|
CT Lumbar Myelography via Lumbar Inj
|
Facility
|
IP
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,850.87 |
| Max. Negotiated Rate |
$3,475.10 |
| Rate for Payer: Aetna Commercial |
$3,399.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,248.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,001.96
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$3,475.10
|
| Rate for Payer: Health EOS Commercial |
$3,361.78
|
| Rate for Payer: HFN Commercial |
$3,475.10
|
| Rate for Payer: Multiplan Commercial |
$3,021.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,475.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,850.87
|
| Rate for Payer: Quartz Commercial |
$2,266.37
|
| Rate for Payer: WEA Trust Commercial |
$2,077.50
|
| Rate for Payer: WPS Commercial |
$2,797.73
|
|
|
CT Lumbar Spine Unenhanced
|
Facility
|
OP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$331.88 |
| Max. Negotiated Rate |
$3,580.35 |
| Rate for Payer: Aetna Commercial |
$3,502.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,089.67
|
| 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 |
$2,062.59
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,580.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,177.84
|
| Rate for Payer: Health EOS Commercial |
$3,463.60
|
| Rate for Payer: HFN Commercial |
$3,580.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,918.76
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,335.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.92
|
| Rate for Payer: Quartz Commercial |
$2,529.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,335.01
|
| Rate for Payer: The Alliance Commercial |
$331.88
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$580.80
|
|
|
CT Lumbar Spine Unenhanced
|
Professional
|
Both
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.97 |
| Max. Negotiated Rate |
$3,697.10 |
| Rate for Payer: Aetna Commercial |
$3,697.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Aetna Managed Medicare |
$82.97
|
| Rate for Payer: Anthem Medicare Advantage |
$82.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.97
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,697.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,945.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.97
|
| Rate for Payer: Health EOS Commercial |
$3,541.43
|
| Rate for Payer: HFN Commercial |
$3,697.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$321.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.97
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: NAPHCARE Commercial |
$124.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,697.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,712.34
|
| Rate for Payer: Quartz Commercial |
$2,218.26
|
| Rate for Payer: Quartz Medicare Advantage |
$82.97
|
| Rate for Payer: The Alliance Commercial |
$315.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.97
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$414.86
|
|
|
CT Lumbar Spine Unenhanced
|
Facility
|
IP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,906.92 |
| Max. Negotiated Rate |
$3,580.35 |
| Rate for Payer: Aetna Commercial |
$3,502.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,062.59
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,580.35
|
| Rate for Payer: Health EOS Commercial |
$3,463.60
|
| Rate for Payer: HFN Commercial |
$3,580.35
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.92
|
| Rate for Payer: Quartz Commercial |
$2,335.01
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$2,882.46
|
|
|
CT Lung Screening Follow Up 12 Months
|
Professional
|
Both
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$86.07 |
| Max. Negotiated Rate |
$3,345.37 |
| Rate for Payer: Aetna Commercial |
$3,345.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$86.07
|
| Rate for Payer: Anthem Medicare Advantage |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.07
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,345.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.07
|
| Rate for Payer: Health EOS Commercial |
$3,204.51
|
| Rate for Payer: HFN Commercial |
$3,345.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$337.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$337.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.07
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$129.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,549.43
|
| Rate for Payer: Quartz Commercial |
$2,007.22
|
| Rate for Payer: Quartz Medicare Advantage |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$327.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.07
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$430.35
|
|
|
CT Lung Screening Follow Up 12 Months
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Follow Up 12 Months
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| 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 |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$344.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$602.49
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| 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 |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$330.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$578.47
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Professional
|
Both
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$3,345.37 |
| Rate for Payer: Aetna Commercial |
$3,345.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$82.64
|
| Rate for Payer: Anthem Medicare Advantage |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.64
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,345.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$3,204.51
|
| Rate for Payer: HFN Commercial |
$3,345.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.64
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$123.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,549.43
|
| Rate for Payer: Quartz Commercial |
$2,007.22
|
| Rate for Payer: Quartz Medicare Advantage |
$82.64
|
| Rate for Payer: The Alliance Commercial |
$314.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.64
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$413.19
|
|
|
CT Lung Screening Low Dose Initial
|
Professional
|
Both
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595336
