|
CT Angiography Coronary Artery w/ Eval
|
Facility
IP
|
$4,883.00
|
|
|
Service Code
|
CPT 75574 TC
|
| Hospital Charge Code |
1240833
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,392.67 |
| Max. Negotiated Rate |
$4,492.36 |
| Rate for Payer: Aetna Commercial |
$4,394.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,587.99
|
| Rate for Payer: Cash Price |
$1,464.90
|
| Rate for Payer: Cigna Commercial |
$4,492.36
|
| Rate for Payer: Health EOS Commercial |
$4,345.87
|
| Rate for Payer: HFN Commercial |
$4,492.36
|
| Rate for Payer: Multiplan Commercial |
$3,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,929.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,492.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,392.67
|
| Rate for Payer: Quartz Commercial |
$2,929.80
|
| Rate for Payer: WEA Trust Commercial |
$2,685.65
|
| Rate for Payer: WPS Commercial |
$3,616.84
|
|
|
CT Angiography Coronary Artery w/o Eval
|
Professional
|
$258.00
|
|
| Hospital Charge Code |
711746
|
| Min. Negotiated Rate |
$113.52 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna Commercial |
$245.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$245.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.80
|
| Rate for Payer: Health EOS Commercial |
$234.78
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$245.10
|
| Rate for Payer: Quartz Beloit One Network |
$113.52
|
| Rate for Payer: Quartz Commercial |
$147.06
|
| Rate for Payer: The Alliance Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CT Angiography Coronary Artery w/o Eval
|
Facility
IP
|
$258.00
|
|
| Hospital Charge Code |
711746
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CT Angiography Coronary Artery w/o Eval
|
Facility
OP
|
$258.00
|
|
| Hospital Charge Code |
711746
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: The Alliance Commercial |
$1,032.00
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
CT Angiography Head
|
Facility
OP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
5426663
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,370.88 |
| Max. Negotiated Rate |
$21,564.00 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,636.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,509.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.23
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$4,959.72
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,043.25
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,959.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,641.59
|
| Rate for Payer: Quartz Commercial |
$3,504.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,234.60
|
| Rate for Payer: The Alliance Commercial |
$21,564.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$1,370.88
|
|
|
CT Angiography Head
|
Facility
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
629762
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$4,626.68 |
| Rate for Payer: Aetna Commercial |
$4,526.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.94
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,268.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,413.92
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,626.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$4,475.81
|
| Rate for Payer: HFN Commercial |
$4,626.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.21
|
| Rate for Payer: Quartz Commercial |
$3,268.85
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$542.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,724.98
|
|
|
CT Angiography Head
|
Facility
IP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
5426663
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,641.59 |
| Max. Negotiated Rate |
$4,959.72 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.23
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$4,959.72
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,959.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,641.59
|
| Rate for Payer: Quartz Commercial |
$3,234.60
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$3,993.11
|
|
|
CT Angiography Head
|
Professional
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
5426663
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.84 |
| Max. Negotiated Rate |
$5,121.45 |
| Rate for Payer: Aetna Commercial |
$5,121.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,636.26
|
| Rate for Payer: Aetna Managed Medicare |
$195.84
|
| Rate for Payer: Anthem Medicare Advantage |
$195.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.84
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,121.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,695.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.84
|
| Rate for Payer: Health EOS Commercial |
$4,905.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$717.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$717.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.84
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,121.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,372.04
|
| Rate for Payer: Quartz Commercial |
$3,072.87
|
| Rate for Payer: Quartz Medicare Advantage |
$195.84
|
| Rate for Payer: The Alliance Commercial |
$744.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.84
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$979.20
|
|
|
CT Angiography Head
|
Professional
|
$5,029.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
629762
|
| Min. Negotiated Rate |
$276.48 |
| Max. Negotiated Rate |
$4,777.55 |
| Rate for Payer: Aetna Commercial |
$4,777.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.94
|
| Rate for Payer: Aetna Managed Medicare |
$276.48
|
| Rate for Payer: Anthem Medicare Advantage |
$276.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$276.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$276.48
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,777.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,514.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.48
|
| Rate for Payer: Health EOS Commercial |
$4,576.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$276.48
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,777.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,212.76
|
| Rate for Payer: Quartz Commercial |
$2,866.53
|
| Rate for Payer: Quartz Medicare Advantage |
$276.48
|
| Rate for Payer: The Alliance Commercial |
$1,050.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.48
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: WPS Commercial |
$1,382.40
|
|
|
CT Angiography Head
|
Facility
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
629762
|
| Min. Negotiated Rate |
$2,464.21 |
| Max. Negotiated Rate |
$4,626.68 |
| Rate for Payer: Aetna Commercial |
$4,526.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.37
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,626.68
|
| Rate for Payer: Health EOS Commercial |
$4,475.81
|
| Rate for Payer: HFN Commercial |
$4,626.68
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,017.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.21
|
