|
CT Thorax Unenhanced
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$888.72 |
| Max. Negotiated Rate |
$12,696.00 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Aetna Managed Medicare |
$888.72
|
| 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 |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,776.17
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,380.50
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$2,063.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,904.40
|
| Rate for Payer: The Alliance Commercial |
$12,696.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$2,350.98
|
|
|
CT Thorax w/ Contrast
|
Facility
|
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,890.42 |
| Max. Negotiated Rate |
$3,549.36 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,314.80
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$2,857.62
|
|
|
CT Thorax w/ Contrast
|
Facility
|
IP
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$1,642.97 |
| Max. Negotiated Rate |
$3,084.76 |
| Rate for Payer: Aetna Commercial |
$3,017.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,883.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,777.09
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,084.76
|
| Rate for Payer: Health EOS Commercial |
$2,984.17
|
| Rate for Payer: HFN Commercial |
$3,084.76
|
| Rate for Payer: Multiplan Commercial |
$2,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,011.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,084.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,642.97
|
| Rate for Payer: Quartz Commercial |
$2,011.80
|
| Rate for Payer: WEA Trust Commercial |
$1,844.15
|
| Rate for Payer: WPS Commercial |
$2,483.57
|
|
|
CT Thorax w/ Contrast
|
Professional
|
Both
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$617.29 |
| Max. Negotiated Rate |
$3,185.35 |
| Rate for Payer: Aetna Commercial |
$3,185.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,883.58
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,185.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,676.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,011.80
|
| Rate for Payer: Health EOS Commercial |
$3,051.23
|
| Rate for Payer: HFN Commercial |
$3,185.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$617.29
|
| Rate for Payer: Multiplan Commercial |
$2,682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,185.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.32
|
| Rate for Payer: Quartz Commercial |
$1,911.21
|
| Rate for Payer: The Alliance Commercial |
$1,676.50
|
| Rate for Payer: WEA Trust Commercial |
$1,844.15
|
| Rate for Payer: WPS Commercial |
$2,483.57
|
|
|
CT Thorax w/ Contrast
|
Facility
|
OP
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,084.76 |
| Rate for Payer: Aetna Commercial |
$3,017.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,883.58
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,179.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,609.44
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,777.09
|
| 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 |
$1,005.90
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,084.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,876.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$2,984.17
|
| Rate for Payer: HFN Commercial |
$3,084.76
|
| 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 |
$2,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,084.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,642.97
|
| Rate for Payer: Quartz Commercial |
$2,179.45
|
| 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 |
$1,844.15
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,483.57
|
|
|
CT Thorax w/ Contrast
|
Professional
|
Both
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$422.68 |
| Max. Negotiated Rate |
$3,665.10 |
| Rate for Payer: Aetna Commercial |
$3,665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,665.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,929.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,314.80
|
| Rate for Payer: Health EOS Commercial |
$3,510.78
|
| Rate for Payer: HFN Commercial |
$3,665.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.68
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,665.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,697.52
|
| Rate for Payer: Quartz Commercial |
$2,199.06
|
| Rate for Payer: The Alliance Commercial |
$1,929.00
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$2,857.62
|
|
|
CT Thorax w/ Contrast
|
Facility
|
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,080.24 |
| Max. Negotiated Rate |
$15,432.00 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,080.24
|
| 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 |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,158.94
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.50
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,507.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,314.80
|
| Rate for Payer: The Alliance Commercial |
$15,432.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$2,857.62
|
|
|
CT Thorax w/o Contrast
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
1241288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$888.72 |
| Max. Negotiated Rate |
$12,696.00 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Aetna Managed Medicare |
$888.72
|
| 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 |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,776.17
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,380.50
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$2,063.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,904.40
|
| Rate for Payer: The Alliance Commercial |
$12,696.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$2,350.98
|
|
|
CT Thorax w/o Contrast
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
629704
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$2,601.76 |
| Rate for Payer: Aetna Commercial |
$2,545.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.08
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,838.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,414.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,357.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,498.84
|
| 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 |
$848.40
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$2,601.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,582.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,516.92
|
| Rate for Payer: HFN Commercial |
$2,601.76
|
| 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 |
$2,262.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,601.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,385.72
|
| Rate for Payer: Quartz Commercial |
$1,838.20
|
| 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 |
$1,555.40
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$2,094.70
|
|
|
CT Thorax w/o Contrast
|
