|
CT Sinus w/ + w/o Contrast
|
Professional
|
Both
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241230
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$476.09 |
| Max. Negotiated Rate |
$3,757.25 |
| Rate for Payer: Aetna Commercial |
$3,757.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,401.30
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cigna Commercial |
$3,757.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,977.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,373.00
|
| Rate for Payer: Health EOS Commercial |
$3,599.05
|
| Rate for Payer: HFN Commercial |
$3,757.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$476.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$476.09
|
| Rate for Payer: Multiplan Commercial |
$3,164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,757.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.20
|
| Rate for Payer: Quartz Commercial |
$2,254.35
|
| Rate for Payer: The Alliance Commercial |
$1,977.50
|
| Rate for Payer: WEA Trust Commercial |
$2,175.25
|
| Rate for Payer: WPS Commercial |
$2,929.47
|
|
|
CT Sinus w/ + w/o Contrast
|
Facility
|
OP
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241230
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,638.60 |
| Rate for Payer: Aetna Commercial |
$3,559.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,401.30
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,096.15
|
| 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 |
$1,186.50
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cigna Commercial |
$3,638.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,213.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,519.95
|
| Rate for Payer: HFN Commercial |
$3,638.60
|
| 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 |
$3,164.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,638.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,937.95
|
| Rate for Payer: Quartz Commercial |
$2,570.75
|
| 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: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,175.25
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,929.47
|
|
|
CT Soft Tissue Neck Enhanced
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
3072650
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.61 |
| Max. Negotiated Rate |
$3,117.88 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,033.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,033.40
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
CT Soft Tissue Neck Enhanced
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
3072650
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.06 |
| Max. Negotiated Rate |
$3,219.55 |
| Rate for Payer: Aetna Commercial |
$3,219.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,219.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,694.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,033.40
|
| Rate for Payer: Health EOS Commercial |
$3,083.99
|
| Rate for Payer: HFN Commercial |
$3,219.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.06
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,219.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.16
|
| Rate for Payer: Quartz Commercial |
$1,931.73
|
| Rate for Payer: The Alliance Commercial |
$1,694.50
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
CT Soft Tissue Neck Enhanced
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
3072650
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| 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 |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,896.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| 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 |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,202.85
|
| 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: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
OP
|
$3,314.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
630158
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,048.88 |
| Rate for Payer: Aetna Commercial |
$2,982.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,850.04
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,154.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,657.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,590.72
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,756.42
|
| 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 |
$994.20
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,048.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,854.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$2,949.46
|
| Rate for Payer: HFN Commercial |
$3,048.88
|
| 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 |
$2,651.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,048.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,623.86
|
| Rate for Payer: Quartz Commercial |
$2,154.10
|
| 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 |
$1,822.70
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,454.68
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Professional
|
Both
|
$3,314.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
630158
|
| Min. Negotiated Rate |
$683.87 |
| Max. Negotiated Rate |
$3,148.30 |
| Rate for Payer: Aetna Commercial |
$3,148.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,850.04
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,148.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,657.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,988.40
|
| Rate for Payer: Health EOS Commercial |
$3,015.74
|
| Rate for Payer: HFN Commercial |
$3,148.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$683.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.87
|
| Rate for Payer: Multiplan Commercial |
$2,651.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,148.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,458.16
|
| Rate for Payer: Quartz Commercial |
$1,888.98
|
| Rate for Payer: The Alliance Commercial |
$1,657.00
|
| Rate for Payer: WEA Trust Commercial |
$1,822.70
|
| Rate for Payer: WPS Commercial |
$2,454.68
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
IP
|
$3,314.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
630158
|
| Min. Negotiated Rate |
$1,623.86 |
| Max. Negotiated Rate |
$3,048.88 |
| Rate for Payer: Aetna Commercial |
$2,982.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,850.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,756.42
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,048.88
|
| Rate for Payer: Health EOS Commercial |
$2,949.46
|
| Rate for Payer: HFN Commercial |
$3,048.88
|
| Rate for Payer: Multiplan Commercial |
