|
CT Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
1241276
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,933.42 |
| Max. Negotiated Rate |
$3,630.10 |
| Rate for Payer: Aetna Commercial |
$3,551.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,393.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.25
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,630.10
|
| Rate for Payer: Health EOS Commercial |
$3,511.73
|
| Rate for Payer: HFN Commercial |
$3,630.10
|
| Rate for Payer: Multiplan Commercial |
$3,156.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,630.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,933.42
|
| Rate for Payer: Quartz Commercial |
$2,367.46
|
| Rate for Payer: WEA Trust Commercial |
$2,170.17
|
| Rate for Payer: WPS Commercial |
$2,922.52
|
|
|
CT Spine Thoracic w/o Contrast
|
Professional
|
Both
|
$3,344.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
630172
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$3,303.87 |
| Rate for Payer: Aetna Commercial |
$3,303.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,990.87
|
| Rate for Payer: Aetna Managed Medicare |
$129.64
|
| Rate for Payer: Anthem Medicare Advantage |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.64
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,303.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,738.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.64
|
| Rate for Payer: Health EOS Commercial |
$3,164.76
|
| Rate for Payer: HFN Commercial |
$3,303.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$496.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$496.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.64
|
| Rate for Payer: Multiplan Commercial |
$2,782.21
|
| Rate for Payer: NAPHCARE Commercial |
$194.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,303.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,530.21
|
| Rate for Payer: Quartz Commercial |
$1,982.32
|
| Rate for Payer: Quartz Medicare Advantage |
$129.64
|
| Rate for Payer: The Alliance Commercial |
$492.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.64
|
| Rate for Payer: WEA Trust Commercial |
$1,912.77
|
| Rate for Payer: WPS Commercial |
$648.18
|
|
|
CT Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$3,344.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
630172
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$3,199.54 |
| Rate for Payer: Aetna Commercial |
$3,129.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,990.87
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,260.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,738.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,669.32
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,843.21
|
| 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 |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,199.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,946.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$3,095.21
|
| Rate for Payer: HFN Commercial |
$3,199.54
|
| 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 |
$2,782.21
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,199.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.10
|
| Rate for Payer: Quartz Commercial |
$2,260.54
|
| 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 |
$1,912.77
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,575.88
|
|
|
CT Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$3,344.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
630172
|
| Min. Negotiated Rate |
$1,704.10 |
| Max. Negotiated Rate |
$3,199.54 |
| Rate for Payer: Aetna Commercial |
$3,129.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,990.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,843.21
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,199.54
|
| Rate for Payer: Health EOS Commercial |
$3,095.21
|
| Rate for Payer: HFN Commercial |
$3,199.54
|
| Rate for Payer: Multiplan Commercial |
$2,782.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,199.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.10
|
| Rate for Payer: Quartz Commercial |
$2,086.66
|
| Rate for Payer: WEA Trust Commercial |
$1,912.77
|
| Rate for Payer: WPS Commercial |
$2,575.88
|
|
|
CT Spine Thoracic w/o Contrast
|
Professional
|
Both
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
1241276
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$3,748.47 |
| Rate for Payer: Aetna Commercial |
$3,748.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,393.35
|
| Rate for Payer: Aetna Managed Medicare |
$83.30
|
| Rate for Payer: Anthem Medicare Advantage |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.30
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,748.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,972.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.30
|
| Rate for Payer: Health EOS Commercial |
$3,590.64
|
| Rate for Payer: HFN Commercial |
$3,748.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.30
|
| Rate for Payer: Multiplan Commercial |
$3,156.61
|
| Rate for Payer: NAPHCARE Commercial |
$124.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,748.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.13
|
| Rate for Payer: Quartz Commercial |
$2,249.08
|
| Rate for Payer: Quartz Medicare Advantage |
$83.30
|
| Rate for Payer: The Alliance Commercial |
$316.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.30
|
| Rate for Payer: WEA Trust Commercial |
$2,170.17
|
| Rate for Payer: WPS Commercial |
$416.52
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$5,148.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
630164
|
| Min. Negotiated Rate |
$197.11 |
| Max. Negotiated Rate |
$5,086.22 |
| Rate for Payer: Aetna Commercial |
$5,086.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,604.37
|
| Rate for Payer: Aetna Managed Medicare |
$197.11
|
| Rate for Payer: Anthem Medicare Advantage |
$197.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.11
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$5,086.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,676.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.11
|
| Rate for Payer: Health EOS Commercial |
$4,872.07
|
| Rate for Payer: HFN Commercial |
$5,086.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.11
|
| Rate for Payer: Multiplan Commercial |
$4,283.14
|
| Rate for Payer: NAPHCARE Commercial |
$295.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,086.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,355.72
|
| Rate for Payer: Quartz Commercial |
