
$2,175.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,175.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.64
|
| Rate for Payer: Quartz Commercial |
$1,305.35
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
CT Drainage Liver
|
Facility
|
OP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
629798
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$2,106.87 |
| Rate for Payer: Aetna Commercial |
$2,061.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Aetna Managed Medicare |
$641.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,488.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,145.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,099.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.74
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,106.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,281.56
|
| Rate for Payer: Health EOS Commercial |
$2,038.17
|
| Rate for Payer: HFN Commercial |
$2,106.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,717.56
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,106.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.14
|
| Rate for Payer: Quartz Commercial |
$1,488.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,374.05
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$1,696.20
|
|
|
CT Drainage Liver
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,223.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,129.40
|
| Rate for Payer: HFN Commercial |
$2,223.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.60
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
CT Drainage Liver
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1240996
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$655.20
|
| 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 |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.50
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,521.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.00
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$782.67
|
|
|
CT Drainage Liver
|
Facility
|
IP
|
$2,202.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
629798
|
| Min. Negotiated Rate |
$1,122.14 |
| Max. Negotiated Rate |
$2,106.87 |
| Rate for Payer: Aetna Commercial |
$2,061.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,969.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.74
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna Commercial |
$2,106.87
|
| Rate for Payer: Health EOS Commercial |
$2,038.17
|
| Rate for Payer: HFN Commercial |
$2,106.87
|
| Rate for Payer: Multiplan Commercial |
$1,832.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,106.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.14
|
| Rate for Payer: Quartz Commercial |
$1,374.05
|
| Rate for Payer: WEA Trust Commercial |
$1,259.54
|
| Rate for Payer: WPS Commercial |
$1,696.20
|
|
