|
CT Pelvis w/o Contrast
|
Professional
|
Both
|
$3,266.00
|
|
|
Service Code
|
CPT 72192 TC
|
| Hospital Charge Code |
1241210
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.31 |
| Max. Negotiated Rate |
$3,226.81 |
| Rate for Payer: Aetna Commercial |
$3,226.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,921.11
|
| Rate for Payer: Aetna Managed Medicare |
$82.31
|
| Rate for Payer: Anthem Medicare Advantage |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.31
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cigna Commercial |
$3,226.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.31
|
| Rate for Payer: Health EOS Commercial |
$3,090.94
|
| Rate for Payer: HFN Commercial |
$3,226.81
|
| 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 |
$82.31
|
| Rate for Payer: Multiplan Commercial |
$2,717.31
|
| Rate for Payer: NAPHCARE Commercial |
$123.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,226.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.52
|
| Rate for Payer: Quartz Commercial |
$1,936.08
|
| Rate for Payer: Quartz Medicare Advantage |
$82.31
|
| Rate for Payer: The Alliance Commercial |
$312.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.31
|
| Rate for Payer: WEA Trust Commercial |
$1,868.15
|
| Rate for Payer: WPS Commercial |
$411.53
|
|
|
CT Pelvis w/o Contrast
|
Professional
|
Both
|
$2,918.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
630114
|
| Min. Negotiated Rate |
$132.08 |
| Max. Negotiated Rate |
$2,882.98 |
| Rate for Payer: Aetna Commercial |
$2,882.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,609.86
|
| Rate for Payer: Aetna Managed Medicare |
$132.08
|
| Rate for Payer: Anthem Medicare Advantage |
$132.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.08
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,882.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,517.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.08
|
| Rate for Payer: Health EOS Commercial |
$2,761.60
|
| Rate for Payer: HFN Commercial |
$2,882.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.08
|
| Rate for Payer: Multiplan Commercial |
$2,427.78
|
| Rate for Payer: NAPHCARE Commercial |
$198.12
|
| Rate for Payer: Preferred Network Access Commercial |
$2,882.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,335.28
|
| Rate for Payer: Quartz Commercial |
$1,729.79
|
| Rate for Payer: Quartz Medicare Advantage |
$132.08
|
| Rate for Payer: The Alliance Commercial |
$501.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.08
|
| Rate for Payer: WEA Trust Commercial |
$1,669.10
|
| Rate for Payer: WPS Commercial |
$660.40
|
|
|
CT Pelvis w/o Contrast
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 72192 TC
|
| Hospital Charge Code |
1241210
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$329.22 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,056.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,921.11
|
| Rate for Payer: Aetna Managed Medicare |
$951.06
|
| 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 |
$1,800.22
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cash Price |
$979.80
|
| Rate for Payer: Cigna Commercial |
$3,124.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.81
|
| Rate for Payer: Health EOS Commercial |
$3,023.01
|
| Rate for Payer: HFN Commercial |
$3,124.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,547.48
|
| Rate for Payer: Multiplan Commercial |
$2,717.31
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.98
|
| 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 |
$2,207.82
|
| Rate for Payer: Quartz Medicare Advantage |
$2,037.98
|
| Rate for Payer: The Alliance Commercial |
$329.22
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,868.15
|
| Rate for Payer: WPS Commercial |
$576.14
|
|
|
CT Pelvis w/o Contrast
|
Facility
|
OP
|
$2,918.00
|
|
|
Service Code
|
CPT 72192
|
| Hospital Charge Code |
630114
|
| Min. Negotiated Rate |
$110.02 |
| 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: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,972.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,517.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,456.67
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,608.40
|
| 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 |
$875.40
|
| Rate for Payer: Cash Price |
$875.40
|
| Rate for Payer: Cigna Commercial |
$2,791.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,698.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,700.90
|
| Rate for Payer: HFN Commercial |
$2,791.94
|
| 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 |
$2,427.78
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| 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 |
$1,972.57
|
| 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 |
$1,669.10
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,247.74
|
|
|
CT Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
630108
|
| Min. Negotiated Rate |
$249.29 |
| Max. Negotiated Rate |
$4,372.89 |
| Rate for Payer: Aetna Commercial |
$4,372.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$249.29
|
| Rate for Payer: Anthem Medicare Advantage |
$249.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$249.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$249.29
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,372.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,301.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.29
|
| Rate for Payer: Health EOS Commercial |
$4,188.77
|
| Rate for Payer: HFN Commercial |
$4,372.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$980.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$980.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$249.29
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$373.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,372.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,025.34
|
| Rate for Payer: Quartz Commercial |
$2,623.73
|
| Rate for Payer: Quartz Medicare Advantage |
$249.29
|
| Rate for Payer: The Alliance Commercial |
$947.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$249.29
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$1,246.44