$3,051.73
|
| Rate for Payer: Quartz Medicare Advantage |
$197.11
|
| Rate for Payer: The Alliance Commercial |
$749.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.11
|
| Rate for Payer: WEA Trust Commercial |
$2,944.66
|
| Rate for Payer: WPS Commercial |
$985.56
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$5,052.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
1241272
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$138.65 |
| Max. Negotiated Rate |
$4,991.38 |
| Rate for Payer: Aetna Commercial |
$4,991.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,518.51
|
| Rate for Payer: Aetna Managed Medicare |
$138.65
|
| Rate for Payer: Anthem Medicare Advantage |
$138.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.65
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,991.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,627.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.65
|
| Rate for Payer: Health EOS Commercial |
$4,781.21
|
| Rate for Payer: HFN Commercial |
$4,991.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$545.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.65
|
| Rate for Payer: Multiplan Commercial |
$4,203.26
|
| Rate for Payer: NAPHCARE Commercial |
$207.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,991.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,311.80
|
| Rate for Payer: Quartz Commercial |
$2,994.83
|
| Rate for Payer: Quartz Medicare Advantage |
$138.65
|
| Rate for Payer: The Alliance Commercial |
$526.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.65
|
| Rate for Payer: WEA Trust Commercial |
$2,889.74
|
| Rate for Payer: WPS Commercial |
$693.26
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$5,052.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
1241272
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$554.61 |
| Max. Negotiated Rate |
$4,833.75 |
| Rate for Payer: Aetna Commercial |
$4,728.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,518.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,471.14
|
| 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 |
$2,784.66
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,833.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,940.26
|
| Rate for Payer: Health EOS Commercial |
$4,676.13
|
| Rate for Payer: HFN Commercial |
$4,833.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,940.56
|
| Rate for Payer: Multiplan Commercial |
$4,203.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,152.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,833.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.50
|
| Rate for Payer: Quartz Commercial |
$3,415.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,152.45
|
| Rate for Payer: The Alliance Commercial |
$554.61
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,889.74
|
| Rate for Payer: WPS Commercial |
$970.57
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$5,148.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
630164
|
| Min. Negotiated Rate |
$2,623.42 |
| Max. Negotiated Rate |
$4,925.61 |
| Rate for Payer: Aetna Commercial |
$4,818.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,604.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,837.58
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,925.61
|
| Rate for Payer: Health EOS Commercial |
$4,764.99
|
| Rate for Payer: HFN Commercial |
$4,925.61
|
| Rate for Payer: Multiplan Commercial |
$4,283.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,925.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,623.42
|
| Rate for Payer: Quartz Commercial |
$3,212.35
|
| Rate for Payer: WEA Trust Commercial |
$2,944.66
|
| Rate for Payer: WPS Commercial |
$3,965.50
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$5,052.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
1241272
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,574.50 |
| Max. Negotiated Rate |
$4,833.75 |
| Rate for Payer: Aetna Commercial |
$4,728.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,518.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,784.66
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,833.75
|
| Rate for Payer: Health EOS Commercial |
$4,676.13
|
| Rate for Payer: HFN Commercial |
$4,833.75
|
| Rate for Payer: Multiplan Commercial |
$4,203.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,833.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.50
|
| Rate for Payer: Quartz Commercial |
$3,152.45
|
| Rate for Payer: WEA Trust Commercial |
$2,889.74
|
| Rate for Payer: WPS Commercial |
$3,891.56
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$5,148.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
630164
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,925.61 |
| Rate for Payer: Aetna Commercial |
$4,818.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,604.37
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,480.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,676.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,569.88
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,837.58
|
| 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 |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,925.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,996.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$4,764.99
|
| Rate for Payer: HFN Commercial |
$4,925.61
|
| 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 |
$4,283.14
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,925.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,623.42
|
| Rate for Payer: Quartz Commercial |
$3,480.05
|
| 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 |
$2,944.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,965.50
|
|
|
CT Stereo Nav for Sinus Surgery
|
Professional
|
Both
|
$2,378.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1238811
|
| Min. Negotiated Rate |
$127.64 |
| Max. Negotiated Rate |
$2,349.46 |
| Rate for Payer: Aetna Commercial |
$2,349.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| 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 |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,349.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,236.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.64
|
| Rate for Payer: Health EOS Commercial |
$2,250.54
|
| Rate for Payer: HFN Commercial |
$2,349.46
|
| 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 |
$1,978.50
|
| Rate for Payer: NAPHCARE Commercial |
$191.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,349.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.17
