|
CT Thorax Enhanced
|
Facility
|
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
2948642
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$448.12 |
| 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: Aetna Managed Medicare |
$1,123.45
|
| 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 |
$2,126.53
|
| 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: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,691.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,245.36
|
| Rate for Payer: Health EOS Commercial |
$3,570.96
|
| Rate for Payer: HFN Commercial |
$3,691.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,009.24
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,407.39
|
| 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 |
$2,608.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,407.39
|
| Rate for Payer: The Alliance Commercial |
$448.12
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$784.20
|
|
|
CT Thorax Unenhanced
|
Professional
|
Both
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$3,135.91 |
| Rate for Payer: Aetna Commercial |
$3,135.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Aetna Managed Medicare |
$82.64
|
| Rate for Payer: Anthem Medicare Advantage |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.64
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,135.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,650.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$3,003.87
|
| Rate for Payer: HFN Commercial |
$3,135.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.64
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: NAPHCARE Commercial |
$123.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,135.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.42
|
| Rate for Payer: Quartz Commercial |
$1,881.55
|
| Rate for Payer: Quartz Medicare Advantage |
$82.64
|
| Rate for Payer: The Alliance Commercial |
$314.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.64
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$413.19
|
|
|
CT Thorax Unenhanced
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,970.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Aetna Managed Medicare |
$924.27
|
| 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 |
$1,749.51
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,036.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,847.27
|
| Rate for Payer: Health EOS Commercial |
$2,937.85
|
| Rate for Payer: HFN Commercial |
$3,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,475.72
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,980.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,617.47
|
| Rate for Payer: Quartz Commercial |
$2,145.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,980.58
|
| Rate for Payer: The Alliance Commercial |
$330.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$578.47
|
|
|
CT Thorax Unenhanced
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,617.47 |
| Max. Negotiated Rate |
$3,036.88 |
| Rate for Payer: Aetna Commercial |
$2,970.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,749.51
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,036.88
|
| Rate for Payer: Health EOS Commercial |
$2,937.85
|
| Rate for Payer: HFN Commercial |
$3,036.88
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,617.47
|
| Rate for Payer: Quartz Commercial |
$1,980.58
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$2,444.93
|
|
|
CT Thorax w/ Contrast
|
Professional
|
Both
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
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
|
|
|
CT Thorax w/ Contrast
|
Facility
|
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
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 w/ Contrast
|
Facility
|
IP
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$1,708.69 |
| Max. Negotiated Rate |
$3,208.15 |
| Rate for Payer: Aetna Commercial |
$3,138.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,998.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,848.17
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,208.15
|
| Rate for Payer: Health EOS Commercial |
$3,103.54
|
| Rate for Payer: HFN Commercial |
$3,208.15
|
| Rate for Payer: Multiplan Commercial |
$2,789.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,208.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.69
|
| Rate for Payer: Quartz Commercial |
$2,092.27
|
| Rate for Payer: WEA Trust Commercial |
$1,917.92
|
| Rate for Payer: WPS Commercial |
$2,582.82
|
|
|
CT Thorax w/ Contrast
|
Facility
|
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$448.12 |
| 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: Aetna Managed Medicare |
$1,123.45
|
| 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 |
$2,126.53
|
| 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: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,691.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,245.36
|
| Rate for Payer: Health EOS Commercial |
$3,570.96
|
| Rate for Payer: HFN Commercial |
$3,691.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,009.24
|
| Rate for Payer: Multiplan Commercial |
$3,209.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,407.39
|
| 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 |
$2,608.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,407.39
|
| Rate for Payer: The Alliance Commercial |
$448.12
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,206.78
|
| Rate for Payer: WPS Commercial |
$784.20
|
|
|
CT Thorax w/ Contrast
|
Professional
|
Both
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$165.67 |
| Max. Negotiated Rate |
$3,312.76 |
| Rate for Payer: Aetna Commercial |
$3,312.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,998.92
|
| Rate for Payer: Aetna Managed Medicare |
$165.67
|