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$86.07 |
| Max. Negotiated Rate |
$3,345.37 |
| Rate for Payer: Aetna Commercial |
$3,345.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$86.07
|
| Rate for Payer: Anthem Medicare Advantage |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.07
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,345.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.07
|
| Rate for Payer: Health EOS Commercial |
$3,204.51
|
| Rate for Payer: HFN Commercial |
$3,345.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$337.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$337.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.07
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$129.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,549.43
|
| Rate for Payer: Quartz Commercial |
$2,007.22
|
| Rate for Payer: Quartz Medicare Advantage |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$327.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.07
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$430.35
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595336
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| 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 |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$344.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$602.49
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
IP
|
$3,386.00
|
|
| Hospital Charge Code |
5595337
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
OP
|
$3,386.00
|
|
| Hospital Charge Code |
5595337
|
| Min. Negotiated Rate |
$986.00 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,288.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,760.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,690.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$1,760.72
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595336
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Maxillofacial w/ Contrast
|
Facility
|
OP
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241202
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$394.87 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,095.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,957.78
|
| Rate for Payer: Aetna Managed Medicare |
$963.00
|
| 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 |
$1,822.82
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cigna Commercial |
$3,164.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,924.67
|
| Rate for Payer: Health EOS Commercial |
$3,060.96
|
| Rate for Payer: HFN Commercial |
$3,164.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,579.46
|
| Rate for Payer: Multiplan Commercial |
$2,751.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,063.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,164.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,685.25
|
| Rate for Payer: Quartz Commercial |
$2,235.53
|
| Rate for Payer: Quartz Medicare Advantage |
$2,063.57
|
| Rate for Payer: The Alliance Commercial |
$394.87
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,891.60
|
| Rate for Payer: WPS Commercial |
$691.02
|
|
|
CT Maxillofacial w/ Contrast
|
Professional
|
Both
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
630090
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$3,110.22 |
| Rate for Payer: Aetna Commercial |
$3,110.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Aetna Managed Medicare |
$150.65
|
| Rate for Payer: Anthem Medicare Advantage |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.65
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,110.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,636.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.65
|
| Rate for Payer: Health EOS Commercial |
$2,979.27
|
| Rate for Payer: HFN Commercial |
$3,110.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.65
|
| Rate for Payer: Multiplan Commercial |
$2,619.14
|
| Rate for Payer: NAPHCARE Commercial |
$225.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,110.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,440.52
|
| Rate for Payer: Quartz Commercial |
$1,866.13
|
| Rate for Payer: Quartz Medicare Advantage |
$150.65
|
| Rate for Payer: The Alliance Commercial |
$572.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.65
|
| Rate for Payer: WEA Trust Commercial |
$1,800.66
|
| Rate for Payer: WPS Commercial |
$753.27
|
|
|
CT Maxillofacial w/ Contrast
|
Facility
|
IP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
630090
|
| Min. Negotiated Rate |
$1,604.22 |
| Max. Negotiated Rate |
$3,012.01 |
| Rate for Payer: Aetna Commercial |
$2,946.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.18
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,012.01
|
| Rate for Payer: Health EOS Commercial |
$2,913.79
|
| Rate for Payer: HFN Commercial |
$3,012.01
|
| Rate for Payer: Multiplan Commercial |
$2,619.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.22
|
| Rate for Payer: Quartz Commercial |
$1,964.35
|
| Rate for Payer: WEA Trust Commercial |
$1,800.66
|
| Rate for Payer: WPS Commercial |
$2,424.90
|
|
|
CT Maxillofacial w/ Contrast
|
Facility
|
OP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
630090
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,012.01 |
| Rate for Payer: Aetna Commercial |
$2,946.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,636.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,571.48
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.18
|
| 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 |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,012.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,832.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,913.79
|
| Rate for Payer: HFN Commercial |
$3,012.01
|
| 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 |
$2,619.14
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.22
|
| Rate for Payer: Quartz Commercial |
$2,128.05
|
| 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 |
$1,800.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,424.90
|
|
|
CT Maxillofacial w/ Contrast
|
Professional
|
Both
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241202
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$3,267.32 |
| Rate for Payer: Aetna Commercial |
