|
CT Angiography Abdomen
|
Professional
|
Both
|
$5,579.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
1240821
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$219.63 |
| Max. Negotiated Rate |
$5,512.05 |
| Rate for Payer: Aetna Commercial |
$5,512.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,989.86
|
| Rate for Payer: Aetna Managed Medicare |
$219.63
|
| Rate for Payer: Anthem Medicare Advantage |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.63
|
| 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 |
$5,512.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,901.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.63
|
| Rate for Payer: Health EOS Commercial |
$5,279.97
|
| Rate for Payer: HFN Commercial |
$5,512.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$850.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$850.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.63
|
| Rate for Payer: Multiplan Commercial |
$4,641.73
|
| Rate for Payer: NAPHCARE Commercial |
$329.44
|
| Rate for Payer: Preferred Network Access Commercial |
$5,512.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,552.95
|
| Rate for Payer: Quartz Commercial |
$3,307.23
|
| Rate for Payer: Quartz Medicare Advantage |
$219.63
|
| Rate for Payer: The Alliance Commercial |
$834.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.63
|
| Rate for Payer: WEA Trust Commercial |
$3,191.19
|
| Rate for Payer: WPS Commercial |
$1,098.14
|
|
|
CT Angiography Abdomen
|
Facility
|
OP
|
$5,579.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
1240821
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$878.51 |
| Max. Negotiated Rate |
$5,337.99 |
| Rate for Payer: Aetna Commercial |
$5,221.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,989.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,624.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,075.14
|
| 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: Cash Price |
$1,673.70
|
| Rate for Payer: Cigna Commercial |
$5,337.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,246.98
|
| Rate for Payer: Health EOS Commercial |
$5,163.92
|
| Rate for Payer: HFN Commercial |
$5,337.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,351.62
|
| Rate for Payer: Multiplan Commercial |
$4,641.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,481.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,337.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,843.06
|
| Rate for Payer: Quartz Commercial |
$3,771.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,481.30
|
| Rate for Payer: The Alliance Commercial |
$878.51
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,191.19
|
| Rate for Payer: WPS Commercial |
$1,537.39
|
|
|
CT Angiography Abdomen
|
Professional
|
Both
|
$7,670.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
625596
|
| Min. Negotiated Rate |
$302.59 |
| Max. Negotiated Rate |
$7,577.96 |
| Rate for Payer: Aetna Commercial |
$7,577.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,860.05
|
| Rate for Payer: Aetna Managed Medicare |
$302.59
|
| Rate for Payer: Anthem Medicare Advantage |
$302.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$302.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$302.59
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cigna Commercial |
$7,577.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,988.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.59
|
| Rate for Payer: Health EOS Commercial |
$7,258.89
|
| Rate for Payer: HFN Commercial |
$7,577.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,164.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$302.59
|
| Rate for Payer: Multiplan Commercial |
$6,381.44
|
| Rate for Payer: NAPHCARE Commercial |
$453.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,577.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,509.79
|
| Rate for Payer: Quartz Commercial |
$4,546.78
|
| Rate for Payer: Quartz Medicare Advantage |
$302.59
|
| Rate for Payer: The Alliance Commercial |
$1,149.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.59
|
| Rate for Payer: WEA Trust Commercial |
$4,387.24
|
| Rate for Payer: WPS Commercial |
$1,512.94
|
|
|
CT Angiography Abdomen
|
Facility
|
IP
|
$7,670.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
625596
|
| Min. Negotiated Rate |
$3,908.63 |
| Max. Negotiated Rate |
$7,338.66 |
| Rate for Payer: Aetna Commercial |
$7,179.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,860.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,227.70
|
| Rate for Payer: Cash Price |
$2,301.00
|
| Rate for Payer: Cigna Commercial |
$7,338.66
|
| Rate for Payer: Health EOS Commercial |
$7,099.35
|
| Rate for Payer: HFN Commercial |
$7,338.66
|
| Rate for Payer: Multiplan Commercial |
$6,381.44
|
| Rate for Payer: Preferred Network Access Commercial |
$7,338.66
|
| Rate for Payer: Quartz Beloit One Network |
$3,908.63
|
| Rate for Payer: Quartz Commercial |
$4,786.08
|
| Rate for Payer: WEA Trust Commercial |
$4,387.24
|
| Rate for Payer: WPS Commercial |
$5,908.20
|
|
|
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 |
$299.37 |
| Max. Negotiated Rate |
$6,734.21 |
| Rate for Payer: Aetna Commercial |
$6,734.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.23
|
| Rate for Payer: Aetna Managed Medicare |
$299.37
|
| Rate for Payer: Anthem Medicare Advantage |
$299.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$299.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$299.37
|
| 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 |
$6,734.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,544.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.37
|
| Rate for Payer: Health EOS Commercial |
$6,450.66
|
| Rate for Payer: HFN Commercial |