| Rate for Payer: Quartz Commercial |
$3,017.40
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: WPS Commercial |
$3,724.98
|
|
|
CT Angiography Head w/ + w/o Contrast
|
Facility
OP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
1240839
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,370.88 |
| Max. Negotiated Rate |
$21,564.00 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,636.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,509.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.23
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$4,959.72
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,043.25
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,959.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,641.59
|
| Rate for Payer: Quartz Commercial |
$3,504.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,234.60
|
| Rate for Payer: The Alliance Commercial |
$21,564.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$1,370.88
|
|
|
CT Angiography Head w/ + w/o Contrast
|
Professional
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
1240839
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.84 |
| Max. Negotiated Rate |
$5,121.45 |
| Rate for Payer: Aetna Commercial |
$5,121.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,636.26
|
| Rate for Payer: Aetna Managed Medicare |
$195.84
|
| Rate for Payer: Anthem Medicare Advantage |
$195.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.84
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,121.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,695.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.84
|
| Rate for Payer: Health EOS Commercial |
$4,905.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$717.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$717.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.84
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,121.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,372.04
|
| Rate for Payer: Quartz Commercial |
$3,072.87
|
| Rate for Payer: Quartz Medicare Advantage |
$195.84
|
| Rate for Payer: The Alliance Commercial |
$744.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.84
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$979.20
|
|
|
CT Angiography Head w/ + w/o Contrast
|
Facility
IP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
1240839
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,641.59 |
| Max. Negotiated Rate |
$4,959.72 |
| Rate for Payer: Aetna Commercial |
$4,851.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,857.23
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$4,959.72
|
| Rate for Payer: Health EOS Commercial |
$4,797.99
|
| Rate for Payer: HFN Commercial |
$4,959.72
|
| Rate for Payer: Multiplan Commercial |
$4,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,959.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,641.59
|
| Rate for Payer: Quartz Commercial |
$3,234.60
|
| Rate for Payer: WEA Trust Commercial |
$2,965.05
|
| Rate for Payer: WPS Commercial |
$3,993.11
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
IP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240841
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,330.04 |
| Max. Negotiated Rate |
$6,252.32 |
| Rate for Payer: Aetna Commercial |
$6,116.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.88
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cigna Commercial |
$6,252.32
|
| Rate for Payer: Health EOS Commercial |
$6,048.44
|
| Rate for Payer: HFN Commercial |
$6,252.32
|
| Rate for Payer: Multiplan Commercial |
$5,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,077.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,252.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,330.04
|
| Rate for Payer: Quartz Commercial |
$4,077.60
|
| Rate for Payer: WEA Trust Commercial |
$3,737.80
|
| Rate for Payer: WPS Commercial |
$5,033.80
|
|
|
CT Angiography Lower Extremity Bilat
|
Professional
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240841
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,990.24 |
| Max. Negotiated Rate |
$6,456.20 |
| Rate for Payer: Aetna Commercial |
$6,456.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,844.56
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cigna Commercial |
$6,456.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,398.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,077.60
|
| Rate for Payer: Health EOS Commercial |
$6,184.36
|
| Rate for Payer: Multiplan Commercial |
$5,436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,456.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,990.24
|
| Rate for Payer: Quartz Commercial |
$3,873.72
|
| Rate for Payer: The Alliance Commercial |
$3,398.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.80
|
| Rate for Payer: WPS Commercial |
$5,033.80
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
IP
|
$13,592.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629764
|
| Min. Negotiated Rate |
$6,660.08 |
| Max. Negotiated Rate |
$12,504.64 |
| Rate for Payer: Aetna Commercial |
$12,232.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,203.76
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cigna Commercial |
$12,504.64
|
| Rate for Payer: Health EOS Commercial |
$12,096.88
|
| Rate for Payer: HFN Commercial |
$12,504.64
|
| Rate for Payer: Multiplan Commercial |
$10,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,155.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,504.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,660.08
|
| Rate for Payer: Quartz Commercial |
$8,155.20
|
| Rate for Payer: WEA Trust Commercial |
$7,475.60
|
| Rate for Payer: WPS Commercial |
$10,067.59
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
OP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240841
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,902.88 |
| Max. Negotiated Rate |
$27,184.00 |
| Rate for Payer: Aetna Commercial |
$6,116.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,844.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,902.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.88
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cigna Commercial |
$6,252.32
|
| Rate for Payer: Health EOS Commercial |
$6,048.44
|
| Rate for Payer: HFN Commercial |
$6,252.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,097.00
|
| Rate for Payer: Multiplan Commercial |
$5,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,077.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,252.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,330.04
|
| Rate for Payer: Quartz Commercial |
$4,417.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,077.60
|
| Rate for Payer: The Alliance Commercial |
$27,184.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.80
|
| Rate for Payer: WPS Commercial |
$5,033.80
|
|
|
CT Angiography Lower Extremity Bilat
|
Professional
|
$13,592.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629764
|
| Min. Negotiated Rate |
$324.71 |
| Max. Negotiated Rate |
$12,912.40 |
