|
CT Pelvis w/o Contrast
|
Professional
|
Both
|
$3,266.00
|
|
|
Service Code
|
CPT 72192 TC
|
| Hospital Charge Code |
1241210
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$307.85 |
| Max. Negotiated Rate |
$3,102.70 |
| Rate for Payer: Aetna Commercial |
$3,102.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,808.76
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cigna Commercial |
$3,102.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,633.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,959.60
|
| Rate for Payer: Health EOS Commercial |
$2,972.06
|
| Rate for Payer: HFN Commercial |
$3,102.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.85
|
| Rate for Payer: Multiplan Commercial |
$2,612.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,102.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,437.04
|
| Rate for Payer: Quartz Commercial |
$1,861.62
|
| Rate for Payer: The Alliance Commercial |
$1,633.00
|
| Rate for Payer: WEA Trust Commercial |
$1,796.30
|
| Rate for Payer: WPS Commercial |
$2,419.13
|
|
|
CT Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
CPT 72194 TC
|
| Hospital Charge Code |
1241206
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$739.82 |
| Max. Negotiated Rate |
$4,283.55 |
| Rate for Payer: Aetna Commercial |
$4,283.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.74
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,283.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,254.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,705.40
|
| Rate for Payer: Health EOS Commercial |
$4,103.19
|
| Rate for Payer: HFN Commercial |
$4,283.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$739.82
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,283.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,983.96
|
| Rate for Payer: Quartz Commercial |
$2,570.13
|
| Rate for Payer: The Alliance Commercial |
$2,254.50
|
| Rate for Payer: WEA Trust Commercial |
$2,479.95
|
| Rate for Payer: WPS Commercial |
$3,339.82
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
630108
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$4,071.92 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.48
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,876.90
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
CT Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
630108
|
| Min. Negotiated Rate |
$942.97 |
| Max. Negotiated Rate |
$4,204.70 |
| Rate for Payer: Aetna Commercial |
$4,204.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,204.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,213.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,655.60
|
| Rate for Payer: Health EOS Commercial |
$4,027.66
|
| Rate for Payer: HFN Commercial |
$4,204.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$942.97
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,204.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,947.44
|
| Rate for Payer: Quartz Commercial |
$2,522.82
|
| Rate for Payer: The Alliance Commercial |
$2,213.00
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$4,509.00
|
|
|
Service Code
|
CPT 72194 TC
|
| Hospital Charge Code |
1241206
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,209.41 |
| Max. Negotiated Rate |
$4,148.28 |
| Rate for Payer: Aetna Commercial |
$4,058.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,389.77
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,148.28
|
| Rate for Payer: Health EOS Commercial |
$4,013.01
|
| Rate for Payer: HFN Commercial |
$4,148.28
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,705.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,148.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.41
|
| Rate for Payer: Quartz Commercial |
$2,705.40
|
| Rate for Payer: WEA Trust Commercial |
$2,479.95
|
| Rate for Payer: WPS Commercial |
$3,339.82
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$4,509.00
|
|
|
Service Code
|
CPT 72194 TC
|
| Hospital Charge Code |
1241206
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,262.52 |
| Max. Negotiated Rate |
$18,036.00 |
| Rate for Payer: Aetna Commercial |
$4,058.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,877.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,262.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,389.77
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,148.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,523.24
|
| Rate for Payer: Health EOS Commercial |
$4,013.01
|
| Rate for Payer: HFN Commercial |
$4,148.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,381.75
|
| Rate for Payer: Multiplan Commercial |
$3,607.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,705.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,148.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,209.41
|
| Rate for Payer: Quartz Commercial |
$2,930.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,705.40
|
| Rate for Payer: The Alliance Commercial |
$18,036.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,479.95
|
| Rate for Payer: WPS Commercial |
$3,339.82
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
630108
|
| Min. Negotiated Rate |
$2,168.74 |
| Max. Negotiated Rate |
$4,071.92 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,655.60
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
CT Perc Nephrostomy Placement
|
Facility
|
IP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
4619016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,323.98 |
| Max. Negotiated Rate |
$2,485.84 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.06
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,485.84
|
| Rate for Payer: Health EOS Commercial |
$2,404.78
|
| Rate for Payer: HFN Commercial |
$2,485.84
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.98
|
| Rate for Payer: Quartz Commercial |
$1,621.20
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
CT Perc Nephrostomy Placement
|
Professional
|
Both
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
4619016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,188.88 |
| Max. Negotiated Rate |
$2,566.90 |
| Rate for Payer: Aetna Commercial |