|
| Rate for Payer: Quartz Commercial |
$1,409.68
|
| 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 |
$1,360.22
|
| Rate for Payer: WPS Commercial |
$638.20
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
|
IP
|
$2,378.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1238811
|
| Min. Negotiated Rate |
$1,211.83 |
| Max. Negotiated Rate |
$2,275.27 |
| Rate for Payer: Aetna Commercial |
$2,225.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.75
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,275.27
|
| Rate for Payer: Health EOS Commercial |
$2,201.08
|
| Rate for Payer: HFN Commercial |
$2,275.27
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.83
|
| Rate for Payer: Quartz Commercial |
$1,483.87
|
| Rate for Payer: WEA Trust Commercial |
$1,360.22
|
| Rate for Payer: WPS Commercial |
$1,831.77
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241281
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$351.85 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,442.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.38
|
| Rate for Payer: Aetna Managed Medicare |
$760.03
|
| 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 |
$1,438.63
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,497.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,519.02
|
| Rate for Payer: Health EOS Commercial |
$2,415.82
|
| Rate for Payer: HFN Commercial |
$2,497.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,035.80
|
| Rate for Payer: Multiplan Commercial |
$2,171.52
|
| Rate for Payer: NAPHCARE Commercial |
$1,628.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.06
|
| Rate for Payer: Quartz Commercial |
$1,764.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,628.64
|
| Rate for Payer: The Alliance Commercial |
$351.85
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,492.92
|
| Rate for Payer: WPS Commercial |
$615.74
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
|
OP
|
$2,378.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1238811
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,275.27 |
| Rate for Payer: Aetna Commercial |
$2,225.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,126.88
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,607.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,236.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,187.10
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,310.75
|
| 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 |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,275.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,384.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,201.08
|
| Rate for Payer: HFN Commercial |
$2,275.27
|
| 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 |
$1,978.50
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,211.83
|
| Rate for Payer: Quartz Commercial |
$1,607.53
|
| 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 |
$1,360.22
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,831.77
|
|
|
CT Stereo Nav for Sinus Surgery
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241281
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$87.96 |
| Max. Negotiated Rate |
$2,578.68 |
| Rate for Payer: Aetna Commercial |
$2,578.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.38
|
| 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 |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,578.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,357.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.96
|
| Rate for Payer: Health EOS Commercial |
$2,470.10
|
| Rate for Payer: HFN Commercial |
$2,578.68
|
| 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 |
$2,171.52
|
| Rate for Payer: NAPHCARE Commercial |
$131.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.34
|
| Rate for Payer: Quartz Commercial |
$1,547.21
|
| 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 |
$1,492.92
|
| Rate for Payer: WPS Commercial |
$439.82
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241281
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,330.06 |
| Max. Negotiated Rate |
$2,497.25 |
| Rate for Payer: Aetna Commercial |
$2,442.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.63
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$2,415.82
|
| Rate for Payer: HFN Commercial |
$2,497.25
|
| Rate for Payer: Multiplan Commercial |
$2,171.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.06
|
| Rate for Payer: Quartz Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,492.92
|
| Rate for Payer: WPS Commercial |
$2,010.48
|
|
|
CT Stone Protocol w/o Contrast
|
Facility
|
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5724172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,037.73 |
| Max. Negotiated Rate |
$5,703.48 |
| Rate for Payer: Aetna Commercial |
$5,579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,285.70
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,703.48
|
| Rate for Payer: Health EOS Commercial |
$5,517.50
|
| Rate for Payer: HFN Commercial |
$5,703.48
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: Preferred Network Access Commercial |
$5,703.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.73
|
| Rate for Payer: Quartz Commercial |
$3,719.66
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$4,591.76
|
|
|
CT Stone Protocol w/o Contrast
|
Facility
|
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5724172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$409.51 |
| Max. Negotiated Rate |
$5,703.48 |
| Rate for Payer: Aetna Commercial |
$5,579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,735.84
|
| 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 |
$3,285.70
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,703.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,469.30
|
| Rate for Payer: Health EOS Commercial |
$5,517.50
|
| Rate for Payer: HFN Commercial |
$5,703.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,649.58
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: NAPHCARE Commercial |
$3,719.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,703.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,037.73
|
| Rate for Payer: Quartz Commercial |
$4,029.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,719.66
|
| Rate for Payer: The Alliance Commercial |
$409.51
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$716.64
|
|
|
CT Stone Protocol w/o Contrast
|
Professional
|
Both
