|
CT Maxillofacial w/o Contrast
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
630094
|
| Min. Negotiated Rate |
$127.64 |
| Max. Negotiated Rate |
$2,580.66 |
| Rate for Payer: Aetna Commercial |
$2,580.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.17
|
| Rate for Payer: Aetna Managed Medicare |
$127.64
|
| Rate for Payer: Anthem Medicare Advantage |
$127.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.64
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,580.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,358.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.64
|
| Rate for Payer: Health EOS Commercial |
$2,472.00
|
| Rate for Payer: HFN Commercial |
$2,580.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$488.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.64
|
| Rate for Payer: Multiplan Commercial |
$2,173.18
|
| Rate for Payer: NAPHCARE Commercial |
$191.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.25
|
| Rate for Payer: Quartz Commercial |
$1,548.39
|
| Rate for Payer: Quartz Medicare Advantage |
$127.64
|
| Rate for Payer: The Alliance Commercial |
$485.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.64
|
| Rate for Payer: WEA Trust Commercial |
$1,494.06
|
| Rate for Payer: WPS Commercial |
$638.20
|
|
|
CT Maxillofacial w/o Contrast
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
630094
|
| Min. Negotiated Rate |
$1,331.08 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.73
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,499.16
|
| Rate for Payer: Health EOS Commercial |
$2,417.67
|
| Rate for Payer: HFN Commercial |
$2,499.16
|
| Rate for Payer: Multiplan Commercial |
$2,173.18
|
| 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 |
$1,629.89
|
| Rate for Payer: WEA Trust Commercial |
$1,494.06
|
| Rate for Payer: WPS Commercial |
$2,012.02
|
|
|
CT Maxillofacial w/ + w/o Contrast
|
Facility
|
OP
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241200
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$498.70 |
| Max. Negotiated Rate |
$3,784.14 |
| Rate for Payer: Aetna Commercial |
$3,701.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,537.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,151.70
|
| 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 |
$2,180.00
|
| 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 |
$3,784.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,301.81
|
| Rate for Payer: Health EOS Commercial |
$3,660.75
|
| Rate for Payer: HFN Commercial |
$3,784.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,084.90
|
| Rate for Payer: Multiplan Commercial |
$3,290.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,467.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,784.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,015.47
|
| Rate for Payer: Quartz Commercial |
$2,673.58
|
| Rate for Payer: Quartz Medicare Advantage |
$2,467.92
|
| Rate for Payer: The Alliance Commercial |
$498.70
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,262.26
|
| Rate for Payer: WPS Commercial |
$872.73
|
|
|
CT Maxillofacial w/ + w/o Contrast
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
630086
|
| Min. Negotiated Rate |
$1,978.78 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,422.99
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT Maxillofacial w/ + w/o Contrast
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
630086
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,624.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,019.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,938.39
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,259.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,624.91
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT Maxillofacial w/ + w/o Contrast
|
Professional
|
Both
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241200
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$3,907.54 |
| Rate for Payer: Aetna Commercial |
$3,907.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,537.35
|
| Rate for Payer: Aetna Managed Medicare |
$124.68
|
| Rate for Payer: Anthem Medicare Advantage |
$124.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.68
|
| 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 |
$3,907.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,056.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.68
|
| Rate for Payer: Health EOS Commercial |
$3,743.01
|
| Rate for Payer: HFN Commercial |
$3,907.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$495.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$495.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.68
|
| Rate for Payer: Multiplan Commercial |
$3,290.56
|
| Rate for Payer: NAPHCARE Commercial |
$187.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,907.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,809.81
|
| Rate for Payer: Quartz Commercial |
$2,344.52
|
| Rate for Payer: Quartz Medicare Advantage |
$124.68
|
| Rate for Payer: The Alliance Commercial |
$473.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.68
|
| Rate for Payer: WEA Trust Commercial |
$2,262.26
|
| Rate for Payer: WPS Commercial |
$623.38
|
|
|
CT Maxillofacial w/ + w/o Contrast
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
630086
|
| Min. Negotiated Rate |
$183.13 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,836.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$183.13
|
