|
CT Angiography Abdomen
|
Professional
|
Both
|
$5,579.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
1240821
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.58 |
| Max. Negotiated Rate |
$5,300.05 |
| Rate for Payer: Aetna Commercial |
$5,300.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,797.94
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,300.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,789.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,347.40
|
| Rate for Payer: Health EOS Commercial |
$5,076.89
|
| Rate for Payer: HFN Commercial |
$5,300.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$817.58
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,300.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,454.76
|
| Rate for Payer: Quartz Commercial |
$3,180.03
|
| Rate for Payer: The Alliance Commercial |
$2,789.50
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: WPS Commercial |
$4,132.37
|
|
|
CT Angiography Abdomen
|
Facility
|
IP
|
$5,579.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
1240821
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,733.71 |
| Max. Negotiated Rate |
$5,132.68 |
| Rate for Payer: Aetna Commercial |
$5,021.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,797.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,956.87
|
| Rate for Payer: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,132.68
|
| Rate for Payer: Health EOS Commercial |
$4,965.31
|
| Rate for Payer: HFN Commercial |
$5,132.68
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,132.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,733.71
|
| Rate for Payer: Quartz Commercial |
$3,347.40
|
| Rate for Payer: WEA Trust Commercial |
$3,068.45
|
| Rate for Payer: WPS Commercial |
$4,132.37
|
|
|
CT Angiography Abdomen + Iliofemoral
|
Facility
|
OP
|
$6,816.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
6182045
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$6,270.72 |
| Rate for Payer: Aetna Commercial |
$6,134.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.76
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,612.48
|
| 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 |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,270.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,814.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$6,066.24
|
| Rate for Payer: HFN Commercial |
$6,270.72
|
| 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 |
$5,452.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,270.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,339.84
|
| Rate for Payer: Quartz Commercial |
$4,430.40
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,748.80
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,048.61
|
|
|
CT Angiography Abdomen + Iliofemoral
|
Professional
|
Both
|
$6,816.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
6182045
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,115.34 |
| Max. Negotiated Rate |
$6,475.20 |
| Rate for Payer: Aetna Commercial |
$6,475.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.76
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,475.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,408.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,089.60
|
| Rate for Payer: Health EOS Commercial |
$6,202.56
|
| Rate for Payer: HFN Commercial |
$6,475.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,115.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,115.34
|
| Rate for Payer: Multiplan Commercial |
$5,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,475.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,999.04
|
| Rate for Payer: Quartz Commercial |
$3,885.12
|
| Rate for Payer: The Alliance Commercial |
$3,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,748.80
|
| Rate for Payer: WPS Commercial |
$5,048.61
|
|
|
CT Angiography Abdomen + Iliofemoral
|
Facility
|
IP
|
$6,816.00
|
|
|
Service Code
|
CPT 75635 TC
|
| Hospital Charge Code |
6182045
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,339.84 |
| Max. Negotiated Rate |
$6,270.72 |
| Rate for Payer: Aetna Commercial |
$6,134.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,861.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,612.48
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,270.72
|
| Rate for Payer: Health EOS Commercial |
$6,066.24
|
| Rate for Payer: HFN Commercial |
$6,270.72
|
| Rate for Payer: Multiplan Commercial |
$5,452.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,089.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,270.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,339.84
|
| Rate for Payer: Quartz Commercial |
$4,089.60
|
| Rate for Payer: WEA Trust Commercial |
$3,748.80
|
| Rate for Payer: WPS Commercial |
$5,048.61
|
|
|
CT Angiography Abdomen, Pelvis
|
Facility
|
IP
|
$7,922.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1220810
|
| Min. Negotiated Rate |
$3,881.78 |
| Max. Negotiated Rate |
$7,288.24 |
| Rate for Payer: Aetna Commercial |
$7,129.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,198.66
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,288.24
|
| Rate for Payer: Health EOS Commercial |
$7,050.58
|
| Rate for Payer: HFN Commercial |
$7,288.24
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,753.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,881.78
|
| Rate for Payer: Quartz Commercial |
$4,753.20
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
CT Angiography Abdomen, Pelvis
|
Facility
|
IP
|
$8,355.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
5426649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,093.95 |
| Max. Negotiated Rate |
$7,686.60 |
| Rate for Payer: Aetna Commercial |
$7,519.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,185.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,428.15
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,686.60
|