Professional
|
Both
|
$2,828.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
629704
|
| Min. Negotiated Rate |
$487.95 |
| Max. Negotiated Rate |
$2,686.60 |
| Rate for Payer: Aetna Commercial |
$2,686.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.08
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$2,686.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,414.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,696.80
|
| Rate for Payer: Health EOS Commercial |
$2,573.48
|
| Rate for Payer: HFN Commercial |
$2,686.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.95
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,244.32
|
| Rate for Payer: Quartz Commercial |
$1,611.96
|
| Rate for Payer: The Alliance Commercial |
$1,414.00
|
| Rate for Payer: WEA Trust Commercial |
$1,555.40
|
| Rate for Payer: WPS Commercial |
$2,094.70
|
|
|
CT Thorax w/o Contrast
|
Professional
|
Both
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
1241288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$307.85 |
| Max. Negotiated Rate |
$3,015.30 |
| Rate for Payer: Aetna Commercial |
$3,015.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,015.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,904.40
|
| Rate for Payer: Health EOS Commercial |
$2,888.34
|
| Rate for Payer: HFN Commercial |
$3,015.30
|
| 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 |
$2,539.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.56
|
| Rate for Payer: Quartz Commercial |
$1,809.18
|
| Rate for Payer: The Alliance Commercial |
$1,587.00
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$2,350.98
|
|
|
CT Thorax w/o Contrast
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
629704
|
| Min. Negotiated Rate |
$1,385.72 |
| Max. Negotiated Rate |
$2,601.76 |
| Rate for Payer: Aetna Commercial |
$2,545.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,432.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,498.84
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$2,601.76
|
| Rate for Payer: Health EOS Commercial |
$2,516.92
|
| Rate for Payer: HFN Commercial |
$2,601.76
|
| Rate for Payer: Multiplan Commercial |
$2,262.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,696.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,601.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,385.72
|
| Rate for Payer: Quartz Commercial |
$1,696.80
|
| Rate for Payer: WEA Trust Commercial |
$1,555.40
|
| Rate for Payer: WPS Commercial |
$2,094.70
|
|
|
CT Thorax w/o Contrast
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
1241288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,555.26 |
| Max. Negotiated Rate |
$2,920.08 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$1,904.40
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$2,350.98
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$731.66 |
| Max. Negotiated Rate |
$3,543.50 |
| Rate for Payer: Aetna Commercial |
$3,543.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,207.80
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,543.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,865.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,238.00
|
| Rate for Payer: Health EOS Commercial |
$3,394.30
|
| Rate for Payer: HFN Commercial |
$3,543.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$731.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$731.66
|
| Rate for Payer: Multiplan Commercial |
$2,984.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,543.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,641.20
|
| Rate for Payer: Quartz Commercial |
$2,126.10
|
| Rate for Payer: The Alliance Commercial |
$1,865.00
|
| Rate for Payer: WEA Trust Commercial |
$2,051.50
|
| Rate for Payer: WPS Commercial |
$2,762.81
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,011.94 |
| Max. Negotiated Rate |
$3,777.52 |
| Rate for Payer: Aetna Commercial |
$3,695.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,531.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,176.18
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,777.52
|
| Rate for Payer: Health EOS Commercial |
$3,654.34
|
| Rate for Payer: HFN Commercial |
$3,777.52
|
| Rate for Payer: Multiplan Commercial |
$3,284.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,463.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,777.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.94
|
| Rate for Payer: Quartz Commercial |
$2,463.60
|
| Rate for Payer: WEA Trust Commercial |
$2,258.30
|
| Rate for Payer: WPS Commercial |
$3,041.31
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,463.72 |
| Max. Negotiated Rate |
$4,625.76 |
| Rate for Payer: Aetna Commercial |
$4,525.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,664.84
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,625.76
|
| Rate for Payer: Health EOS Commercial |
$4,474.92
|
| Rate for Payer: HFN Commercial |
$4,625.76
|
| Rate for Payer: Multiplan Commercial |
$4,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,016.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,625.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.72
|
| Rate for Payer: Quartz Commercial |
$3,016.80
|
| Rate for Payer: WEA Trust Commercial |
$2,765.40
|
| Rate for Payer: WPS Commercial |
$3,724.24
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$3,431.60 |
| Rate for Payer: Aetna Commercial |
$3,357.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,207.80
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,424.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,865.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,790.40
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,976.90
|
| 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 |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,431.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,087.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,319.70
|
| Rate for Payer: HFN Commercial |
$3,431.60
|
| 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 |
$2,984.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,431.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,827.70
|
| Rate for Payer: Quartz Commercial |
$2,424.50
|
| 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 |
$2,051.50
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$2,762.81
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$523.68 |
| Max. Negotiated Rate |
$3,900.70 |
| Rate for Payer: Aetna Commercial |
$3,900.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,531.16
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,900.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,053.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,463.60
|
| Rate for Payer: Health EOS Commercial |
$3,736.46
|
| Rate for Payer: HFN Commercial |
$3,900.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.68
|
| Rate for Payer: Multiplan Commercial |
$3,284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,900.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,806.64