| Rate for Payer: Anthem Medicare Advantage |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$183.13
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,019.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.13
|
| Rate for Payer: Health EOS Commercial |
$3,674.87
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$183.13
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$274.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.86
|
| Rate for Payer: Quartz Commercial |
$2,301.84
|
| Rate for Payer: Quartz Medicare Advantage |
$183.13
|
| Rate for Payer: The Alliance Commercial |
$695.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.13
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$915.67
|
|
|
CT Maxillofacial w/ + w/o Contrast
|
Facility
|
IP
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241200
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,015.47 |
| Max. Negotiated Rate |
$3,784.14 |
| Rate for Payer: Aetna Commercial |
$3,701.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,537.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,180.00
|
| Rate for Payer: Cash Price |
$1,186.50
|
| Rate for Payer: Cigna Commercial |
$3,784.14
|
| Rate for Payer: Health EOS Commercial |
$3,660.75
|
| Rate for Payer: HFN Commercial |
$3,784.14
|
| Rate for Payer: Multiplan Commercial |
$3,290.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,784.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,015.47
|
| Rate for Payer: Quartz Commercial |
$2,467.92
|
| Rate for Payer: WEA Trust Commercial |
$2,262.26
|
| Rate for Payer: WPS Commercial |
$3,046.54
|
|
|
CT Maxiofacial Unenhanced
|
Professional
|
Both
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
3072764
|
|
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 Maxiofacial Unenhanced
|
Facility
|
IP
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
3072764
|
|
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
|
|
|
CT Maxiofacial Unenhanced
|
Facility
|
OP
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
3072764
|
|
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 Pancreas w + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724154
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$4,475.64 |
| Rate for Payer: Aetna Commercial |
$4,475.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Aetna Managed Medicare |
$193.55
|
| Rate for Payer: Anthem Medicare Advantage |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.55
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,475.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,355.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.55
|
| Rate for Payer: Health EOS Commercial |
$4,287.19
|
| Rate for Payer: HFN Commercial |
$4,475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$767.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.55
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: NAPHCARE Commercial |
$290.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,475.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,072.93
|
| Rate for Payer: Quartz Commercial |
$2,685.38
|
| Rate for Payer: Quartz Medicare Advantage |
$193.55
|
| Rate for Payer: The Alliance Commercial |
$735.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.55
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$967.77
|
|
|
CT Pancreas w + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724154
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,308.49 |
| Max. Negotiated Rate |
$4,334.30 |
| Rate for Payer: Aetna Commercial |
$4,240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,496.94
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,334.30
|
| Rate for Payer: Health EOS Commercial |
$4,192.97
|
| Rate for Payer: HFN Commercial |
$4,334.30
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.49
|
| Rate for Payer: Quartz Commercial |
$2,826.72
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$3,489.46
|
|
|
CT Pancreas w + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724154
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$774.22 |
| Max. Negotiated Rate |
$4,334.30 |
| Rate for Payer: Aetna Commercial |
$4,240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,051.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,319.14
|
| 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 |
$2,496.94
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cash Price |
$1,359.00
|
| Rate for Payer: Cigna Commercial |
$4,334.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,636.46
|
| Rate for Payer: Health EOS Commercial |
$4,192.97
|
| Rate for Payer: HFN Commercial |
$4,334.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,533.40
|
| Rate for Payer: Multiplan Commercial |
$3,768.96
|
| Rate for Payer: NAPHCARE Commercial |
$2,826.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,334.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.49
|
| Rate for Payer: Quartz Commercial |
$3,062.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,826.72
|
| Rate for Payer: The Alliance Commercial |
$774.22
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,591.16
|
| Rate for Payer: WPS Commercial |
$1,354.88
|
|
|
CT Pancreas w + w/o, Pelvis w/ Contrast
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724157
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$243.58 |
| Max. Negotiated Rate |
$7,446.56 |
| Rate for Payer: Aetna Commercial |
$7,446.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Aetna Managed Medicare |
$243.58
|