| Rate for Payer: Anthem Medicare Advantage |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.67
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,312.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,743.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.67
|
| Rate for Payer: Health EOS Commercial |
$3,173.28
|
| Rate for Payer: HFN Commercial |
$3,312.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.67
|
| Rate for Payer: Multiplan Commercial |
$2,789.70
|
| Rate for Payer: NAPHCARE Commercial |
$248.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,312.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.33
|
| Rate for Payer: Quartz Commercial |
$1,987.66
|
| Rate for Payer: Quartz Medicare Advantage |
$165.67
|
| Rate for Payer: The Alliance Commercial |
$629.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.67
|
| Rate for Payer: WEA Trust Commercial |
$1,917.92
|
| Rate for Payer: WPS Commercial |
$828.36
|
|
|
CT Thorax w/ Contrast
|
Facility
|
OP
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,208.15 |
| Rate for Payer: Aetna Commercial |
$3,138.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,998.92
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,266.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,743.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,673.82
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,848.17
|
| 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 |
$1,005.90
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,208.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,951.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,103.54
|
| Rate for Payer: HFN Commercial |
$3,208.15
|
| 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 |
$2,789.70
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,208.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.69
|
| Rate for Payer: Quartz Commercial |
$2,266.63
|
| 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 |
$1,917.92
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,582.82
|
|
|
CT Thorax w/o Contrast
|
Facility
|
IP
|
$2,828.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
629704
|
| Min. Negotiated Rate |
$1,441.15 |
| Max. Negotiated Rate |
$2,705.83 |
| Rate for Payer: Aetna Commercial |
$2,647.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,529.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,558.79
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$2,705.83
|
| Rate for Payer: Health EOS Commercial |
$2,617.60
|
| Rate for Payer: HFN Commercial |
$2,705.83
|
| Rate for Payer: Multiplan Commercial |
$2,352.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,705.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.15
|
| Rate for Payer: Quartz Commercial |
$1,764.67
|
| Rate for Payer: WEA Trust Commercial |
$1,617.62
|
| Rate for Payer: WPS Commercial |
$2,178.41
|
|
|
CT Thorax w/o Contrast
|
Professional
|
Both
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
1241288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$3,135.91 |
| Rate for Payer: Aetna Commercial |
$3,135.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Aetna Managed Medicare |
$82.64
|
| Rate for Payer: Anthem Medicare Advantage |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.64
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,135.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,650.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$3,003.87
|
| Rate for Payer: HFN Commercial |
$3,135.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.64
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: NAPHCARE Commercial |
$123.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,135.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,452.42
|
| Rate for Payer: Quartz Commercial |
$1,881.55
|
| Rate for Payer: Quartz Medicare Advantage |
$82.64
|
| Rate for Payer: The Alliance Commercial |
$314.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.64
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$413.19
|
|
|
CT Thorax w/o Contrast
|
Facility
|
OP
|
$2,828.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
629704
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$2,705.83 |
| Rate for Payer: Aetna Commercial |
$2,647.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,529.36
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,911.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,470.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,411.74
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,558.79
|
| 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 |
$848.40
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$2,705.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,645.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,617.60
|
| Rate for Payer: HFN Commercial |
$2,705.83
|
| 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 |
$2,352.90
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,705.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.15
|
| Rate for Payer: Quartz Commercial |
$1,911.73
|
| 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 |
$1,617.62
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,178.41
|
|
|
CT Thorax w/o Contrast
|
Professional
|
Both
|
$2,828.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
629704
|
| Min. Negotiated Rate |
$132.07 |
| Max. Negotiated Rate |
$2,794.06 |
| Rate for Payer: Aetna Commercial |
$2,794.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,529.36
|
| Rate for Payer: Aetna Managed Medicare |
$132.07
|
| Rate for Payer: Anthem Medicare Advantage |
$132.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.07
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cash Price |
$848.40
|
| Rate for Payer: Cigna Commercial |
$2,794.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,470.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.07
|
| Rate for Payer: Health EOS Commercial |
