|
CT Sinus w/ + w/o Contrast
|
Facility
|
OP
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241230
|
|
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 Sinus w/ + w/o Contrast
|
Professional
|
Both
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241230
|
|
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 Sinus w/ + w/o Contrast
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
661599
|
| 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 Sinus w/ + w/o Contrast
|
Facility
|
IP
|
$3,955.00
|
|
|
Service Code
|
CPT 70488 TC
|
| Hospital Charge Code |
1241230
|
|
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 Sinus w/ + w/o Contrast
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
661599
|
| 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 Soft Tissue Neck Enhanced
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
3072650
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$3,348.33 |
| Rate for Payer: Aetna Commercial |
$3,348.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Aetna Managed Medicare |
$119.02
|
| Rate for Payer: Anthem Medicare Advantage |
$119.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,348.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,762.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.02
|
| Rate for Payer: Health EOS Commercial |
$3,207.35
|
| Rate for Payer: HFN Commercial |
$3,348.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.02
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: NAPHCARE Commercial |
$178.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,348.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,550.81
|
| Rate for Payer: Quartz Commercial |
$2,009.00
|
| Rate for Payer: Quartz Medicare Advantage |
$119.02
|
| Rate for Payer: The Alliance Commercial |
$452.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.02
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$595.09
|
|
|
CT Soft Tissue Neck Enhanced
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
3072650
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$476.07 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Aetna Managed Medicare |
$986.88
|
| 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 |
$1,868.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,242.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,972.40
|
| Rate for Payer: Health EOS Commercial |
$3,136.86
|
| Rate for Payer: HFN Commercial |
$3,242.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,643.42
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: NAPHCARE Commercial |
$2,114.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,242.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.03
|
| Rate for Payer: Quartz Commercial |
$2,290.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,114.74
|
| Rate for Payer: The Alliance Commercial |
$476.07
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$833.12
|
|
|
CT Soft Tissue Neck Enhanced
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
3072650
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,727.03 |
| Max. Negotiated Rate |
$3,242.60 |
| Rate for Payer: Aetna Commercial |
$3,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,868.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,242.60
|
| Rate for Payer: Health EOS Commercial |
$3,136.86
|
| Rate for Payer: HFN Commercial |
$3,242.60
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,242.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.03
|
| Rate for Payer: Quartz Commercial |
$2,114.74
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$2,610.55
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
OP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
1241241
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$476.07 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Aetna Managed Medicare |
$986.88
|
| 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 |
$1,868.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,242.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,972.40
|
| Rate for Payer: Health EOS Commercial |
$3,136.86
|
| Rate for Payer: HFN Commercial |
$3,242.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,643.42
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: NAPHCARE Commercial |
$2,114.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,242.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.03
|
| Rate for Payer: Quartz Commercial |
$2,290.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,114.74
|
| Rate for Payer: The Alliance Commercial |
$476.07
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$833.12
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
OP
|
$3,314.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
630158
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,170.84 |
| Rate for Payer: Aetna Commercial |
$3,101.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,240.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,723.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,654.35
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.68
|
| 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 |
$994.20
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,170.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,928.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,067.44
|
| Rate for Payer: HFN Commercial |
$3,170.84
|
| 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 |
$2,757.25
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,170.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,688.81
|
| Rate for Payer: Quartz Commercial |
$2,240.26
|
| 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 |
$1,895.61
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,552.77
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Professional
|
Both
|
$3,314.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
630158
|
| Min. Negotiated Rate |
$182.63 |
| Max. Negotiated Rate |
$3,274.23 |
| Rate for Payer: Aetna Commercial |
$3,274.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Aetna Managed Medicare |
$182.63
|
| Rate for Payer: Anthem Medicare Advantage |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$182.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$182.63
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,274.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,723.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.63
|
| Rate for Payer: Health EOS Commercial |
$3,136.37
|
| Rate for Payer: HFN Commercial |
$3,274.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$711.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$711.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$182.63
|
| Rate for Payer: Multiplan Commercial |
$2,757.25
|
| Rate for Payer: NAPHCARE Commercial |
$273.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,274.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,516.49
|
| Rate for Payer: Quartz Commercial |
$1,964.54
|
| Rate for Payer: Quartz Medicare Advantage |
$182.63
|
| Rate for Payer: The Alliance Commercial |
$694.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.63
|
| Rate for Payer: WEA Trust Commercial |
$1,895.61
|
| Rate for Payer: WPS Commercial |
$913.17
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Professional
|
Both
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
1241241
