|
CT Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630134
|
| Min. Negotiated Rate |
$244.96 |
| Max. Negotiated Rate |
$4,130.83 |
| Rate for Payer: Aetna Commercial |
$4,130.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$244.96
|
| Rate for Payer: Anthem Medicare Advantage |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.96
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,130.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.96
|
| Rate for Payer: Health EOS Commercial |
$3,956.90
|
| Rate for Payer: HFN Commercial |
$4,130.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.96
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$367.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,913.23
|
| Rate for Payer: Quartz Commercial |
$2,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$244.96
|
| Rate for Payer: The Alliance Commercial |
$930.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.96
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$1,224.81
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241216
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.47 |
| Max. Negotiated Rate |
$4,206.90 |
| Rate for Payer: Aetna Commercial |
$4,206.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,206.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,214.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,656.99
|
| Rate for Payer: Health EOS Commercial |
$4,029.77
|
| Rate for Payer: HFN Commercial |
$4,206.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.47
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.46
|
| Rate for Payer: Quartz Commercial |
$2,524.14
|
| Rate for Payer: The Alliance Commercial |
$2,214.16
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630134
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73202
|
| Hospital Charge Code |
630134
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| 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 |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| 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 |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| 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 |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241216
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,239.93 |
| Max. Negotiated Rate |
$4,074.05 |
| Rate for Payer: Aetna Commercial |
$3,985.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.93
|
| 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 |
$2,347.01
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,074.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,478.16
|
| Rate for Payer: Health EOS Commercial |
$3,941.20
|
| Rate for Payer: HFN Commercial |
$4,074.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,321.24
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.88
|
| Rate for Payer: Quartz Commercial |
$2,878.41
|
| Rate for Payer: Quartz Medicare Advantage |
$2,656.99
|
| Rate for Payer: The Alliance Commercial |
$2,214.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73202 TC,RT
|
| Hospital Charge Code |
2980023
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| 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 |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
CPT 73202 RT,TC
|
| Hospital Charge Code |
1241216
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,169.88 |
| Max. Negotiated Rate |
$4,074.05 |
| Rate for Payer: Aetna Commercial |
$3,985.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,808.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,347.01
|
| Rate for Payer: Cash Price |
$1,277.40
|
| Rate for Payer: Cigna Commercial |
$4,074.05
|
| Rate for Payer: Health EOS Commercial |
$3,941.20
|
| Rate for Payer: HFN Commercial |
$4,074.05
|
| Rate for Payer: Multiplan Commercial |
$3,542.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,074.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.88
|
| Rate for Payer: Quartz Commercial |
$2,656.99
|
| Rate for Payer: WEA Trust Commercial |
$2,435.58
|
| Rate for Payer: WPS Commercial |
$3,279.94
|
|
|
CT Sinus w/ Contrast
|
Facility
|
OP
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241232
|
|
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 Sinus w/ Contrast
|
Professional
|
Both
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241232
|
|
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 Sinus w/ Contrast
|
Professional
|
Both
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
661601
|
| 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 Sinus w/ Contrast
|
Facility
|
IP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
661601
|
| 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 Sinus w/ Contrast
|
Facility
|
IP
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241232
|
|
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 Sinus w/ Contrast
|
Facility
|
OP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
661601
|
| 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 Sinus w/o Contrast
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
3072679
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$1,506.70 |
| Rate for Payer: Aetna Commercial |
$1,506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| 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 |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,506.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$793.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.96
|
| Rate for Payer: Health EOS Commercial |
$1,443.26
|
| Rate for Payer: HFN Commercial |
$1,506.70
|
| 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 |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$131.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.70
|
| Rate for Payer: Quartz Beloit One Network |
$697.84
|
| Rate for Payer: Quartz Commercial |
$904.02
|
| 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 |
$872.30
|
| Rate for Payer: WPS Commercial |
$439.82
|
|
|
CT Sinus w/o Contrast
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
661603
|
| 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 Sinus w/o Contrast
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
661603
|
| 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 Sinus w/o Contrast
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
661603
|
| 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 Sinus w/o Contrast
|
Facility
|
OP
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241234
|
|
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 Sinus w/o Contrast
|
Facility
|
IP
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241234
|
|
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 Sinus w/o Contrast
|
Professional
|
Both
|
$2,867.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241234
|
|
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 Sinus w/o Contrast
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
3072679
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$777.14 |
| Max. Negotiated Rate |
$1,459.12 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$1,174.71
|
|
|
CT Sinus w/o Contrast
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
3072679
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$351.85 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$1,427.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.96
|
| Rate for Payer: Aetna Managed Medicare |
$444.08
|
| 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 |
$840.58
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,459.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$887.55
|
| Rate for Payer: Health EOS Commercial |
$1,411.54
|
| Rate for Payer: HFN Commercial |
$1,459.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,189.50
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$951.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,459.12
|
| Rate for Payer: Quartz Beloit One Network |
$777.14
|
| Rate for Payer: Quartz Commercial |
$1,030.90
|
| Rate for Payer: Quartz Medicare Advantage |
$951.60
|
| Rate for Payer: The Alliance Commercial |
$351.85
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$872.30
|
| Rate for Payer: WPS Commercial |
$615.74
|
|
|
CT Sinus w/ + w/o Contrast
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
661599
|
| 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
|
|