$2,676.42
|
| Rate for Payer: HFN Commercial |
$2,794.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$507.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.07
|
| Rate for Payer: Multiplan Commercial |
$2,352.90
|
| Rate for Payer: NAPHCARE Commercial |
$198.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,794.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,294.09
|
| Rate for Payer: Quartz Commercial |
$1,676.44
|
| Rate for Payer: Quartz Medicare Advantage |
$132.07
|
| Rate for Payer: The Alliance Commercial |
$501.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.07
|
| Rate for Payer: WEA Trust Commercial |
$1,617.62
|
| Rate for Payer: WPS Commercial |
$660.35
|
|
|
CT Thorax w/o Contrast
|
Facility
|
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
1241288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,970.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Aetna Managed Medicare |
$924.27
|
| 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 |
$1,749.51
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,036.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,847.27
|
| Rate for Payer: Health EOS Commercial |
$2,937.85
|
| Rate for Payer: HFN Commercial |
$3,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,475.72
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: NAPHCARE Commercial |
$1,980.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,617.47
|
| Rate for Payer: Quartz Commercial |
$2,145.62
|
| Rate for Payer: Quartz Medicare Advantage |
$1,980.58
|
| Rate for Payer: The Alliance Commercial |
$330.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$578.47
|
|
|
CT Thorax w/o Contrast
|
Facility
|
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
1241288
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,617.47 |
| Max. Negotiated Rate |
$3,036.88 |
| Rate for Payer: Aetna Commercial |
$2,970.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,838.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,749.51
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,036.88
|
| Rate for Payer: Health EOS Commercial |
$2,937.85
|
| Rate for Payer: HFN Commercial |
$3,036.88
|
| Rate for Payer: Multiplan Commercial |
$2,640.77
|
| Rate for Payer: Preferred Network Access Commercial |
$3,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,617.47
|
| Rate for Payer: Quartz Commercial |
$1,980.58
|
| Rate for Payer: WEA Trust Commercial |
$1,815.53
|
| Rate for Payer: WPS Commercial |
$2,444.93
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$194.76 |
| Max. Negotiated Rate |
$3,685.24 |
| Rate for Payer: Aetna Commercial |
$3,685.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,336.11
|
| Rate for Payer: Aetna Managed Medicare |
$194.76
|
| Rate for Payer: Anthem Medicare Advantage |
$194.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.76
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,685.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,939.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.76
|
| Rate for Payer: Health EOS Commercial |
$3,530.07
|
| Rate for Payer: HFN Commercial |
$3,685.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$760.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$760.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.76
|
| Rate for Payer: Multiplan Commercial |
$3,103.36
|
| Rate for Payer: NAPHCARE Commercial |
$292.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,685.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,706.85
|
| Rate for Payer: Quartz Commercial |
$2,211.14
|
| Rate for Payer: Quartz Medicare Advantage |
$194.76
|
| Rate for Payer: The Alliance Commercial |
$740.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.76
|
| Rate for Payer: WEA Trust Commercial |
$2,133.56
|
| Rate for Payer: WPS Commercial |
$973.80
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$4,810.79 |
| Rate for Payer: Aetna Commercial |
$4,706.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,464.15
|
| 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 |
$2,771.43
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,810.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,926.30
|
| Rate for Payer: Health EOS Commercial |
$4,653.92
|
| Rate for Payer: HFN Commercial |
$4,810.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,921.84
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,137.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.27
|
| Rate for Payer: Quartz Commercial |
$3,398.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3,137.47
|
| Rate for Payer: The Alliance Commercial |
$549.29
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$961.25
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,568.86 |
| Rate for Payer: Aetna Commercial |
$3,491.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,336.11
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,521.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,939.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,862.02
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,055.98
|
| 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 |
$1,119.00
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,568.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,170.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,452.49
|
| Rate for Payer: HFN Commercial |
$3,568.86
|
| 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 |
$3,103.36
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,568.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,900.81
|
| Rate for Payer: Quartz Commercial |
$2,521.48
|
| 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 |
$2,133.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,873.22
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
OP
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$549.29 |