$2,566.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,566.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,351.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.20
|
| Rate for Payer: Health EOS Commercial |
$2,458.82
|
| Rate for Payer: HFN Commercial |
$2,566.90
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.88
|
| Rate for Payer: Quartz Commercial |
$1,540.14
|
| Rate for Payer: The Alliance Commercial |
$1,351.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
CT Perc Nephrostomy Placement
|
Facility
|
OP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
4619016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$756.56 |
| Max. Negotiated Rate |
$10,808.00 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Aetna Managed Medicare |
$756.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.06
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,485.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.78
|
| Rate for Payer: HFN Commercial |
$2,485.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.50
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.98
|
| Rate for Payer: Quartz Commercial |
$1,756.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.20
|
| Rate for Payer: The Alliance Commercial |
$10,808.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
CT Renal Mass w + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724160
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,268.40 |
| Max. Negotiated Rate |
$18,120.00 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,268.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,400.90
|
| 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 |
$4,167.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.99
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,397.50
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,944.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,718.00
|
| Rate for Payer: The Alliance Commercial |
$18,120.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Renal Mass w + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724160
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$737.52 |
| Max. Negotiated Rate |
$4,303.50 |
| Rate for Payer: Aetna Commercial |
$4,303.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,303.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,718.00
|
| Rate for Payer: Health EOS Commercial |
$4,122.30
|
| Rate for Payer: HFN Commercial |
$4,303.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$737.52
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,303.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,993.20
|
| Rate for Payer: Quartz Commercial |
$2,582.10
|
| Rate for Payer: The Alliance Commercial |
$2,265.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Renal Mass w + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724160
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,219.70 |
| Max. Negotiated Rate |
$4,167.60 |
| Rate for Payer: Aetna Commercial |
$4,077.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,895.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,400.90
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$4,031.70
|
| Rate for Payer: HFN Commercial |
$4,167.60
|
| Rate for Payer: Multiplan Commercial |
$3,624.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,718.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,167.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,219.70
|
| Rate for Payer: Quartz Commercial |
$2,718.00
|
| Rate for Payer: WEA Trust Commercial |
$2,491.50
|
| Rate for Payer: WPS Commercial |
$3,355.37
|
|
|
CT Renal Mass w + w/o, Pelvis w/ Cont
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724163
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,065.00 |
| Max. Negotiated Rate |
$30,148.00 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,110.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,217.71
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,652.75
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,899.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,522.20
|
| Rate for Payer: The Alliance Commercial |
$30,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
CT Renal Mass w + w/o, Pelvis w/ Cont
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724163
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$935.91 |
| Max. Negotiated Rate |
$7,160.15 |
| Rate for Payer: Aetna Commercial |
$7,160.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,160.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,768.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,522.20
|
| Rate for Payer: Health EOS Commercial |
$6,858.67
|
| Rate for Payer: HFN Commercial |
$7,160.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$935.91
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,160.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,316.28
|
| Rate for Payer: Quartz Commercial |
$4,296.09
|
| Rate for Payer: The Alliance Commercial |
$3,768.50
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
CT Renal Mass w + w/o, Pelvis w/ Cont
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724163
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,693.13 |
| Max. Negotiated Rate |
$6,934.04 |
| Rate for Payer: Aetna Commercial |
$6,783.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,481.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,994.61
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$6,934.04
|
| Rate for Payer: Health EOS Commercial |
$6,707.93
|
| Rate for Payer: HFN Commercial |
$6,934.04
|
| Rate for Payer: Multiplan Commercial |
$6,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,934.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,693.13
|
| Rate for Payer: Quartz Commercial |
$4,522.20
|
| Rate for Payer: WEA Trust Commercial |
$4,145.35
|
| Rate for Payer: WPS Commercial |
$5,582.66
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ 30906
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
6230256
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.40 |
| Max. Negotiated Rate |
$770.45 |
| Rate for Payer: Aetna Commercial |