| Rate for Payer: Aetna Commercial |
$12,912.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,689.12
|
| Rate for Payer: Aetna Managed Medicare |
$324.71
|
| Rate for Payer: Anthem Medicare Advantage |
$324.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.71
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cigna Commercial |
$12,912.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,796.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.71
|
| Rate for Payer: Health EOS Commercial |
$12,368.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,201.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.71
|
| Rate for Payer: Multiplan Commercial |
$10,873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,912.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,980.48
|
| Rate for Payer: Quartz Commercial |
$7,747.44
|
| Rate for Payer: Quartz Medicare Advantage |
$324.71
|
| Rate for Payer: The Alliance Commercial |
$1,233.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.71
|
| Rate for Payer: WEA Trust Commercial |
$7,475.60
|
| Rate for Payer: WPS Commercial |
$1,623.55
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
OP
|
$13,592.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629764
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$12,504.64 |
| Rate for Payer: Aetna Commercial |
$12,232.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,689.12
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,834.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,796.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,524.16
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,203.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cigna Commercial |
$12,504.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$12,096.88
|
| Rate for Payer: HFN Commercial |
$12,504.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$10,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$12,504.64
|
| Rate for Payer: Quartz Beloit One Network |
$6,660.08
|
| Rate for Payer: Quartz Commercial |
$8,834.80
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$7,475.60
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$10,067.59
|
|
|
CT Angiography Lower Extremity Left
|
Professional
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629766
|
| Min. Negotiated Rate |
$324.71 |
| Max. Negotiated Rate |
$6,455.25 |
| Rate for Payer: Aetna Commercial |
$6,455.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Aetna Managed Medicare |
$324.71
|
| Rate for Payer: Anthem Medicare Advantage |
$324.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.71
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,455.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,397.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.71
|
| Rate for Payer: Health EOS Commercial |
$6,183.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,201.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.71
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,455.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.80
|
| Rate for Payer: Quartz Commercial |
$3,873.15
|
| Rate for Payer: Quartz Medicare Advantage |
$324.71
|
| Rate for Payer: The Alliance Commercial |
$1,233.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.71
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: WPS Commercial |
$1,623.55
|
|
|
CT Angiography Lower Extremity Left
|
Facility
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629766
|
| Min. Negotiated Rate |
$3,329.55 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,077.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,077.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
CT Angiography Lower Extremity Left
|
Facility
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629766
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,416.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,397.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,261.60
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,416.75
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
CT Angiography Lower Extremity Left
|
Professional
|
$10,096.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240843
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,442.24 |
| Max. Negotiated Rate |
$9,591.20 |
| Rate for Payer: Aetna Commercial |
$9,591.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,682.56
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cigna Commercial |
$9,591.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,048.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,057.60
|
| Rate for Payer: Health EOS Commercial |
$9,187.36
|
| Rate for Payer: Multiplan Commercial |
$8,076.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,591.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,442.24
|
| Rate for Payer: Quartz Commercial |
$5,754.72
|
| Rate for Payer: The Alliance Commercial |
$5,048.00
|
| Rate for Payer: WEA Trust Commercial |
$5,552.80
|
| Rate for Payer: WPS Commercial |
$7,478.11
|
|
|
CT Angiography Lower Extremity Left
|
Facility
OP
|
$10,096.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240843
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,065.00 |
| Max. Negotiated Rate |
$40,384.00 |
| Rate for Payer: Aetna Commercial |
$9,086.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,682.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,826.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,350.88
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cigna Commercial |
$9,288.32
|
| Rate for Payer: Health EOS Commercial |
$8,985.44
|
| Rate for Payer: HFN Commercial |
$9,288.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,572.00
|
| Rate for Payer: Multiplan Commercial |
$8,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,057.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,288.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,947.04
|
| Rate for Payer: Quartz Commercial |
$6,562.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,057.60
|
| Rate for Payer: The Alliance Commercial |
$40,384.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$5,552.80
|
| Rate for Payer: WPS Commercial |
$7,478.11
|
|
|
CT Angiography Lower Extremity Left
|
Facility
IP
|
$10,096.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240843
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,947.04 |
| Max. Negotiated Rate |
$9,288.32 |
| Rate for Payer: Aetna Commercial |
$9,086.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,350.88
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cigna Commercial |
$9,288.32
|
| Rate for Payer: Health EOS Commercial |
$8,985.44
|
| Rate for Payer: HFN Commercial |
$9,288.32
|
| Rate for Payer: Multiplan Commercial |
$8,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,057.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,288.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,947.04
|
| Rate for Payer: Quartz Commercial |
$6,057.60
|
| Rate for Payer: WEA Trust Commercial |
$5,552.80
|
| Rate for Payer: WPS Commercial |
$7,478.11
|
|