| Max. Negotiated Rate |
$3,928.62 |
| Rate for Payer: Aetna Commercial |
$3,843.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.67
|
| 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 |
$2,263.23
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,928.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,389.69
|
| Rate for Payer: Health EOS Commercial |
$3,800.51
|
| Rate for Payer: HFN Commercial |
$3,928.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,202.68
|
| Rate for Payer: Multiplan Commercial |
$3,416.19
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.42
|
| Rate for Payer: Quartz Commercial |
$2,775.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.14
|
| Rate for Payer: The Alliance Commercial |
$549.29
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,348.63
|
| Rate for Payer: WPS Commercial |
$961.25
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$3,730.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
629698
|
| Min. Negotiated Rate |
$1,900.81 |
| Max. Negotiated Rate |
$3,568.86 |
| Rate for Payer: Aetna Commercial |
$3,491.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,336.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,055.98
|
| Rate for Payer: Cash Price |
$1,119.00
|
| Rate for Payer: Cigna Commercial |
$3,568.86
|
| Rate for Payer: Health EOS Commercial |
$3,452.49
|
| Rate for Payer: HFN Commercial |
$3,568.86
|
| Rate for Payer: Multiplan Commercial |
$3,103.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,568.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,900.81
|
| Rate for Payer: Quartz Commercial |
$2,327.52
|
| Rate for Payer: WEA Trust Commercial |
$2,133.56
|
| Rate for Payer: WPS Commercial |
$2,873.22
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$4,056.73 |
| Rate for Payer: Aetna Commercial |
$4,056.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.41
|
| Rate for Payer: Aetna Managed Medicare |
$137.32
|
| Rate for Payer: Anthem Medicare Advantage |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.32
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$4,056.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,135.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.32
|
| Rate for Payer: Health EOS Commercial |
$3,885.92
|
| Rate for Payer: HFN Commercial |
$4,056.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.32
|
| Rate for Payer: Multiplan Commercial |
$3,416.19
|
| Rate for Payer: NAPHCARE Commercial |
$205.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,056.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,878.91
|
| Rate for Payer: Quartz Commercial |
$2,434.04
|
| Rate for Payer: Quartz Medicare Advantage |
$137.32
|
| Rate for Payer: The Alliance Commercial |
$521.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.32
|
| Rate for Payer: WEA Trust Commercial |
$2,348.63
|
| Rate for Payer: WPS Commercial |
$686.61
|
|
|
CT Thorax w/ + w/o Contrast
|
Professional
|
Both
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$4,967.66 |
| Rate for Payer: Aetna Commercial |
$4,967.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Aetna Managed Medicare |
$137.32
|
| Rate for Payer: Anthem Medicare Advantage |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.32
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,967.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,614.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.32
|
| Rate for Payer: Health EOS Commercial |
$4,758.50
|
| Rate for Payer: HFN Commercial |
$4,967.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$544.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$544.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.32
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: NAPHCARE Commercial |
$205.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,967.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,300.81
|
| Rate for Payer: Quartz Commercial |
$2,980.60
|
| Rate for Payer: Quartz Medicare Advantage |
$137.32
|
| Rate for Payer: The Alliance Commercial |
$521.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.32
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$686.61
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$5,028.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
3072757
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,562.27 |
| Max. Negotiated Rate |
$4,810.79 |
| Rate for Payer: Aetna Commercial |
$4,706.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.43
|
| Rate for Payer: Cash Price |
$1,508.40
|
| Rate for Payer: Cigna Commercial |
$4,810.79
|
| Rate for Payer: Health EOS Commercial |
$4,653.92
|
| Rate for Payer: HFN Commercial |
$4,810.79
|
| Rate for Payer: Multiplan Commercial |
$4,183.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,810.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.27
|
| Rate for Payer: Quartz Commercial |
$3,137.47
|
| Rate for Payer: WEA Trust Commercial |
$2,876.02
|
| Rate for Payer: WPS Commercial |
$3,873.07
|
|
|
CT Thorax w/ + w/o Contrast
|
Facility
|
IP
|
$4,106.00
|
|
|
Service Code
|
CPT 71270 TC
|
| Hospital Charge Code |
1241284
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,092.42 |
| Max. Negotiated Rate |
$3,928.62 |
| Rate for Payer: Aetna Commercial |
$3,843.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,672.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.23
|
| Rate for Payer: Cash Price |
$1,231.80
|
| Rate for Payer: Cigna Commercial |
$3,928.62
|
| Rate for Payer: Health EOS Commercial |
$3,800.51
|
| Rate for Payer: HFN Commercial |
$3,928.62
|
| Rate for Payer: Multiplan Commercial |
$3,416.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,928.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.42
|
| Rate for Payer: Quartz Commercial |
$2,562.14
|
| Rate for Payer: WEA Trust Commercial |
$2,348.63
|
| Rate for Payer: WPS Commercial |
$3,162.85
|
|