$6,734.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,159.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$299.37
|
| Rate for Payer: Multiplan Commercial |
$5,670.91
|
| Rate for Payer: NAPHCARE Commercial |
$449.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,734.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.00
|
| Rate for Payer: Quartz Commercial |
$4,040.52
|
| Rate for Payer: Quartz Medicare Advantage |
$299.37
|
| Rate for Payer: The Alliance Commercial |
$1,137.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$299.37
|
| Rate for Payer: WEA Trust Commercial |
$3,898.75
|
| Rate for Payer: WPS Commercial |
$1,496.87
|
|
|
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 |
$1,197.50 |
| Max. Negotiated Rate |
$6,521.55 |
| Rate for Payer: Aetna Commercial |
$6,379.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,984.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,756.98
|
| 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 |
$6,521.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,966.91
|
| Rate for Payer: Health EOS Commercial |
$6,308.89
|
| Rate for Payer: HFN Commercial |
$6,521.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,316.48
|
| Rate for Payer: Multiplan Commercial |
$5,670.91
|
| Rate for Payer: NAPHCARE Commercial |
$4,253.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,521.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,473.43
|
| Rate for Payer: Quartz Commercial |
$4,607.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4,253.18
|
| Rate for Payer: The Alliance Commercial |
$1,197.50
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,898.75
|
| Rate for Payer: WPS Commercial |
$2,095.62
|
|
|
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 |
$3,473.43 |
| Max. Negotiated Rate |
$6,521.55 |
| Rate for Payer: Aetna Commercial |
$6,379.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,096.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,756.98
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cigna Commercial |
$6,521.55
|
| Rate for Payer: Health EOS Commercial |
$6,308.89
|
| Rate for Payer: HFN Commercial |
$6,521.55
|
| Rate for Payer: Multiplan Commercial |
$5,670.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,521.55
|
| Rate for Payer: Quartz Beloit One Network |
$3,473.43
|
| Rate for Payer: Quartz Commercial |
$4,253.18
|
| Rate for Payer: WEA Trust Commercial |
$3,898.75
|
| Rate for Payer: WPS Commercial |
$5,250.36
|
|
|
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 |
$275.64 |
| Max. Negotiated Rate |
$8,254.74 |
| Rate for Payer: Aetna Commercial |
$8,254.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,472.71
|
| Rate for Payer: Aetna Managed Medicare |
$275.64
|
| Rate for Payer: Anthem Medicare Advantage |
$275.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$275.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$275.64
|
| 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 |
$8,254.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,344.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.64
|
| Rate for Payer: Health EOS Commercial |
$7,907.17
|
| Rate for Payer: HFN Commercial |
$8,254.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,073.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$275.64
|
| Rate for Payer: Multiplan Commercial |
$6,951.36
|
| Rate for Payer: NAPHCARE Commercial |
$413.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,254.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,823.25
|
| Rate for Payer: Quartz Commercial |
$4,952.84
|
| Rate for Payer: Quartz Medicare Advantage |
$275.64
|
| Rate for Payer: The Alliance Commercial |
$1,047.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.64
|
| Rate for Payer: WEA Trust Commercial |
$4,779.06
|
| Rate for Payer: WPS Commercial |
$1,378.21
|
|
|
CT Angiography Abdomen, Pelvis
|
Facility
|
IP
|
$7,922.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1220810
|
| Min. Negotiated Rate |
$4,037.05 |
| Max. Negotiated Rate |
$7,579.77 |
| Rate for Payer: Aetna Commercial |
$7,414.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.61
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,579.77
|
| Rate for Payer: Health EOS Commercial |
$7,332.60
|
| Rate for Payer: HFN Commercial |
$7,579.77
|
| Rate for Payer: Multiplan Commercial |
$6,591.10
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.05
|
| Rate for Payer: Quartz Commercial |
$4,943.33
|
| Rate for Payer: WEA Trust Commercial |
$4,531.38
|
| Rate for Payer: WPS Commercial |
$6,102.32
|
|
|
CT Angiography Abdomen, Pelvis
|
Professional
|
Both
|
$7,922.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1220810
|
| Min. Negotiated Rate |
$376.33 |
| Max. Negotiated Rate |
$7,826.94 |
| Rate for Payer: Aetna Commercial |
$7,826.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.44
|
| Rate for Payer: Aetna Managed Medicare |
$376.33
|
| Rate for Payer: Anthem Medicare Advantage |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$376.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$376.33
|
| 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 |
$7,826.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,119.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.33
|
| Rate for Payer: Health EOS Commercial |
$7,497.38
|
| Rate for Payer: HFN Commercial |
$7,826.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,450.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,450.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$376.33
|
| Rate for Payer: Multiplan Commercial |
$6,591.10
|
| Rate for Payer: NAPHCARE Commercial |
$564.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,826.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,625.11