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5724172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$5,889.47 |
| Rate for Payer: Aetna Commercial |
$5,889.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,331.52
|
| Rate for Payer: Aetna Managed Medicare |
$102.38
|
| Rate for Payer: Anthem Medicare Advantage |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.38
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,889.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,099.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.38
|
| Rate for Payer: Health EOS Commercial |
$5,641.49
|
| Rate for Payer: HFN Commercial |
$5,889.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.38
|
| Rate for Payer: Multiplan Commercial |
$4,959.55
|
| Rate for Payer: NAPHCARE Commercial |
$153.57
|
| Rate for Payer: Preferred Network Access Commercial |
$5,889.47
|
| Rate for Payer: Quartz Beloit One Network |
$2,727.75
|
| Rate for Payer: Quartz Commercial |
$3,533.68
|
| Rate for Payer: Quartz Medicare Advantage |
$102.38
|
| Rate for Payer: The Alliance Commercial |
$389.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.38
|
| Rate for Payer: WEA Trust Commercial |
$3,409.69
|
| Rate for Payer: WPS Commercial |
$511.89
|
|
|
CT Thoracic Spine Unenhanced
|
Professional
|
Both
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
3072652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$3,748.47 |
| Rate for Payer: Aetna Commercial |
$3,748.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,393.35
|
| Rate for Payer: Aetna Managed Medicare |
$83.30
|
| Rate for Payer: Anthem Medicare Advantage |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.30
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,748.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,972.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.30
|
| Rate for Payer: Health EOS Commercial |
$3,590.64
|
| Rate for Payer: HFN Commercial |
$3,748.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.30
|
| Rate for Payer: Multiplan Commercial |
$3,156.61
|
| Rate for Payer: NAPHCARE Commercial |
$124.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,748.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.13
|
| Rate for Payer: Quartz Commercial |
$2,249.08
|
| Rate for Payer: Quartz Medicare Advantage |
$83.30
|
| Rate for Payer: The Alliance Commercial |
$316.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.30
|
| Rate for Payer: WEA Trust Commercial |
$2,170.17
|
| Rate for Payer: WPS Commercial |
$416.52
|
|
|
CT Thoracic Spine Unenhanced
|
Facility
|
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
3072652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,933.42 |
| Max. Negotiated Rate |
$3,630.10 |
| Rate for Payer: Aetna Commercial |
$3,551.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,393.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,091.25
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,630.10
|
| Rate for Payer: Health EOS Commercial |
$3,511.73
|
| Rate for Payer: HFN Commercial |
$3,630.10
|
| Rate for Payer: Multiplan Commercial |
$3,156.61
|
| Rate for Payer: Preferred Network Access Commercial |
$3,630.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,933.42
|
| Rate for Payer: Quartz Commercial |
$2,367.46
|
| Rate for Payer: WEA Trust Commercial |
$2,170.17
|
| Rate for Payer: WPS Commercial |
$2,922.52
|
|
|
CT Thoracic Spine Unenhanced
|
Facility
|
OP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
3072652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$333.22 |
| Max. Negotiated Rate |
$3,630.10 |
| Rate for Payer: Aetna Commercial |
$3,551.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,393.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,104.81
|
| 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 |
$2,091.25
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,630.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,208.11
|
| Rate for Payer: Health EOS Commercial |
$3,511.73
|
| Rate for Payer: HFN Commercial |
$3,630.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,959.32
|
| Rate for Payer: Multiplan Commercial |
$3,156.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,367.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,630.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,933.42
|
| Rate for Payer: Quartz Commercial |
$2,564.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,367.46
|
| Rate for Payer: The Alliance Commercial |
$333.22
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,170.17
|
| Rate for Payer: WPS Commercial |
$583.13
|
|
|
CT Thorax Enhanced
|
Facility
|
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
2948642
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,966.04 |
| Max. Negotiated Rate |
$3,691.33 |
| Rate for Payer: Aetna Commercial |
$3,611.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,450.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,126.53
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,691.33
|
| Rate for Payer: Health EOS Commercial |
$3,570.96
|
| Rate for Payer: HFN Commercial |
$3,691.33
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,691.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.04
|
| Rate for Payer: Quartz Commercial |
$2,407.39
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$2,971.82
|
|
|
CT Thorax Enhanced
|
Professional
|
Both
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
2948642
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.03 |
| Max. Negotiated Rate |
$3,811.70 |
| Rate for Payer: Aetna Commercial |
$3,811.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,450.60
|
| Rate for Payer: Aetna Managed Medicare |
$112.03
|
| Rate for Payer: Anthem Medicare Advantage |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.03
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,811.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,006.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.03
|
| Rate for Payer: Health EOS Commercial |
$3,651.21
|
| Rate for Payer: HFN Commercial |
$3,811.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.03
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: NAPHCARE Commercial |
$168.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,811.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,765.42
|
| Rate for Payer: Quartz Commercial |
$2,287.02
|
| Rate for Payer: Quartz Medicare Advantage |
$112.03
|
| Rate for Payer: The Alliance Commercial |
$425.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.03
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$560.14
|
|