| Rate for Payer: Health EOS Commercial |
$7,435.95
|
| Rate for Payer: HFN Commercial |
$7,686.60
|
| Rate for Payer: Multiplan Commercial |
$6,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,013.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,686.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,093.95
|
| Rate for Payer: Quartz Commercial |
$5,013.00
|
| Rate for Payer: WEA Trust Commercial |
$4,595.25
|
| Rate for Payer: WPS Commercial |
$6,188.55
|
|
|
CT Angiography Abdomen, Pelvis
|
Facility
|
OP
|
$7,922.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1220810
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$7,288.24 |
| Rate for Payer: Aetna Commercial |
$7,129.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,149.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,961.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,802.56
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,288.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,433.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$7,050.58
|
| Rate for Payer: HFN Commercial |
$7,288.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,288.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,881.78
|
| Rate for Payer: Quartz Commercial |
$5,149.30
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
CT Angiography Abdomen, Pelvis
|
Professional
|
Both
|
$7,922.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1220810
|
| Min. Negotiated Rate |
$1,394.95 |
| Max. Negotiated Rate |
$7,525.90 |
| Rate for Payer: Aetna Commercial |
$7,525.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,812.92
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,525.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,961.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,753.20
|
| Rate for Payer: Health EOS Commercial |
$7,209.02
|
| Rate for Payer: HFN Commercial |
$7,525.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,394.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,394.95
|
| Rate for Payer: Multiplan Commercial |
$6,337.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,525.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,485.68
|
| Rate for Payer: Quartz Commercial |
$4,515.54
|
| Rate for Payer: The Alliance Commercial |
$3,961.00
|
| Rate for Payer: WEA Trust Commercial |
$4,357.10
|
| Rate for Payer: WPS Commercial |
$5,867.83
|
|
|
CT Angiography Abdomen, Pelvis
|
Facility
|
OP
|
$8,355.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
5426649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$7,686.60 |
| Rate for Payer: Aetna Commercial |
$7,519.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,185.30
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| 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: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,428.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,686.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,675.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$7,435.95
|
| Rate for Payer: HFN Commercial |
$7,686.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$6,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,686.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,093.95
|
| Rate for Payer: Quartz Commercial |
$5,430.75
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,595.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$6,188.55
|
|
|
CT Angiography Abdomen, Pelvis
|
Professional
|
Both
|
$8,355.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
5426649
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,031.78 |
| Max. Negotiated Rate |
$7,937.25 |
| Rate for Payer: Aetna Commercial |
$7,937.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,185.30
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,937.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,177.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,013.00
|
| Rate for Payer: Health EOS Commercial |
$7,603.05
|
| Rate for Payer: HFN Commercial |
$7,937.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,031.78
|
| Rate for Payer: Multiplan Commercial |
$6,684.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,937.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,676.20
|
| Rate for Payer: Quartz Commercial |
$4,762.35
|
| Rate for Payer: The Alliance Commercial |
$4,177.50
|
| Rate for Payer: WEA Trust Commercial |
$4,595.25
|
| Rate for Payer: WPS Commercial |
$6,188.55
|
|
|
CT Angiography Abdomen, Pelvis w/Cont
|
Facility
|
IP
|
$8,355.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
1240823
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$4,093.95 |
| Max. Negotiated Rate |
$7,686.60 |
| Rate for Payer: Aetna Commercial |
$7,519.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,185.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,428.15
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,686.60
|
| Rate for Payer: Health EOS Commercial |
$7,435.95
|
| Rate for Payer: HFN Commercial |
$7,686.60
|
| Rate for Payer: Multiplan Commercial |
$6,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,013.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,686.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,093.95
|
| Rate for Payer: Quartz Commercial |
$5,013.00
|
| Rate for Payer: WEA Trust Commercial |
$4,595.25
|
| Rate for Payer: WPS Commercial |
$6,188.55
|
|
|
CT Angiography Abdomen, Pelvis w/Cont
|
Facility
|
OP
|
$8,355.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
1240823
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$7,686.60 |
| Rate for Payer: Aetna Commercial |
$7,519.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,185.30
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| 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: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,428.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,686.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,675.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$7,435.95