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$119.02 |
| Max. Negotiated Rate |
$3,348.33 |
| Rate for Payer: Aetna Commercial |
$3,348.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Aetna Managed Medicare |
$119.02
|
| Rate for Payer: Anthem Medicare Advantage |
$119.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,348.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,762.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.02
|
| Rate for Payer: Health EOS Commercial |
$3,207.35
|
| Rate for Payer: HFN Commercial |
$3,348.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.02
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: NAPHCARE Commercial |
$178.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,348.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,550.81
|
| Rate for Payer: Quartz Commercial |
$2,009.00
|
| Rate for Payer: Quartz Medicare Advantage |
$119.02
|
| Rate for Payer: The Alliance Commercial |
$452.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.02
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$595.09
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
IP
|
$3,314.00
|
|
|
Service Code
|
CPT 70491
|
| Hospital Charge Code |
630158
|
| Min. Negotiated Rate |
$1,688.81 |
| Max. Negotiated Rate |
$3,170.84 |
| Rate for Payer: Aetna Commercial |
$3,101.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,964.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,826.68
|
| Rate for Payer: Cash Price |
$994.20
|
| Rate for Payer: Cigna Commercial |
$3,170.84
|
| Rate for Payer: Health EOS Commercial |
$3,067.44
|
| Rate for Payer: HFN Commercial |
$3,170.84
|
| Rate for Payer: Multiplan Commercial |
$2,757.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,170.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,688.81
|
| Rate for Payer: Quartz Commercial |
$2,067.94
|
| Rate for Payer: WEA Trust Commercial |
$1,895.61
|
| Rate for Payer: WPS Commercial |
$2,552.77
|
|
|
CT Soft Tissue Neck w/ Contrast
|
Facility
|
IP
|
$3,389.00
|
|
|
Service Code
|
CPT 70491 TC
|
| Hospital Charge Code |
1241241
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,727.03 |
| Max. Negotiated Rate |
$3,242.60 |
| Rate for Payer: Aetna Commercial |
$3,172.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,031.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,868.02
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,242.60
|
| Rate for Payer: Health EOS Commercial |
$3,136.86
|
| Rate for Payer: HFN Commercial |
$3,242.60
|
| Rate for Payer: Multiplan Commercial |
$2,819.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,242.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,727.03
|
| Rate for Payer: Quartz Commercial |
$2,114.74
|
| Rate for Payer: WEA Trust Commercial |
$1,938.51
|
| Rate for Payer: WPS Commercial |
$2,610.55
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
CPT 70490 TC
|
| Hospital Charge Code |
1241243
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$359.84 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$857.58
|
| 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 |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,713.99
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,297.10
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,837.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,990.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,837.68
|
| Rate for Payer: The Alliance Commercial |
$359.84
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$629.72
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Professional
|
Both
|
$2,696.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
630160
|
| Min. Negotiated Rate |
$149.10 |
| Max. Negotiated Rate |
$2,663.65 |
| Rate for Payer: Aetna Commercial |
$2,663.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.30
|
| Rate for Payer: Aetna Managed Medicare |
$149.10
|
| Rate for Payer: Anthem Medicare Advantage |
$149.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$149.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$149.10
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$2,663.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,401.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.10
|
| Rate for Payer: Health EOS Commercial |
$2,551.49
|
| Rate for Payer: HFN Commercial |
$2,663.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$574.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$149.10
|
| Rate for Payer: Multiplan Commercial |
$2,243.07
|
| Rate for Payer: NAPHCARE Commercial |
$223.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,663.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,233.69
|
| Rate for Payer: Quartz Commercial |
$1,598.19
|
| Rate for Payer: Quartz Medicare Advantage |
$149.10
|
| Rate for Payer: The Alliance Commercial |
$566.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.10
|
| Rate for Payer: WEA Trust Commercial |
$1,542.11
|
| Rate for Payer: WPS Commercial |
$745.52
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
OP
|
$2,696.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
630160
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,579.53 |
| Rate for Payer: Aetna Commercial |
$2,523.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.30
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,822.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,401.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,345.84
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.04
|
| 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 |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$2,579.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,569.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,495.42
|
| Rate for Payer: HFN Commercial |
$2,579.53
|
| 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 |
$2,243.07
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,579.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.88
|
| Rate for Payer: Quartz Commercial |
$1,822.50
|
| 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 |
$1,542.11
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,076.73
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Professional
|
Both
|
$2,945.00
|
|
|
Service Code
|
CPT 70490 TC
|
| Hospital Charge Code |
1241243
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$2,909.66 |
| Rate for Payer: Aetna Commercial |
$2,909.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Aetna Managed Medicare |
$89.96
|
| Rate for Payer: Anthem Medicare Advantage |
$89.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.96
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,909.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,531.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.96
|
| Rate for Payer: Health EOS Commercial |
$2,787.15
|
| Rate for Payer: HFN Commercial |
$2,909.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$352.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$352.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.96
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: NAPHCARE Commercial |
$134.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,909.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.63
|
| Rate for Payer: Quartz Commercial |
$1,745.80
|
| Rate for Payer: Quartz Medicare Advantage |
$89.96
|
