|
CT Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
629938
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| 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 |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| 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 |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| 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 |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Hand w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241100
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980021
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| 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 |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Head/Brain Combined
|
Professional
|
Both
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
3072654
|
|
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 Head/Brain Combined
|
Facility
|
OP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
3072654
|
|
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 Head/Brain Combined
|
Facility
|
IP
|
$3,602.00
|
|
|
Service Code
|
CPT 70470 TC
|
| Hospital Charge Code |
3072654
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,835.58 |
| 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 Head/Brain Unenhanced
|
Facility
|
IP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
2950237
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,380.00 |
| 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 Head/Brain Unenhanced
|
Facility
|
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
2950237
|
|
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 Head/Brain Unenhanced
|
Professional
|
Both
|
$2,708.00
|
|
|
Service Code
|
CPT 70450 TC
|
| Hospital Charge Code |
2950237
|
|
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 Head or Brain w/ Contrast
|
Facility
|
OP
|
$3,060.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
629962
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,068.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,591.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,527.55
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| 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 |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,780.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| 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 |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$2,068.56
|
| 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 |
$1,750.32
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
CT Head or Brain w/ Contrast
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
629962
|
| Min. Negotiated Rate |
$147.33 |
| Max. Negotiated Rate |
$3,023.28 |
| Rate for Payer: Aetna Commercial |
$3,023.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Aetna Managed Medicare |
$147.33
|
| Rate for Payer: Anthem Medicare Advantage |
$147.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.33
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$3,023.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,591.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.33
|
| Rate for Payer: Health EOS Commercial |
$2,895.98
|
| Rate for Payer: HFN Commercial |
$3,023.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.33
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: NAPHCARE Commercial |
$220.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,023.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,400.26
|
| Rate for Payer: Quartz Commercial |
$1,813.97
|
| Rate for Payer: Quartz Medicare Advantage |
$147.33
|
| Rate for Payer: The Alliance Commercial |
$559.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.33
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$736.63
|
|
|
CT Head or Brain w/ Contrast
|
Facility
|
IP
|
$3,060.00
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
629962
|
| Min. Negotiated Rate |
$1,559.38 |
| Max. Negotiated Rate |
$2,927.81 |
| Rate for Payer: Aetna Commercial |
$2,864.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,736.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,686.67
|
| Rate for Payer: Cash Price |
$918.00
|
| Rate for Payer: Cigna Commercial |
$2,927.81
|
| Rate for Payer: Health EOS Commercial |
$2,832.34
|
| Rate for Payer: HFN Commercial |
$2,927.81
|
| Rate for Payer: Multiplan Commercial |
$2,545.92
|
| Rate for Payer: Preferred Network Access Commercial |
$2,927.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,559.38
|
| Rate for Payer: Quartz Commercial |
$1,909.44
|
| Rate for Payer: WEA Trust Commercial |
$1,750.32
|
| Rate for Payer: WPS Commercial |
$2,357.12
|
|
|
CT Head or Brain w/o Contrast
|
Facility
|
IP
|
$2,362.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
629966
|
| Min. Negotiated Rate |
$1,203.68 |
| Max. Negotiated Rate |
$2,259.96 |
| Rate for Payer: Aetna Commercial |
$2,210.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,112.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.93
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,259.96
|
| Rate for Payer: Health EOS Commercial |
$2,186.27
|
| Rate for Payer: HFN Commercial |
$2,259.96
|
| Rate for Payer: Multiplan Commercial |
$1,965.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,203.68
|
| Rate for Payer: Quartz Commercial |
$1,473.89
|
| Rate for Payer: WEA Trust Commercial |
$1,351.06
|
| Rate for Payer: WPS Commercial |
$1,819.45
|
|
|
CT Head or Brain w/o Contrast
|
Facility
|
OP
|
$2,362.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
629966
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,259.96 |
| Rate for Payer: Aetna Commercial |
$2,210.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,112.57
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,596.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,228.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,179.11
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,301.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,259.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,374.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,186.27
|
| Rate for Payer: HFN Commercial |
$2,259.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,965.18
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,203.68
|
| Rate for Payer: Quartz Commercial |
$1,596.71
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$1,351.06
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,819.45
|
|
|
CT Head or Brain w/o Contrast
|
Professional
|
Both
|
$2,362.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
629966
|
| Min. Negotiated Rate |
$106.02 |
| Max. Negotiated Rate |
$2,333.66 |
| Rate for Payer: Aetna Commercial |
$2,333.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,112.57
|
| Rate for Payer: Aetna Managed Medicare |
$106.02
|
| Rate for Payer: Anthem Medicare Advantage |
$106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.02
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cash Price |