| Rate for Payer: Anthem Medicare Advantage |
$243.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.58
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,446.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,919.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.58
|
| Rate for Payer: Health EOS Commercial |
$7,133.02
|
| Rate for Payer: HFN Commercial |
$7,446.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$973.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$973.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.58
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$365.37
|
| Rate for Payer: Preferred Network Access Commercial |
$7,446.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,448.93
|
| Rate for Payer: Quartz Commercial |
$4,467.93
|
| Rate for Payer: Quartz Medicare Advantage |
$243.58
|
| Rate for Payer: The Alliance Commercial |
$925.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.58
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$1,217.89
|
|
|
CT Pancreas w + w/o, Pelvis w/ Contrast
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724157
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$974.31 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Aetna Managed Medicare |
$2,194.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.53
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,878.86
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,703.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$5,095.01
|
| Rate for Payer: Quartz Medicare Advantage |
$4,703.09
|
| Rate for Payer: The Alliance Commercial |
$974.31
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$1,705.05
|
|
|
CT Pancreas w + w/o, Pelvis w/ Contrast
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724157
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,840.86 |
| Max. Negotiated Rate |
$7,211.40 |
| Rate for Payer: Aetna Commercial |
$7,054.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,741.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,154.39
|
| Rate for Payer: Cash Price |
$2,261.10
|
| Rate for Payer: Cigna Commercial |
$7,211.40
|
| Rate for Payer: Health EOS Commercial |
$6,976.25
|
| Rate for Payer: HFN Commercial |
$7,211.40
|
| Rate for Payer: Multiplan Commercial |
$6,270.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,211.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.86
|
| Rate for Payer: Quartz Commercial |
$4,703.09
|
| Rate for Payer: WEA Trust Commercial |
$4,311.16
|
| Rate for Payer: WPS Commercial |
$5,805.75
|
|
|
CT Pelvis w/ Contrast
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
630112
|
| Min. Negotiated Rate |
$224.58 |
| Max. Negotiated Rate |
$3,124.06 |
| Rate for Payer: Aetna Commercial |
$3,124.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,828.09
|
| Rate for Payer: Aetna Managed Medicare |
$224.58
|
| Rate for Payer: Anthem Medicare Advantage |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$224.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$224.58
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna Commercial |
$3,124.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,644.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.58
|
| Rate for Payer: Health EOS Commercial |
$2,992.52
|
| Rate for Payer: HFN Commercial |
$3,124.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$880.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$880.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$224.58
|
| Rate for Payer: Multiplan Commercial |
$2,630.78
|
| Rate for Payer: NAPHCARE Commercial |
$336.87
|
| Rate for Payer: Preferred Network Access Commercial |
$3,124.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.93
|
| Rate for Payer: Quartz Commercial |
$1,874.43
|
| Rate for Payer: Quartz Medicare Advantage |
$224.58
|
| Rate for Payer: The Alliance Commercial |
$853.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$224.58
|
| Rate for Payer: WEA Trust Commercial |
$1,808.66
|
| Rate for Payer: WPS Commercial |
$1,122.89
|
|
|
CT Pelvis w/ Contrast
|
Professional
|
Both
|
$3,719.00
|
|
|
Service Code
|
CPT 72193 TC
|
| Hospital Charge Code |
1241208
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$171.27 |
| Max. Negotiated Rate |
$3,674.37 |
| Rate for Payer: Aetna Commercial |
$3,674.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Aetna Managed Medicare |
$171.27
|
| Rate for Payer: Anthem Medicare Advantage |
$171.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.27
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,674.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,933.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$3,519.66
|
| Rate for Payer: HFN Commercial |
$3,674.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$679.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$679.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: NAPHCARE Commercial |
$256.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,674.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.81
|
| Rate for Payer: Quartz Commercial |
$2,204.62
|
| Rate for Payer: Quartz Medicare Advantage |
$171.27
|
| Rate for Payer: The Alliance Commercial |
$650.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.27
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$856.34
|
|
|
CT Pelvis w/ Contrast
|
Facility
|
OP
|
$3,719.00
|
|
|
Service Code
|
CPT 72193 TC
|
| Hospital Charge Code |
1241208
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$685.07 |