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
630108
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| 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 |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| 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 |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| 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 |
$2,531.67
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$4,509.00
|
|
|
Service Code
|
CPT 72194 TC
|
| Hospital Charge Code |
1241206
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,297.79 |
| Max. Negotiated Rate |
$4,314.21 |
| Rate for Payer: Aetna Commercial |
$4,220.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,032.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,485.36
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,314.21
|
| Rate for Payer: Health EOS Commercial |
$4,173.53
|
| Rate for Payer: HFN Commercial |
$4,314.21
|
| Rate for Payer: Multiplan Commercial |
$3,751.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,314.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,297.79
|
| Rate for Payer: Quartz Commercial |
$2,813.62
|
| Rate for Payer: WEA Trust Commercial |
$2,579.15
|
| Rate for Payer: WPS Commercial |
$3,473.28
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$4,509.00
|
|
|
Service Code
|
CPT 72194 TC
|
| Hospital Charge Code |
1241206
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$772.89 |
| Max. Negotiated Rate |
$4,314.21 |
| Rate for Payer: Aetna Commercial |
$4,220.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,032.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,313.02
|
| 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 |
$2,485.36
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,314.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,624.24
|
| Rate for Payer: Health EOS Commercial |
$4,173.53
|
| Rate for Payer: HFN Commercial |
$4,314.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,517.02
|
| Rate for Payer: Multiplan Commercial |
$3,751.49
|
| Rate for Payer: NAPHCARE Commercial |
$2,813.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,314.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,297.79
|
| Rate for Payer: Quartz Commercial |
$3,048.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,813.62
|
| Rate for Payer: The Alliance Commercial |
$772.89
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,579.15
|
| Rate for Payer: WPS Commercial |
$1,352.55
|
|
|
CT Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 72194
|
| Hospital Charge Code |
630108
|
| Min. Negotiated Rate |
$2,255.49 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,761.82
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
CT Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$4,509.00
|
|
|
Service Code
|
CPT 72194 TC
|
| Hospital Charge Code |
1241206
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.22 |
| Max. Negotiated Rate |
$4,454.89 |
| Rate for Payer: Aetna Commercial |
$4,454.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,032.85
|
| Rate for Payer: Aetna Managed Medicare |
$193.22
|
| Rate for Payer: Anthem Medicare Advantage |
$193.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.22
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cash Price |
$1,352.70
|
| Rate for Payer: Cigna Commercial |
$4,454.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,344.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.22
|
| Rate for Payer: Health EOS Commercial |
$4,267.32
|
| Rate for Payer: HFN Commercial |
$4,454.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$769.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$769.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.22
|
| Rate for Payer: Multiplan Commercial |
$3,751.49
|
| Rate for Payer: NAPHCARE Commercial |
$289.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,454.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,063.32
|
| Rate for Payer: Quartz Commercial |
$2,672.94
|
| Rate for Payer: Quartz Medicare Advantage |
$193.22
|
| Rate for Payer: The Alliance Commercial |
$734.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.22
|
| Rate for Payer: WEA Trust Commercial |
$2,579.15
|
| Rate for Payer: WPS Commercial |
$966.11
|
|
|
CT Perc Nephrostomy Placement
|
Facility
|
OP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
4619016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$786.82 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,529.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.67
|
| Rate for Payer: Aetna Managed Medicare |
$786.82
|
| 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 |
$1,489.34
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,585.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,500.97
|
| Rate for Payer: HFN Commercial |
$2,585.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,107.56
|
| Rate for Payer: Multiplan Commercial |
$2,248.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.94
|
| Rate for Payer: Quartz Commercial |
$1,826.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,686.05
|
| Rate for Payer: The Alliance Commercial |
$1,405.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,545.54
|
| Rate for Payer: WPS Commercial |
$2,081.35
|
|
|
CT Perc Nephrostomy Placement
|
Professional
|
Both
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
4619016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$683.21 |
| Max. Negotiated Rate |
$2,669.58 |
| Rate for Payer: Aetna Commercial |
$2,669.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.67
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,669.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,686.05
|
| Rate for Payer: Health EOS Commercial |
$2,557.17
|
| Rate for Payer: HFN Commercial |
$2,669.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$2,248.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.44
|
| Rate for Payer: Quartz Commercial |
$1,601.75
|
| Rate for Payer: The Alliance Commercial |
$1,405.04
|
| Rate for Payer: United Healthcare Medicaid |
$683.21
|
| Rate for Payer: WEA Trust Commercial |
$1,545.54
|
| Rate for Payer: WPS Commercial |
$2,081.35
|
|
|
CT Perc Nephrostomy Placement
|
