|
CT Angiography Lower Extremity Right
|
Facility
IP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 RT,TC
|
| Hospital Charge Code |
1240845
|
|
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 Right
|
Professional
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 RT,TC
|
| Hospital Charge Code |
1240845
|
|
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 Right
|
Facility
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629768
|
| 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 Right
|
Facility
IP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 TC,RT
|
| Hospital Charge Code |
2980090
|
|
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 Right
|
Facility
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629768
|
| 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 Right
|
Facility
OP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 RT,TC
|
| Hospital Charge Code |
1240845
|
|
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 Right
|
Professional
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629768
|
| 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 Right
|
Facility
OP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 TC,RT
|
| Hospital Charge Code |
2980090
|
|
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 Right
|
Professional
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 TC,RT
|
| Hospital Charge Code |
2980090
|
|
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 Neck
|
Facility
OP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
5426664
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,280.16 |
| Max. Negotiated Rate |
$18,288.00 |
| Rate for Payer: Aetna Commercial |
$4,114.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,280.16
|
| 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 |
$2,423.16
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,206.24
|
| Rate for Payer: Health EOS Commercial |
$4,069.08
|
| Rate for Payer: HFN Commercial |
$4,206.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,429.00
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.28
|
| Rate for Payer: Quartz Commercial |
$2,971.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,743.20
|
| Rate for Payer: The Alliance Commercial |
$18,288.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$1,368.57
|
|
|
CT Angiography Neck
|
Professional
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
5426664
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$4,343.40 |
| Rate for Payer: Aetna Commercial |
$4,343.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.92
|
| Rate for Payer: Aetna Managed Medicare |
$195.51
|
| Rate for Payer: Anthem Medicare Advantage |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.51
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,343.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.51
|
| Rate for Payer: Health EOS Commercial |
$4,160.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$716.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.68
|
| Rate for Payer: Quartz Commercial |
$2,606.04
|
| Rate for Payer: Quartz Medicare Advantage |
$195.51
|
| Rate for Payer: The Alliance Commercial |
$742.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.51
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$977.55
|
|
|
CT Angiography Neck
|
Professional
|
$4,075.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
629770
|
| Min. Negotiated Rate |
$276.16 |
| Max. Negotiated Rate |
$3,871.25 |
| Rate for Payer: Aetna Commercial |
$3,871.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.50
|
| Rate for Payer: Aetna Managed Medicare |
$276.16
|
| Rate for Payer: Anthem Medicare Advantage |
$276.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$276.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$276.16
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,871.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,037.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.16
|
| Rate for Payer: Health EOS Commercial |
$3,708.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,007.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,007.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$276.16
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,871.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,793.00
|
| Rate for Payer: Quartz Commercial |
$2,322.75
|
| Rate for Payer: Quartz Medicare Advantage |
$276.16
|
| Rate for Payer: The Alliance Commercial |
$1,049.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.16
|
| Rate for Payer: WEA Trust Commercial |
$2,241.25
|
| Rate for Payer: WPS Commercial |
$1,380.80
|
|
|
CT Angiography Neck
|
Facility
IP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
5426664
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$4,206.24 |
| Rate for Payer: Aetna Commercial |
$4,114.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,423.16
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,206.24
|
| Rate for Payer: Health EOS Commercial |
$4,069.08
|
| Rate for Payer: HFN Commercial |
$4,206.24
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.28
|
| Rate for Payer: Quartz Commercial |
$2,743.20
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$3,386.48
|
|
|
CT Angiography Neck
|
Facility
OP
|
$4,075.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
629770
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$3,749.00 |
| Rate for Payer: Aetna Commercial |
$3,667.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,504.50
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,648.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,037.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,956.00
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.75
|
| 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 |
$1,222.50