|
| Rate for Payer: HFN Commercial |
$7,686.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$6,684.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,686.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,093.95
|
| Rate for Payer: Quartz Commercial |
$5,430.75
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,595.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$6,188.55
|
|
|
CT Angiography Abdomen, Pelvis w/Cont
|
Professional
|
Both
|
$8,355.00
|
|
|
Service Code
|
CPT 74174 TC
|
| Hospital Charge Code |
1240823
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,031.78 |
| Max. Negotiated Rate |
$7,937.25 |
| Rate for Payer: Aetna Commercial |
$7,937.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,185.30
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,937.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,177.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,013.00
|
| Rate for Payer: Health EOS Commercial |
$7,603.05
|
| Rate for Payer: HFN Commercial |
$7,937.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,031.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,031.78
|
| Rate for Payer: Multiplan Commercial |
$6,684.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,937.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,676.20
|
| Rate for Payer: Quartz Commercial |
$4,762.35
|
| Rate for Payer: The Alliance Commercial |
$4,177.50
|
| Rate for Payer: WEA Trust Commercial |
$4,595.25
|
| Rate for Payer: WPS Commercial |
$6,188.55
|
|
|
CT Angiography Chest
|
Professional
|
Both
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$1,029.95 |
| Max. Negotiated Rate |
$6,308.95 |
| Rate for Payer: Aetna Commercial |
$6,308.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,711.26
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,308.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,320.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,984.60
|
| Rate for Payer: Health EOS Commercial |
$6,043.31
|
| Rate for Payer: HFN Commercial |
$6,308.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,029.95
|
| Rate for Payer: Multiplan Commercial |
$5,312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,308.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.04
|
| Rate for Payer: Quartz Commercial |
$3,785.37
|
| Rate for Payer: The Alliance Commercial |
$3,320.50
|
| Rate for Payer: WEA Trust Commercial |
$3,652.55
|
| Rate for Payer: WPS Commercial |
$4,918.99
|
|
|
CT Angiography Chest
|
Facility
|
IP
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$3,254.09 |
| Max. Negotiated Rate |
$6,109.72 |
| Rate for Payer: Aetna Commercial |
$5,976.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,711.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,519.73
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,109.72
|
| Rate for Payer: Health EOS Commercial |
$5,910.49
|
| Rate for Payer: HFN Commercial |
$6,109.72
|
| Rate for Payer: Multiplan Commercial |
$5,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,984.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,109.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,254.09
|
| Rate for Payer: Quartz Commercial |
$3,984.60
|
| Rate for Payer: WEA Trust Commercial |
$3,652.55
|
| Rate for Payer: WPS Commercial |
$4,918.99
|
|
|
CT Angiography Chest
|
Facility
|
OP
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$6,109.72 |
| Rate for Payer: Aetna Commercial |
$5,976.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,711.26
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,316.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,320.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,519.73
|
| 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 |
$1,992.30
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,109.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$5,910.49
|
| Rate for Payer: HFN Commercial |
$6,109.72
|
| 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 |
$5,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,109.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,254.09
|
| Rate for Payer: Quartz Commercial |
$4,316.65
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$3,652.55
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$4,918.99
|
|
|
CT Angiography Chest, Abd + Iliofemoral
|
Facility
|
IP
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
6182015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,619.63 |
| Max. Negotiated Rate |
$6,796.04 |
| Rate for Payer: Aetna Commercial |
$6,648.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.11
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$6,796.04
|
| Rate for Payer: Health EOS Commercial |
$6,574.43
|
| Rate for Payer: HFN Commercial |
$6,796.04
|
| Rate for Payer: Multiplan Commercial |
$5,909.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,619.63
|
| Rate for Payer: Quartz Commercial |
$4,432.20
|
| Rate for Payer: WEA Trust Commercial |
$4,062.85
|
| Rate for Payer: WPS Commercial |
$5,471.55
|
|
|
CT Angiography Chest, Abd + Iliofemoral
|
Facility
|
OP
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
6182015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$6,796.04 |
| Rate for Payer: Aetna Commercial |
$6,648.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,352.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.11
|
| 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 |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$6,796.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,133.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$6,574.43
|
| Rate for Payer: HFN Commercial |
$6,796.04
|
| 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 |
$5,909.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,619.63
|
| Rate for Payer: Quartz Commercial |
$4,801.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,062.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,471.55