$770.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.46
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$770.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.60
|
| Rate for Payer: Health EOS Commercial |
$738.01
|
| Rate for Payer: HFN Commercial |
$770.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$447.18
|
| Rate for Payer: Multiplan Commercial |
$648.80
|
| Rate for Payer: Preferred Network Access Commercial |
$770.45
|
| Rate for Payer: Quartz Beloit One Network |
$356.84
|
| Rate for Payer: Quartz Commercial |
$462.27
|
| Rate for Payer: The Alliance Commercial |
$405.50
|
| Rate for Payer: United Healthcare Medicaid |
$295.40
|
| Rate for Payer: WEA Trust Commercial |
$446.05
|
| Rate for Payer: WPS Commercial |
$600.71
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ, BILAT 3090650
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
CPT 30906 50
|
| Hospital Charge Code |
6230366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$648.56 |
| Max. Negotiated Rate |
$1,400.30 |
| Rate for Payer: Aetna Commercial |
$1,400.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,267.64
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$1,400.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$737.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$884.40
|
| Rate for Payer: Health EOS Commercial |
$1,341.34
|
| Rate for Payer: HFN Commercial |
$1,400.30
|
| Rate for Payer: Multiplan Commercial |
$1,179.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.30
|
| Rate for Payer: Quartz Beloit One Network |
$648.56
|
| Rate for Payer: Quartz Commercial |
$840.18
|
| Rate for Payer: The Alliance Commercial |
$737.00
|
| Rate for Payer: WEA Trust Commercial |
$810.70
|
| Rate for Payer: WPS Commercial |
$1,091.79
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241218
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,116.28 |
| Max. Negotiated Rate |
$2,410.15 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,410.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.20
|
| Rate for Payer: Health EOS Commercial |
$2,308.67
|
| Rate for Payer: HFN Commercial |
$2,410.15
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,410.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.28
|
| Rate for Payer: Quartz Commercial |
$1,446.09
|
| Rate for Payer: The Alliance Commercial |
$1,268.50
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241218
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,243.13 |
| Max. Negotiated Rate |
$2,334.04 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,522.20
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630136
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,361.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,482.08
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,893.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,361.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630136
|
| Min. Negotiated Rate |
$2,533.79 |
| Max. Negotiated Rate |
$4,757.32 |
| Rate for Payer: Aetna Commercial |
$4,653.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,740.63
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,757.32
|
| Rate for Payer: Health EOS Commercial |
$4,602.19
|
| Rate for Payer: HFN Commercial |
$4,757.32
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,757.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.79
|
| Rate for Payer: Quartz Commercial |
$3,102.60
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630136
|
| Min. Negotiated Rate |
$754.22 |
| Max. Negotiated Rate |
$4,912.45 |
| Rate for Payer: Aetna Commercial |
$4,912.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,447.06
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,912.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,585.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,102.60
|
| Rate for Payer: Health EOS Commercial |
$4,705.61
|
| Rate for Payer: HFN Commercial |
$4,912.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$754.22
|
| Rate for Payer: Multiplan Commercial |
$4,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,912.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,275.24
|
| Rate for Payer: Quartz Commercial |
$2,947.47
|
| Rate for Payer: The Alliance Commercial |
$2,585.50
|
| Rate for Payer: WEA Trust Commercial |
$2,844.05
|
| Rate for Payer: WPS Commercial |
$3,830.16
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241218
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$710.36 |
| Max. Negotiated Rate |
$10,148.00 |
| Rate for Payer: Aetna Commercial |
$2,283.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.82
|
| Rate for Payer: Aetna Managed Medicare |
$710.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.61
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,334.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.71
|
| Rate for Payer: Health EOS Commercial |
$2,257.93
|
| Rate for Payer: HFN Commercial |
$2,334.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.75
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.13
|
| Rate for Payer: Quartz Commercial |
$1,649.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.20
|
| Rate for Payer: The Alliance Commercial |
$10,148.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,395.35
|
| Rate for Payer: WPS Commercial |
$1,879.16
|
|
|
CT Shoulder w/ Contrast Left
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630138
|
| Min. Negotiated Rate |
$1,266.65 |
| Max. Negotiated Rate |
$2,378.20 |
| Rate for Payer: Aetna Commercial |
$2,326.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,223.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,370.05
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,378.20
|
| Rate for Payer: Health EOS Commercial |
$2,300.65
|
| Rate for Payer: HFN Commercial |
$2,378.20
|
| Rate for Payer: Multiplan Commercial |
$2,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,551.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.65
|
| Rate for Payer: Quartz Commercial |
$1,551.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.75
|
| Rate for Payer: WPS Commercial |
$1,914.71
|
|