$708.60
|
| Rate for Payer: Cigna Commercial |
$2,333.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,228.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.02
|
| Rate for Payer: Health EOS Commercial |
$2,235.40
|
| Rate for Payer: HFN Commercial |
$2,333.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$404.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.02
|
| Rate for Payer: Multiplan Commercial |
$1,965.18
|
| Rate for Payer: NAPHCARE Commercial |
$159.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.85
|
| Rate for Payer: Quartz Commercial |
$1,400.19
|
| Rate for Payer: Quartz Medicare Advantage |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$402.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.02
|
| Rate for Payer: WEA Trust Commercial |
$1,351.06
|
| Rate for Payer: WPS Commercial |
$530.09
|
|
|
CT Heart No Contrast Quant Eval Coronry Calcium 7557126
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
CPT 75571 26
|
| Hospital Charge Code |
5152628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$790.40 |
| Rate for Payer: Aetna Commercial |
$790.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$26.78
|
| Rate for Payer: Anthem Medicare Advantage |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.78
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$790.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$416.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.78
|
| Rate for Payer: Health EOS Commercial |
$757.12
|
| Rate for Payer: HFN Commercial |
$790.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.78
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.17
|
| Rate for Payer: Preferred Network Access Commercial |
$790.40
|
| Rate for Payer: Quartz Beloit One Network |
$366.08
|
| Rate for Payer: Quartz Commercial |
$474.24
|
| Rate for Payer: Quartz Medicare Advantage |
$26.78
|
| Rate for Payer: The Alliance Commercial |
$101.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.78
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$133.90
|
|
|
CT Hemo/ Urogram w + w/o Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724145
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$974.31 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Aetna Managed Medicare |
$2,194.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.53
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,878.86
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,703.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$5,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,703.09
|
| Rate for Payer: The Alliance Commercial |
$974.31
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$1,705.05
|
|
|
CT Hemo/ Urogram w + w/o Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724145
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$243.58 |
| Max. Negotiated Rate |
$7,446.56 |
| Rate for Payer: Aetna Commercial |
$7,446.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Aetna Managed Medicare |
$243.58
|
| Rate for Payer: Anthem Medicare Advantage |
$243.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.58
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,446.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,919.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.58
|
| Rate for Payer: Health EOS Commercial |
$7,133.02
|
| Rate for Payer: HFN Commercial |
$7,446.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$973.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$973.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.58
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$365.37
|
| Rate for Payer: Preferred Network Access Commercial |
$7,446.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.93
|
| Rate for Payer: Quartz Commercial |
$4,467.93
|
| Rate for Payer: Quartz Medicare Advantage |
$243.58
|
| Rate for Payer: The Alliance Commercial |
$925.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.58
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$1,217.89
|
|
|
CT Hemo/ Urogram w + w/o Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724145
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,840.86 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$4,703.09
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241126
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,430.96 |
| Max. Negotiated Rate |
$2,686.69 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629978
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,878.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,983.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.91
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| 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 |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| 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 |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,878.21
|
| 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 |
$3,281.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
|
CT Hip w/ Contrast Bilateral
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241126
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,774.30 |
| Rate for Payer: Aetna Commercial |
$2,774.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,774.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,460.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.19
|
| Rate for Payer: Health EOS Commercial |
$2,657.49
|
| Rate for Payer: HFN Commercial |
$2,774.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.94
|
| Rate for Payer: Quartz Commercial |
$1,664.58
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Hip w/ Contrast Bilateral
|
Professional
|
Both
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629978
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$5,668.16 |
| Rate for Payer: Aetna Commercial |
$5,668.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,668.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,983.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$5,429.50
|
| Rate for Payer: HFN Commercial |
$5,668.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,668.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.25
|
| Rate for Payer: Quartz Commercial |
$3,400.89
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241126
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.69
|
| 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 |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,634.26
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,190.24
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,898.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,752.19
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Hip w/ Contrast Bilateral
|
Facility
|
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629978
|
| Min. Negotiated Rate |
$2,923.58 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,579.89
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