|
|
|
CT Angiography Chest, Abd + Iliofemoral
|
Professional
|
Both
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
6182015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$727.07 |
| Max. Negotiated Rate |
$7,017.65 |
| Rate for Payer: Aetna Commercial |
$7,017.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,352.82
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$7,017.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,693.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,432.20
|
| Rate for Payer: Health EOS Commercial |
$6,722.17
|
| Rate for Payer: HFN Commercial |
$7,017.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$727.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$727.07
|
| Rate for Payer: Multiplan Commercial |
$5,909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,017.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,250.28
|
| Rate for Payer: Quartz Commercial |
$4,210.59
|
| Rate for Payer: The Alliance Commercial |
$3,693.50
|
| Rate for Payer: WEA Trust Commercial |
$4,062.85
|
| Rate for Payer: WPS Commercial |
$5,471.55
|
|
|
CT Angiography Chest, Abdomen w/ Con
|
Facility
|
IP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240830
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,382.87 |
| Max. Negotiated Rate |
$4,473.96 |
| Rate for Payer: Aetna Commercial |
$4,376.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,182.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,577.39
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,473.96
|
| Rate for Payer: Health EOS Commercial |
$4,328.07
|
| Rate for Payer: HFN Commercial |
$4,473.96
|
| Rate for Payer: Multiplan Commercial |
$3,890.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,917.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,473.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,382.87
|
| Rate for Payer: Quartz Commercial |
$2,917.80
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: WPS Commercial |
$3,602.02
|
|
|
CT Angiography Chest, Abdomen w/ Con
|
Professional
|
Both
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240830
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$727.07 |
| Max. Negotiated Rate |
$4,619.85 |
| Rate for Payer: Aetna Commercial |
$4,619.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,182.18
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,619.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,431.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,917.80
|
| Rate for Payer: Health EOS Commercial |
$4,425.33
|
| Rate for Payer: HFN Commercial |
$4,619.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$727.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$727.07
|
| Rate for Payer: Multiplan Commercial |
$3,890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,619.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,139.72
|
| Rate for Payer: Quartz Commercial |
$2,771.91
|
| Rate for Payer: The Alliance Commercial |
$2,431.50
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: WPS Commercial |
$3,602.02
|
|
|
CT Angiography Chest, Abdomen w/ Con
|
Facility
|
OP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240830
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$4,473.96 |
| Rate for Payer: Aetna Commercial |
$4,376.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,182.18
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,577.39
|
| 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 |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,473.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,721.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$4,328.07
|
| Rate for Payer: HFN Commercial |
$4,473.96
|
| 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 |
$3,890.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,473.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,382.87
|
| Rate for Payer: Quartz Commercial |
$3,160.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,674.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,602.02
|
|
|
CT Angiography Chest w/ + w/o Contrast
|
Facility
|
IP
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240828
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,619.63 |
| Max. Negotiated Rate |
$6,796.04 |
| Rate for Payer: Aetna Commercial |
$6,648.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,352.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.11
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$6,796.04
|
| Rate for Payer: Health EOS Commercial |
$6,574.43
|
| Rate for Payer: HFN Commercial |
$6,796.04
|
| Rate for Payer: Multiplan Commercial |
$5,909.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,619.63
|
| Rate for Payer: Quartz Commercial |
$4,432.20
|
| Rate for Payer: WEA Trust Commercial |
$4,062.85
|
| Rate for Payer: WPS Commercial |
$5,471.55
|
|
|
CT Angiography Chest w/ + w/o Contrast
|
Facility
|
OP
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240828
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$6,796.04 |
| Rate for Payer: Aetna Commercial |
$6,648.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,352.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| 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: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.11
|
| 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 |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$6,796.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,133.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$6,574.43
|
| Rate for Payer: HFN Commercial |
$6,796.04
|
| 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 |
$5,909.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,619.63
|
| Rate for Payer: Quartz Commercial |
$4,801.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$4,062.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$5,471.55
|
|