|
| Rate for Payer: Quartz Commercial |
$4,696.16
|
| Rate for Payer: Quartz Medicare Advantage |
$376.33
|
| Rate for Payer: The Alliance Commercial |
$1,430.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$376.33
|
| Rate for Payer: WEA Trust Commercial |
$4,531.38
|
| Rate for Payer: WPS Commercial |
$1,881.67
|
|
|
CT Angiography Abdomen, Pelvis
|
Facility
|
OP
|
$7,922.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1220810
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$7,579.77 |
| Rate for Payer: Aetna Commercial |
$7,414.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,085.44
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,355.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,119.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,954.66
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cash Price |
$2,376.60
|
| Rate for Payer: Cigna Commercial |
$7,579.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,610.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$7,332.60
|
| Rate for Payer: HFN Commercial |
$7,579.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$6,591.10
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$7,579.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,037.05
|
| Rate for Payer: Quartz Commercial |
$5,355.27
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$4,531.38
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$6,102.32
|
|
|
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 |
$1,102.57 |
| Max. Negotiated Rate |
$7,994.06 |
| Rate for Payer: Aetna Commercial |
$7,820.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,472.71
|
| Rate for Payer: Aetna Managed Medicare |
$2,432.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,605.28
|
| 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 |
$7,994.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,862.61
|
| Rate for Payer: Health EOS Commercial |
$7,733.39
|
| Rate for Payer: HFN Commercial |
$7,994.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,516.90
|
| Rate for Payer: Multiplan Commercial |
$6,951.36
|
| Rate for Payer: NAPHCARE Commercial |
$5,213.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,994.06
|
| Rate for Payer: Quartz Beloit One Network |
$4,257.71
|
| Rate for Payer: Quartz Commercial |
$5,647.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,213.52
|
| Rate for Payer: The Alliance Commercial |
$1,102.57
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,779.06
|
| Rate for Payer: WPS Commercial |
$1,929.49
|
|
|
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 |
$4,257.71 |
| Max. Negotiated Rate |
$7,994.06 |
| Rate for Payer: Aetna Commercial |
$7,820.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,472.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,605.28
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,994.06
|
| Rate for Payer: Health EOS Commercial |
$7,733.39
|
| Rate for Payer: HFN Commercial |
$7,994.06
|
| Rate for Payer: Multiplan Commercial |
$6,951.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,994.06
|
| Rate for Payer: Quartz Beloit One Network |
$4,257.71
|
| Rate for Payer: Quartz Commercial |
$5,213.52
|
| Rate for Payer: WEA Trust Commercial |
$4,779.06
|
| Rate for Payer: WPS Commercial |
$6,435.86
|
|
|
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 |
$1,102.57 |
| Max. Negotiated Rate |
$7,994.06 |
| Rate for Payer: Aetna Commercial |
$7,820.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,472.71
|
| Rate for Payer: Aetna Managed Medicare |
$2,432.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,605.28
|
| 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 |
$7,994.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,862.61
|
| Rate for Payer: Health EOS Commercial |
$7,733.39
|
| Rate for Payer: HFN Commercial |
$7,994.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,516.90
|
| Rate for Payer: Multiplan Commercial |
$6,951.36
|
| Rate for Payer: NAPHCARE Commercial |
$5,213.52
|
| Rate for Payer: Preferred Network Access Commercial |
$7,994.06
|
| Rate for Payer: Quartz Beloit One Network |
$4,257.71
|
| Rate for Payer: Quartz Commercial |
$5,647.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,213.52
|
| Rate for Payer: The Alliance Commercial |
$1,102.57
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,779.06
|
| Rate for Payer: WPS Commercial |
$1,929.49
|
|
|
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 |
$4,257.71 |
| Max. Negotiated Rate |
$7,994.06 |
| Rate for Payer: Aetna Commercial |
$7,820.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,472.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,605.28
|
| Rate for Payer: Cash Price |
$2,506.50
|
| Rate for Payer: Cigna Commercial |
$7,994.06
|
| Rate for Payer: Health EOS Commercial |
$7,733.39
|
| Rate for Payer: HFN Commercial |
$7,994.06
|
| Rate for Payer: Multiplan Commercial |
$6,951.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,994.06
|
| Rate for Payer: Quartz Beloit One Network |
$4,257.71
|
| Rate for Payer: Quartz Commercial |
$5,213.52
|
| Rate for Payer: WEA Trust Commercial |
$4,779.06
|
| Rate for Payer: WPS Commercial |
$6,435.86
|
|
|
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 |
$275.64 |
| Max. Negotiated Rate |
$8,254.74 |
| Rate for Payer: Aetna Commercial |
$8,254.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,472.71
|
| Rate for Payer: Aetna Managed Medicare |
$275.64
|
| Rate for Payer: Anthem Medicare Advantage |
$275.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$275.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$275.64
|
| 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 |
$8,254.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,344.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.64