Facility
|
IP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 TC
|
| Hospital Charge Code |
4619016
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,376.94 |
| Max. Negotiated Rate |
$2,585.27 |
| Rate for Payer: Aetna Commercial |
$2,529.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.34
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,585.27
|
| Rate for Payer: Health EOS Commercial |
$2,500.97
|
| Rate for Payer: HFN Commercial |
$2,585.27
|
| Rate for Payer: Multiplan Commercial |
$2,248.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.94
|
| Rate for Payer: Quartz Commercial |
$1,686.05
|
| Rate for Payer: WEA Trust Commercial |
$1,545.54
|
| Rate for Payer: WPS Commercial |
$2,081.35
|
|
|
CT Renal Mass w + w/o Contrast
|
Facility
|
IP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724160
|
|
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 Renal Mass w + w/o Contrast
|
Professional
|
Both
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724160
|
|
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 Renal Mass w + w/o Contrast
|
Facility
|
OP
|
$4,530.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
5724160
|
|
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 Renal Mass w + w/o, Pelvis w/ Cont
|
Professional
|
Both
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724163
|
|
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 Renal Mass w + w/o, Pelvis w/ Cont
|
Facility
|
OP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724163
|
|
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 Renal Mass w + w/o, Pelvis w/ Cont
|
Facility
|
IP
|
$7,537.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
5724163
|
|
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
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ 30906
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
CPT 30906
|
| Hospital Charge Code |
6230256
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$801.27 |
| Rate for Payer: Aetna Commercial |
$801.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$725.36
|
| Rate for Payer: Aetna Managed Medicare |
$112.58
|
| Rate for Payer: Anthem Medicare Advantage |
$112.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.58
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cash Price |
$243.30
|
| Rate for Payer: Cigna Commercial |
$801.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.58
|
| Rate for Payer: Health EOS Commercial |
$767.53
|
| Rate for Payer: HFN Commercial |
$801.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$465.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.58
|
| Rate for Payer: Multiplan Commercial |
$674.75
|
| Rate for Payer: NAPHCARE Commercial |
$168.87
|
| Rate for Payer: Preferred Network Access Commercial |
$801.27
|
| Rate for Payer: Quartz Beloit One Network |
$371.11
|
| Rate for Payer: Quartz Commercial |
$480.76
|
| Rate for Payer: Quartz Medicare Advantage |
$112.58
|
| Rate for Payer: The Alliance Commercial |
$478.46
|
| Rate for Payer: United Healthcare Medicaid |
$307.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.58
|
| Rate for Payer: WEA Trust Commercial |
$463.89
|
| Rate for Payer: WPS Commercial |
$506.61
|
|
|
CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ, BILAT 3090650
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
CPT 30906 50
|
| Hospital Charge Code |
6230366
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$307.22 |
| Max. Negotiated Rate |
$1,456.31 |
| Rate for Payer: Aetna Commercial |
$1,456.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,318.35
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cash Price |
$442.20
|
| Rate for Payer: Cigna Commercial |
$1,456.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.78
|
| Rate for Payer: Health EOS Commercial |
$1,394.99
|
| Rate for Payer: HFN Commercial |
$1,456.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$465.07
|
| Rate for Payer: Multiplan Commercial |
$1,226.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,456.31
|
| Rate for Payer: Quartz Beloit One Network |
$674.50
|
| Rate for Payer: Quartz Commercial |
$873.79
|
| Rate for Payer: The Alliance Commercial |
$766.48
|
| Rate for Payer: United Healthcare Medicaid |
$307.22
|
| Rate for Payer: WEA Trust Commercial |
$843.13
|
| Rate for Payer: WPS Commercial |
$1,135.42
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
IP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630136
|
| Min. Negotiated Rate |
$2,635.14 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,226.70
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241218
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$738.77 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Aetna Managed Medicare |
$738.77
|
| 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 |
$1,398.39
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,427.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,476.53
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,583.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,715.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,583.09
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241218
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$2,506.56 |
| Rate for Payer: Aetna Commercial |
$2,506.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,506.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,319.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,583.09
|
| Rate for Payer: Health EOS Commercial |
$2,401.02
|
| Rate for Payer: HFN Commercial |
$2,506.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,506.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.93
|
| Rate for Payer: Quartz Commercial |
$1,503.93
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
CT Shoulder w/ Contrast Bilateral
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
630136
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,495.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,688.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,581.36
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,009.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,495.60
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