| Max. Negotiated Rate |
$3,558.34 |
| Rate for Payer: Aetna Commercial |
$3,480.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,082.97
|
| 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 |
$2,049.91
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,558.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,164.46
|
| Rate for Payer: Health EOS Commercial |
$3,442.31
|
| Rate for Payer: HFN Commercial |
$3,558.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,900.82
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,320.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.20
|
| Rate for Payer: Quartz Commercial |
$2,514.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,320.66
|
| Rate for Payer: The Alliance Commercial |
$685.07
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$1,198.87
|
|
|
CT Pelvis w/ Contrast
|
Facility
|
IP
|
$3,719.00
|
|
|
Service Code
|
CPT 72193 TC
|
| Hospital Charge Code |
1241208
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,895.20 |
| Max. Negotiated Rate |
$3,558.34 |
| Rate for Payer: Aetna Commercial |
$3,480.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,326.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,049.91
|
| Rate for Payer: Cash Price |
$1,115.70
|
| Rate for Payer: Cigna Commercial |
$3,558.34
|
| Rate for Payer: Health EOS Commercial |
$3,442.31
|
| Rate for Payer: HFN Commercial |
$3,558.34
|
| Rate for Payer: Multiplan Commercial |
$3,094.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,558.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.20
|
| Rate for Payer: Quartz Commercial |
$2,320.66
|
| Rate for Payer: WEA Trust Commercial |
$2,127.27
|
| Rate for Payer: WPS Commercial |
$2,864.75
|
|
|
CT Pelvis w/ Contrast
|
Facility
|
OP
|
$3,162.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
630112
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,025.40 |
| Rate for Payer: Aetna Commercial |
$2,959.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,828.09
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,137.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,644.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,578.47
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.89
|
| 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 |
$948.60
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna Commercial |
$3,025.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,840.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,926.75
|
| Rate for Payer: HFN Commercial |
$3,025.40
|
| 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 |
$2,630.78
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,025.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,611.36
|
| Rate for Payer: Quartz Commercial |
$2,137.51
|
| 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 |
$1,808.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,435.69
|
|
|
CT Pelvis w/ Contrast
|
Facility
|
IP
|
$3,162.00
|
|
|
Service Code
|
CPT 72193
|
| Hospital Charge Code |
630112
|
| Min. Negotiated Rate |
$1,611.36 |
| Max. Negotiated Rate |
$3,025.40 |
| Rate for Payer: Aetna Commercial |
$2,959.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,828.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,742.89
|
| Rate for Payer: Cash Price |
$948.60
|
| Rate for Payer: Cigna Commercial |
$3,025.40
|
| Rate for Payer: Health EOS Commercial |
$2,926.75
|
| Rate for Payer: HFN Commercial |
$3,025.40
|
| Rate for Payer: Multiplan Commercial |
$2,630.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,025.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,611.36
|
| Rate for Payer: Quartz Commercial |
$1,973.09
|
| Rate for Payer: WEA Trust Commercial |
$1,808.66
|
| Rate for Payer: WPS Commercial |
$2,435.69
|
|
|
CT Pelvis w/o Contrast
|
Facility
|
IP
|
$2,918.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
630114
|
| Min. Negotiated Rate |
$1,487.01 |
| Max. Negotiated Rate |
$2,791.94 |
| Rate for Payer: Aetna Commercial |
$2,731.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,609.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,608.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,791.94
|
| Rate for Payer: Health EOS Commercial |
$2,700.90
|
| Rate for Payer: HFN Commercial |
$2,791.94
|
| Rate for Payer: Multiplan Commercial |
$2,427.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,791.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,487.01
|
| Rate for Payer: Quartz Commercial |
$1,820.83
|
| Rate for Payer: WEA Trust Commercial |
$1,669.10
|
| Rate for Payer: WPS Commercial |
$2,247.74
|
|
|
CT Pelvis w/o Contrast
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 72192 TC
|
| Hospital Charge Code |
1241210
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,664.35 |
| Max. Negotiated Rate |
$3,124.91 |
| Rate for Payer: Aetna Commercial |
$3,056.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,921.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,800.22
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cigna Commercial |
$3,124.91
|
| Rate for Payer: Health EOS Commercial |
$3,023.01
|
| Rate for Payer: HFN Commercial |
$3,124.91
|
| Rate for Payer: Multiplan Commercial |
$2,717.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,124.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.35
|
| Rate for Payer: Quartz Commercial |
$2,037.98
|
| Rate for Payer: WEA Trust Commercial |
$1,868.15
|
| Rate for Payer: WPS Commercial |
$2,515.80
|
|