$3,267.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,957.78
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Medicare Advantage |
$98.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.72
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cigna Commercial |
$3,267.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,719.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.72
|
| Rate for Payer: Health EOS Commercial |
$3,129.74
|
| Rate for Payer: HFN Commercial |
$3,267.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$388.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.72
|
| Rate for Payer: Multiplan Commercial |
$2,751.42
|
| Rate for Payer: NAPHCARE Commercial |
$148.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.28
|
| Rate for Payer: Quartz Commercial |
$1,960.39
|
| Rate for Payer: Quartz Medicare Advantage |
$98.72
|
| Rate for Payer: The Alliance Commercial |
$375.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.72
|
| Rate for Payer: WEA Trust Commercial |
$1,891.60
|
| Rate for Payer: WPS Commercial |
$493.58
|
|
|
CT Maxillofacial w/ Contrast
|
Facility
|
IP
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241202
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,685.25 |
| Max. Negotiated Rate |
$3,164.14 |
| Rate for Payer: Aetna Commercial |
$3,095.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,957.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,822.82
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cigna Commercial |
$3,164.14
|
| Rate for Payer: Health EOS Commercial |
$3,060.96
|
| Rate for Payer: HFN Commercial |
$3,164.14
|
| Rate for Payer: Multiplan Commercial |
$2,751.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,164.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,685.25
|
| Rate for Payer: Quartz Commercial |
$2,063.57
|
| Rate for Payer: WEA Trust Commercial |
$1,891.60
|
| Rate for Payer: WPS Commercial |
$2,547.38
|
|
|
CT Maxillofacial w/o Contrast
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
630094
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,499.16 |
| Rate for Payer: Aetna Commercial |
$2,444.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.17
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,765.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,358.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,303.91
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.73
|
| 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 |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,499.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,520.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,417.67
|
| Rate for Payer: HFN Commercial |
$2,499.16
|
| 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 |
$2,173.18
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.08
|
| Rate for Payer: Quartz Commercial |
$1,765.71
|
| 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 |
$1,494.06
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,012.02
|
|
|
CT Maxillofacial w/o Contrast
|
Professional
|
Both
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241204
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$2,832.60 |
| Rate for Payer: Aetna Commercial |
$2,832.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,564.24
|
| Rate for Payer: Aetna Managed Medicare |
$87.96
|
| Rate for Payer: Anthem Medicare Advantage |
$87.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.96
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cigna Commercial |
$2,832.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,490.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.96
|
| Rate for Payer: Health EOS Commercial |
$2,713.33
|
| Rate for Payer: HFN Commercial |
$2,832.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$340.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.96
|
| Rate for Payer: Multiplan Commercial |
$2,385.34
|
| Rate for Payer: NAPHCARE Commercial |
$131.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,832.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,311.94
|
| Rate for Payer: Quartz Commercial |
$1,699.56
|
| Rate for Payer: Quartz Medicare Advantage |
$87.96
|
| Rate for Payer: The Alliance Commercial |
$334.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.96
|
| Rate for Payer: WEA Trust Commercial |
$1,639.92
|
| Rate for Payer: WPS Commercial |
$439.82
|
|
|
CT Maxillofacial w/o Contrast
|
Facility
|
OP
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241204
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$351.85 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,683.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,564.24
|
| Rate for Payer: Aetna Managed Medicare |
$834.87
|
| 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 |
$1,580.29
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,668.59
|
| Rate for Payer: Health EOS Commercial |
$2,653.70
|
| Rate for Payer: HFN Commercial |
$2,743.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,236.26
|
| Rate for Payer: Multiplan Commercial |
$2,385.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,789.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,743.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.02
|
| Rate for Payer: Quartz Commercial |
$1,938.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,789.01
|
| Rate for Payer: The Alliance Commercial |
$351.85
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,639.92
|
| Rate for Payer: WPS Commercial |
$615.74
|
|
|
CT Maxillofacial w/o Contrast
|
Facility
|
IP
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241204
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,461.02 |
| Max. Negotiated Rate |
$2,743.15 |
| Rate for Payer: Aetna Commercial |
$2,683.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,564.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.29
|
| Rate for Payer: Cash Price |
$860.10
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: Health EOS Commercial |
$2,653.70
|
| Rate for Payer: HFN Commercial |
$2,743.15
|
| Rate for Payer: Multiplan Commercial |
$2,385.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,743.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.02
|
| Rate for Payer: Quartz Commercial |
$1,789.01
|
| Rate for Payer: WEA Trust Commercial |
$1,639.92
|
| Rate for Payer: WPS Commercial |
$2,208.45
|
|