|
| Rate for Payer: Quartz Commercial |
$2,340.42
|
| Rate for Payer: The Alliance Commercial |
$2,053.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.30
|
| Rate for Payer: WPS Commercial |
$3,041.31
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$1,827.70 |
| Max. Negotiated Rate |
$3,431.60 |
| Rate for Payer: Aetna Commercial |
$3,357.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,207.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,976.90
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,431.60
|
| Rate for Payer: Health EOS Commercial |
$3,319.70
|
| Rate for Payer: HFN Commercial |
$3,431.60
|
| Rate for Payer: Multiplan Commercial |
$2,984.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,238.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,431.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,827.70
|
| Rate for Payer: Quartz Commercial |
$2,238.00
|
| Rate for Payer: WEA Trust Commercial |
$2,051.50
|
| Rate for Payer: WPS Commercial |
$2,762.81
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$523.68 |
| Max. Negotiated Rate |
$4,776.60 |
| Rate for Payer: Aetna Commercial |
$4,776.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.08
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,776.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,514.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,016.80
|
| Rate for Payer: Health EOS Commercial |
$4,575.48
|
| Rate for Payer: HFN Commercial |
$4,776.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.68
|
| Rate for Payer: Multiplan Commercial |
$4,022.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,776.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,212.32
|
| Rate for Payer: Quartz Commercial |
$2,865.96
|
| Rate for Payer: The Alliance Commercial |
$2,514.00
|
| Rate for Payer: WEA Trust Commercial |
$2,765.40
|
| Rate for Payer: WPS Commercial |
$3,724.24
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,149.68 |
| Max. Negotiated Rate |
$16,424.00 |
| Rate for Payer: Aetna Commercial |
$3,695.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,531.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,149.68
|
| 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 |
$2,176.18
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,777.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,297.72
|
| Rate for Payer: Health EOS Commercial |
$3,654.34
|
| Rate for Payer: HFN Commercial |
$3,777.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,079.50
|
| Rate for Payer: Multiplan Commercial |
$3,284.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,463.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,777.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.94
|
| Rate for Payer: Quartz Commercial |
$2,668.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,463.60
|
| Rate for Payer: The Alliance Commercial |
$16,424.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,258.30
|
| Rate for Payer: WPS Commercial |
$3,041.31
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,407.84 |
| Max. Negotiated Rate |
$20,112.00 |
| Rate for Payer: Aetna Commercial |
$4,525.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,407.84
|
| 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 |
$2,664.84
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,625.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,813.67
|
| Rate for Payer: Health EOS Commercial |
$4,474.92
|
| Rate for Payer: HFN Commercial |
$4,625.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,771.00
|
| Rate for Payer: Multiplan Commercial |
$4,022.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,016.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,625.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,463.72
|
| Rate for Payer: Quartz Commercial |
$3,268.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,016.80
|
| Rate for Payer: The Alliance Commercial |
$20,112.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,765.40
|
| Rate for Payer: WPS Commercial |
$3,724.24
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241296
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,235.52 |
| Max. Negotiated Rate |
$2,667.60 |
| Rate for Payer: Aetna Commercial |
$2,667.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,667.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,404.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,684.80
|
| Rate for Payer: Health EOS Commercial |
$2,555.28
|
| Rate for Payer: HFN Commercial |
$2,667.60
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,667.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.52
|
| Rate for Payer: Quartz Commercial |
$1,600.56
|
| Rate for Payer: The Alliance Commercial |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
630190
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$5,278.04 |
| Rate for Payer: Aetna Commercial |
$5,163.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,933.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,729.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,868.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,753.76
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,040.61
|
| 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 |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,278.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,210.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$5,105.93
|
| Rate for Payer: HFN Commercial |
$5,278.04
|
| 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 |
$4,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,278.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,811.13
|
| Rate for Payer: Quartz Commercial |
$3,729.05
|
| 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 |
$3,155.35
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$4,249.40
|
|
|
CT Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241296
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$786.24 |
| Max. Negotiated Rate |
$11,232.00 |
| Rate for Payer: Aetna Commercial |
$2,527.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,414.88
|
| Rate for Payer: Aetna Managed Medicare |
$786.24
|
| 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 |
$1,488.24
|
| 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 |
$2,583.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$2,499.12
|
| Rate for Payer: HFN Commercial |
$2,583.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,106.00
|
| Rate for Payer: Multiplan Commercial |
$2,246.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,684.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,583.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,375.92
|
| Rate for Payer: Quartz Commercial |
$1,825.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,684.80
|
| Rate for Payer: The Alliance Commercial |
$11,232.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,544.40
|
| Rate for Payer: WPS Commercial |
$2,079.89
|
|