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,749.00
|
| 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 |
$3,626.75
|
| Rate for Payer: HFN Commercial |
$3,749.00
|
| 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 |
$3,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,749.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.75
|
| Rate for Payer: Quartz Commercial |
$2,648.75
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$7.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,241.25
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,018.35
|
|
|
CT Angiography Neck
|
Facility
IP
|
$4,075.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
629770
|
| Min. Negotiated Rate |
$1,996.75 |
| Max. Negotiated Rate |
$3,749.00 |
| Rate for Payer: Aetna Commercial |
$3,667.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.75
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,749.00
|
| Rate for Payer: Health EOS Commercial |
$3,626.75
|
| Rate for Payer: HFN Commercial |
$3,749.00
|
| Rate for Payer: Multiplan Commercial |
$3,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,445.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,749.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.75
|
| Rate for Payer: Quartz Commercial |
$2,445.00
|
| Rate for Payer: WEA Trust Commercial |
$2,241.25
|
| Rate for Payer: WPS Commercial |
$3,018.35
|
|
|
CT Angiography Neck w/ + w/o Contrast
|
Facility
OP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
1240847
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,280.16 |
| Max. Negotiated Rate |
$18,288.00 |
| Rate for Payer: Aetna Commercial |
$4,114.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,280.16
|
| 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 |
$2,423.16
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,206.24
|
| Rate for Payer: Health EOS Commercial |
$4,069.08
|
| Rate for Payer: HFN Commercial |
$4,206.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,429.00
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.28
|
| Rate for Payer: Quartz Commercial |
$2,971.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,743.20
|
| Rate for Payer: The Alliance Commercial |
$18,288.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$1,368.57
|
|
|
CT Angiography Neck w/ + w/o Contrast
|
Facility
IP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
1240847
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,240.28 |
| Max. Negotiated Rate |
$4,206.24 |
| Rate for Payer: Aetna Commercial |
$4,114.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,423.16
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,206.24
|
| Rate for Payer: Health EOS Commercial |
$4,069.08
|
| Rate for Payer: HFN Commercial |
$4,206.24
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,206.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,240.28
|
| Rate for Payer: Quartz Commercial |
$2,743.20
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$3,386.48
|
|
|
CT Angiography Neck w/ + w/o Contrast
|
Professional
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
1240847
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$4,343.40 |
| Rate for Payer: Aetna Commercial |
$4,343.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.92
|
| Rate for Payer: Aetna Managed Medicare |
$195.51
|
| Rate for Payer: Anthem Medicare Advantage |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.51
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,343.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.51
|
| Rate for Payer: Health EOS Commercial |
$4,160.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$716.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$3,657.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.68
|
| Rate for Payer: Quartz Commercial |
$2,606.04
|
| Rate for Payer: Quartz Medicare Advantage |
$195.51
|
| Rate for Payer: The Alliance Commercial |
$742.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.51
|
| Rate for Payer: WEA Trust Commercial |
$2,514.60
|
| Rate for Payer: WPS Commercial |
$977.55
|
|
|
CT Angiography Pelvis
|
Facility
IP
|
$5,405.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
629772
|
| Min. Negotiated Rate |
$2,648.45 |
| Max. Negotiated Rate |
$4,972.60 |
| Rate for Payer: Aetna Commercial |
$4,864.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,864.65
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$4,972.60
|
| Rate for Payer: Health EOS Commercial |
$4,810.45
|
| Rate for Payer: HFN Commercial |
$4,972.60
|
| Rate for Payer: Multiplan Commercial |
$4,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,243.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,972.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,648.45
|
| Rate for Payer: Quartz Commercial |
$3,243.00
|
| Rate for Payer: WEA Trust Commercial |
$2,972.75
|
| Rate for Payer: WPS Commercial |
$4,003.48
|
|
|
CT Angiography Pelvis
|
Professional
|
$5,405.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
629772
|
| Min. Negotiated Rate |
$306.20 |
| Max. Negotiated Rate |
$5,134.75 |
| Rate for Payer: Aetna Commercial |
$5,134.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,648.30
|
| Rate for Payer: Aetna Managed Medicare |
$306.20
|
| Rate for Payer: Anthem Medicare Advantage |
$306.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$306.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$306.20
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$5,134.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,702.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.20
|
| Rate for Payer: Health EOS Commercial |
$4,918.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,119.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$306.20
|
| Rate for Payer: Multiplan Commercial |