| Rate for Payer: The Alliance Commercial |
$341.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.96
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$449.80
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
IP
|
$2,696.00
|
|
|
Service Code
|
CPT 70490
|
| Hospital Charge Code |
630160
|
| Min. Negotiated Rate |
$1,373.88 |
| Max. Negotiated Rate |
$2,579.53 |
| Rate for Payer: Aetna Commercial |
$2,523.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,411.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,486.04
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cigna Commercial |
$2,579.53
|
| Rate for Payer: Health EOS Commercial |
$2,495.42
|
| Rate for Payer: HFN Commercial |
$2,579.53
|
| Rate for Payer: Multiplan Commercial |
$2,243.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,579.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,373.88
|
| Rate for Payer: Quartz Commercial |
$1,682.30
|
| Rate for Payer: WEA Trust Commercial |
$1,542.11
|
| Rate for Payer: WPS Commercial |
$2,076.73
|
|
|
CT Soft Tissue Neck w/o Contrast
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
CPT 70490 TC
|
| Hospital Charge Code |
1241243
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,500.77 |
| Max. Negotiated Rate |
$2,817.78 |
| Rate for Payer: Aetna Commercial |
$2,756.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,634.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,623.28
|
| Rate for Payer: Cash Price |
$883.50
|
| Rate for Payer: Cigna Commercial |
$2,817.78
|
| Rate for Payer: Health EOS Commercial |
$2,725.89
|
| Rate for Payer: HFN Commercial |
$2,817.78
|
| Rate for Payer: Multiplan Commercial |
$2,450.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,817.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.77
|
| Rate for Payer: Quartz Commercial |
$1,837.68
|
| Rate for Payer: WEA Trust Commercial |
$1,684.54
|
| Rate for Payer: WPS Commercial |
$2,268.53
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
OP
|
$4,064.00
|
|
|
Service Code
|
CPT 70492 TC
|
| Hospital Charge Code |
1241239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$579.90 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,183.44
|
| 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 |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,365.25
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,169.92
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,535.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,747.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,535.94
|
| Rate for Payer: The Alliance Commercial |
$579.90
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$1,014.83
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Professional
|
Both
|
$4,064.00
|
|
|
Service Code
|
CPT 70492 TC
|
| Hospital Charge Code |
1241239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$4,015.23 |
| Rate for Payer: Aetna Commercial |
$4,015.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Aetna Managed Medicare |
$144.98
|
| Rate for Payer: Anthem Medicare Advantage |
$144.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.98
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$4,015.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,113.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.98
|
| Rate for Payer: Health EOS Commercial |
$3,846.17
|
| Rate for Payer: HFN Commercial |
$4,015.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$578.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$578.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.98
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: NAPHCARE Commercial |
$217.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,015.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.69
|
| Rate for Payer: Quartz Commercial |
$2,409.14
|
| Rate for Payer: Quartz Medicare Advantage |
$144.98
|
| Rate for Payer: The Alliance Commercial |
$550.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.98
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$724.88
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
630154
|
| Min. Negotiated Rate |
$1,788.70 |
| Max. Negotiated Rate |
$3,358.37 |
| Rate for Payer: Aetna Commercial |
$3,285.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,934.71
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$3,358.37
|
| Rate for Payer: Health EOS Commercial |
$3,248.86
|
| Rate for Payer: HFN Commercial |
$3,358.37
|
| Rate for Payer: Multiplan Commercial |
$2,920.32
|
| Rate for Payer: Preferred Network Access Commercial |
$3,358.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.70
|
| Rate for Payer: Quartz Commercial |
$2,190.24
|
| Rate for Payer: WEA Trust Commercial |
$2,007.72
|
| Rate for Payer: WPS Commercial |
$2,703.75
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Professional
|
Both
|
$3,510.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
630154
|
| Min. Negotiated Rate |
$219.01 |
| Max. Negotiated Rate |
$3,467.88 |
| Rate for Payer: Aetna Commercial |
$3,467.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.34
|
| Rate for Payer: Aetna Managed Medicare |
$219.01
|
| Rate for Payer: Anthem Medicare Advantage |
$219.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.01
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$3,467.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,825.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.01
|
| Rate for Payer: Health EOS Commercial |
$3,321.86
|
| Rate for Payer: HFN Commercial |
$3,467.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$859.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$859.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.01
|
| Rate for Payer: Multiplan Commercial |
$2,920.32
|
| Rate for Payer: NAPHCARE Commercial |
$328.52
|
| Rate for Payer: Preferred Network Access Commercial |
$3,467.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.18
|
| Rate for Payer: Quartz Commercial |
$2,080.73
|
| Rate for Payer: Quartz Medicare Advantage |
$219.01
|
| Rate for Payer: The Alliance Commercial |
$832.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.01
|
| Rate for Payer: WEA Trust Commercial |
$2,007.72
|
| Rate for Payer: WPS Commercial |
$1,095.07
|
|
|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT 70492
|
| Hospital Charge Code |
630154
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,358.37 |
| Rate for Payer: Aetna Commercial |
$3,285.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,139.34
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,372.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,825.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,752.19
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,934.71
|
| 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 |
$1,053.00
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$3,358.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,042.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,248.86
|
| Rate for Payer: HFN Commercial |
$3,358.37
|
| 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 |
$2,920.32
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,358.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,788.70
|
| Rate for Payer: Quartz Commercial |
$2,372.76
|
| 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 |
$2,007.72
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,703.75
|
|