$2,651.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,988.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,048.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,623.86
|
| Rate for Payer: Quartz Commercial |
$1,988.40
|
| Rate for Payer: WEA Trust Commercial |
$1,822.70
|
| Rate for Payer: WPS Commercial |
$2,454.68
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
1241241
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$454.06 |
| Max. Negotiated Rate |
$3,219.55 |
| Rate for Payer: Aetna Commercial |
$3,219.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,219.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,694.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,033.40
|
| Rate for Payer: Health EOS Commercial |
$3,083.99
|
| Rate for Payer: HFN Commercial |
$3,219.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.06
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,219.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,491.16
|
| Rate for Payer: Quartz Commercial |
$1,931.73
|
| Rate for Payer: The Alliance Commercial |
$1,694.50
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
1241241
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| 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 |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,896.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| 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 |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,202.85
|
| 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: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
1241241
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,660.61 |
| Max. Negotiated Rate |
$3,117.88 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,033.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,033.40
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 70490 TC
|
| Hospital Charge Code |
1241243
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,443.05 |
| Max. Negotiated Rate |
$2,709.40 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,767.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 70490 TC
|
| Hospital Charge Code |
1241243
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$339.16 |
| Max. Negotiated Rate |
$2,797.75 |
| Rate for Payer: Aetna Commercial |
$2,797.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,797.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,767.00
|
| Rate for Payer: Health EOS Commercial |
$2,679.95
|
| Rate for Payer: HFN Commercial |
$2,797.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$339.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$339.16
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,797.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.80
|
| Rate for Payer: Quartz Commercial |
$1,678.65
|
| Rate for Payer: The Alliance Commercial |
$1,472.50
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
IP
|
$2,696.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
630160
|
| Min. Negotiated Rate |
$1,321.04 |
| Max. Negotiated Rate |
$2,480.32 |
| Rate for Payer: Aetna Commercial |
$2,426.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.88
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$2,480.32
|
| Rate for Payer: Health EOS Commercial |
$2,399.44
|
| Rate for Payer: HFN Commercial |
$2,480.32
|
| Rate for Payer: Multiplan Commercial |
$2,156.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,617.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,321.04
|
| Rate for Payer: Quartz Commercial |
$1,617.60
|
| Rate for Payer: WEA Trust Commercial |
$1,482.80
|
| Rate for Payer: WPS Commercial |
$1,996.93
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
630160
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,480.32 |
| Rate for Payer: Aetna Commercial |
$2,426.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.56
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,752.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,348.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,294.08
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$2,480.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,508.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,399.44
|
| Rate for Payer: HFN Commercial |
$2,480.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,156.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,321.04
|
| Rate for Payer: Quartz Commercial |
$1,752.40
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,482.80
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,996.93
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Professional
|
Both
|
$2,696.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
630160
|
| Min. Negotiated Rate |
$552.02 |
| Max. Negotiated Rate |
$2,561.20 |
| Rate for Payer: Aetna Commercial |
$2,561.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.56
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$2,561.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,348.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,617.60
|
| Rate for Payer: Health EOS Commercial |
$2,453.36
|
| Rate for Payer: HFN Commercial |
$2,561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$552.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$552.02
|
| Rate for Payer: Multiplan Commercial |
$2,156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,561.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,186.24
|
| Rate for Payer: Quartz Commercial |
$1,536.72
|
| Rate for Payer: The Alliance Commercial |
$1,348.00
|
| Rate for Payer: WEA Trust Commercial |
$1,482.80
|
| Rate for Payer: WPS Commercial |
$1,996.93
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 70490 TC
|
| Hospital Charge Code |
1241243
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$2,650.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,532.70
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| 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: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,709.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,621.05
|
| Rate for Payer: HFN Commercial |
$2,709.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,356.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.05
|
| Rate for Payer: Quartz Commercial |
$1,914.25
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,619.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$2,181.36
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
OP
|
$4,064.00
|
|
|
Service Code
|
CPT 70492 TC
|
| Hospital Charge Code |