$4,324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,134.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,378.20
|
| Rate for Payer: Quartz Commercial |
$3,080.85
|
| Rate for Payer: Quartz Medicare Advantage |
$306.20
|
| Rate for Payer: The Alliance Commercial |
$1,163.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$306.20
|
| Rate for Payer: WEA Trust Commercial |
$2,972.75
|
| Rate for Payer: WPS Commercial |
$1,531.00
|
|
|
CT Angiography Pelvis
|
Facility
OP
|
$5,405.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
629772
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$13,481.56 |
| Rate for Payer: Aetna Commercial |
$4,864.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,648.30
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,513.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,702.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,594.40
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,864.65
|
| 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 |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$4,972.60
|
| 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 |
$4,810.45
|
| Rate for Payer: HFN Commercial |
$4,972.60
|
| 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 |
$4,324.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,972.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,648.45
|
| Rate for Payer: Quartz Commercial |
$3,513.25
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$13,481.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,972.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$4,003.48
|
|
|
CT Angiography Pelvis w/ + w/o Contrast
|
Facility
OP
|
$5,302.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
1240849
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,484.56 |
| Max. Negotiated Rate |
$21,208.00 |
| Rate for Payer: Aetna Commercial |
$4,771.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,559.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,484.56
|
| 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 |
$2,810.06
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna Commercial |
$4,877.84
|
| Rate for Payer: Health EOS Commercial |
$4,718.78
|
| Rate for Payer: HFN Commercial |
$4,877.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,976.50
|
| Rate for Payer: Multiplan Commercial |
$4,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,877.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,597.98
|
| Rate for Payer: Quartz Commercial |
$3,446.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,181.20
|
| Rate for Payer: The Alliance Commercial |
$21,208.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,916.10
|
| Rate for Payer: WPS Commercial |
$1,566.88
|
|
|
CT Angiography Pelvis w/ + w/o Contrast
|
Facility
IP
|
$5,302.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
1240849
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,597.98 |
| Max. Negotiated Rate |
$4,877.84 |
| Rate for Payer: Aetna Commercial |
$4,771.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,810.06
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna Commercial |
$4,877.84
|
| Rate for Payer: Health EOS Commercial |
$4,718.78
|
| Rate for Payer: HFN Commercial |
$4,877.84
|
| Rate for Payer: Multiplan Commercial |
$4,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,877.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,597.98
|
| Rate for Payer: Quartz Commercial |
$3,181.20
|
| Rate for Payer: WEA Trust Commercial |
$2,916.10
|
| Rate for Payer: WPS Commercial |
$3,927.19
|
|
|
CT Angiography Pelvis w/ + w/o Contrast
|
Professional
|
$5,302.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
1240849
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$5,036.90 |
| Rate for Payer: Aetna Commercial |
$5,036.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,559.72
|
| Rate for Payer: Aetna Managed Medicare |
$223.84
|
| Rate for Payer: Anthem Medicare Advantage |
$223.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.84
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna Commercial |
$5,036.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,651.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.84
|
| Rate for Payer: Health EOS Commercial |
$4,824.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$819.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$819.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.84
|
| Rate for Payer: Multiplan Commercial |
$4,241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,036.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,332.88
|
| Rate for Payer: Quartz Commercial |
$3,022.14
|
| Rate for Payer: Quartz Medicare Advantage |
$223.84
|
| Rate for Payer: The Alliance Commercial |
$850.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.84
|
| Rate for Payer: WEA Trust Commercial |
$2,916.10
|
| Rate for Payer: WPS Commercial |
$1,119.20
|
|
|
CT Angiography Upper Extremity Bilat
|
Facility
IP
|
$3,269.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240851
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,601.81 |
| Max. Negotiated Rate |
$3,007.48 |
| Rate for Payer: Aetna Commercial |
$2,942.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,732.57
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cigna Commercial |
$3,007.48
|
| Rate for Payer: Health EOS Commercial |
$2,909.41
|
| Rate for Payer: HFN Commercial |
$3,007.48
|
| Rate for Payer: Multiplan Commercial |
$2,615.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,961.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,007.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,601.81
|
| Rate for Payer: Quartz Commercial |
$1,961.40
|
| Rate for Payer: WEA Trust Commercial |
$1,797.95
|
| Rate for Payer: WPS Commercial |
$2,421.35
|
|