1241239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,738.88 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| 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 |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,274.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| 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 |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,641.60
|
| 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: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
630154
|
| Min. Negotiated Rate |
$1,719.90 |
| Max. Negotiated Rate |
$3,229.20 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,018.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$3,229.20
|
| Rate for Payer: Health EOS Commercial |
$3,123.90
|
| Rate for Payer: HFN Commercial |
$3,229.20
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,106.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,229.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,719.90
|
| Rate for Payer: Quartz Commercial |
$2,106.00
|
| Rate for Payer: WEA Trust Commercial |
$1,930.50
|
| Rate for Payer: WPS Commercial |
$2,599.86
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
IP
|
$4,064.00
|
|
|
Service Code
|
CPT 70492 TC
|
| Hospital Charge Code |
1241239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,991.36 |
| Max. Negotiated Rate |
$3,738.88 |
| Rate for Payer: Aetna Commercial |
$3,657.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,153.92
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,738.88
|
| Rate for Payer: Health EOS Commercial |
$3,616.96
|
| Rate for Payer: HFN Commercial |
$3,738.88
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,438.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,738.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,991.36
|
| Rate for Payer: Quartz Commercial |
$2,438.40
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
630154
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,229.20 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,018.60
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,281.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,755.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,684.80
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,860.30
|
| 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 |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$3,229.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,964.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,123.90
|
| Rate for Payer: HFN Commercial |
$3,229.20
|
| 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 |
$2,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,229.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,719.90
|
| Rate for Payer: Quartz Commercial |
$2,281.50
|
| 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 |
$1,930.50
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,599.86
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Professional
|
Both
|
$3,510.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
630154
|
| Min. Negotiated Rate |
$826.27 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Aetna Commercial |
$3,334.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,018.60
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$3,334.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,755.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,106.00
|
| Rate for Payer: Health EOS Commercial |
$3,194.10
|
| Rate for Payer: HFN Commercial |
$3,334.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$826.27
|
| Rate for Payer: Multiplan Commercial |
$2,808.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,334.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.40
|
| Rate for Payer: Quartz Commercial |
$2,000.70
|
| Rate for Payer: The Alliance Commercial |
$1,755.00
|
| Rate for Payer: WEA Trust Commercial |
$1,930.50
|
| Rate for Payer: WPS Commercial |
$2,599.86
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Professional
|
Both
|
$4,064.00
|
|
|
Service Code
|
CPT 70492 TC
|
| Hospital Charge Code |
1241239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$3,860.80 |
| Rate for Payer: Aetna Commercial |
$3,860.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,495.04
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,860.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,032.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,438.40
|
| Rate for Payer: Health EOS Commercial |
$3,698.24
|
| Rate for Payer: HFN Commercial |
$3,860.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$556.15
|
| Rate for Payer: Multiplan Commercial |
$3,251.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,860.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.16
|
| Rate for Payer: Quartz Commercial |
$2,316.48
|
| Rate for Payer: The Alliance Commercial |
$2,032.00
|
| Rate for Payer: WEA Trust Commercial |
$2,235.20
|
| Rate for Payer: WPS Commercial |
$3,010.20
|
|
|
CT Spine Cervical w/ Contrast
|
Facility
|
IP
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$2,098.67 |
| Max. Negotiated Rate |
$3,940.36 |
| Rate for Payer: Aetna Commercial |
$3,854.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,683.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.99
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$3,940.36
|
| Rate for Payer: Health EOS Commercial |
$3,811.87
|
| Rate for Payer: HFN Commercial |
$3,940.36
|
| Rate for Payer: Multiplan Commercial |
$3,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,940.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.67
|
| Rate for Payer: Quartz Commercial |
$2,569.80
|
| Rate for Payer: WEA Trust Commercial |
$2,355.65
|
| Rate for Payer: WPS Commercial |
$3,172.42
|
|
|
CT Spine Cervical w/ Contrast
|
Professional
|
Both
|
$4,364.00
|
|
|
Service Code
|
CPT 72126 TC
|
| Hospital Charge Code |
1241253
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$420.39 |
| Max. Negotiated Rate |
$4,145.80 |
| Rate for Payer: Aetna Commercial |
$4,145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,753.04
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$4,145.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,618.40
|
| Rate for Payer: Health EOS Commercial |
$3,971.24
|
| Rate for Payer: HFN Commercial |
$4,145.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.39
|
| Rate for Payer: Multiplan Commercial |
$3,491.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,145.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,920.16
|
| Rate for Payer: Quartz Commercial |
$2,487.48
|
| Rate for Payer: The Alliance Commercial |
$2,182.00
|
| Rate for Payer: WEA Trust Commercial |
$2,400.20
|
| Rate for Payer: WPS Commercial |
$3,232.41
|
|