|
| Rate for Payer: Health EOS Commercial |
$7,907.17
|
| Rate for Payer: HFN Commercial |
$8,254.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,073.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$275.64
|
| Rate for Payer: Multiplan Commercial |
$6,951.36
|
| Rate for Payer: NAPHCARE Commercial |
$413.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,254.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,823.25
|
| Rate for Payer: Quartz Commercial |
$4,952.84
|
| Rate for Payer: Quartz Medicare Advantage |
$275.64
|
| Rate for Payer: The Alliance Commercial |
$1,047.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.64
|
| Rate for Payer: WEA Trust Commercial |
$4,779.06
|
| Rate for Payer: WPS Commercial |
$1,378.21
|
|
|
CT Angiography Chest
|
Facility
|
IP
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$3,384.25 |
| Max. Negotiated Rate |
$6,354.11 |
| Rate for Payer: Aetna Commercial |
$6,215.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,939.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,660.52
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,354.11
|
| Rate for Payer: Health EOS Commercial |
$6,146.91
|
| Rate for Payer: HFN Commercial |
$6,354.11
|
| Rate for Payer: Multiplan Commercial |
$5,525.31
|
| Rate for Payer: Preferred Network Access Commercial |
$6,354.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,384.25
|
| Rate for Payer: Quartz Commercial |
$4,143.98
|
| Rate for Payer: WEA Trust Commercial |
$3,798.65
|
| Rate for Payer: WPS Commercial |
$5,115.56
|
|
|
CT Angiography Chest
|
Professional
|
Both
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$6,561.31 |
| Rate for Payer: Aetna Commercial |
$6,561.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,939.71
|
| Rate for Payer: Aetna Managed Medicare |
$278.96
|
| Rate for Payer: Anthem Medicare Advantage |
$278.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$278.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$278.96
|
| 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 |
$6,561.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,453.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.96
|
| Rate for Payer: Health EOS Commercial |
$6,285.04
|
| Rate for Payer: HFN Commercial |
$6,561.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,071.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$278.96
|
| Rate for Payer: Multiplan Commercial |
$5,525.31
|
| Rate for Payer: NAPHCARE Commercial |
$418.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,561.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,038.92
|
| Rate for Payer: Quartz Commercial |
$3,936.78
|
| Rate for Payer: Quartz Medicare Advantage |
$278.96
|
| Rate for Payer: The Alliance Commercial |
$1,060.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$278.96
|
| Rate for Payer: WEA Trust Commercial |
$3,798.65
|
| Rate for Payer: WPS Commercial |
$1,394.80
|
|
|
CT Angiography Chest
|
Facility
|
OP
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$6,354.11 |
| Rate for Payer: Aetna Commercial |
$6,215.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,939.71
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,489.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,453.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,315.19
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,660.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,354.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$6,146.91
|
| Rate for Payer: HFN Commercial |
$6,354.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$5,525.31
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$6,354.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,384.25
|
| Rate for Payer: Quartz Commercial |
$4,489.32
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$3,798.65
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$5,115.56
|
|
|
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 |
$3,764.42 |
| Max. Negotiated Rate |
$7,067.88 |
| Rate for Payer: Aetna Commercial |
$6,914.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,071.71
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$7,067.88
|
| Rate for Payer: Health EOS Commercial |
$6,837.41
|
| Rate for Payer: HFN Commercial |
$7,067.88
|
| Rate for Payer: Multiplan Commercial |
$6,145.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,067.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.42
|
| Rate for Payer: Quartz Commercial |
$4,609.49
|
| Rate for Payer: WEA Trust Commercial |
$4,225.36
|
| Rate for Payer: WPS Commercial |
$5,690.21
|
|
|
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 |
$195.67 |
| Max. Negotiated Rate |
$7,298.36 |
| Rate for Payer: Aetna Commercial |
$7,298.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.93
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| 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 |
$7,298.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,841.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$6,991.06
|
| Rate for Payer: HFN Commercial |
$7,298.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$6,145.98
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,298.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,380.29
|
| Rate for Payer: Quartz Commercial |
$4,379.01
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$4,225.36
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
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 |
$782.66 |
| Max. Negotiated Rate |
$7,067.88 |
| Rate for Payer: Aetna Commercial |
$6,914.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.93
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,071.71
|
| 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 |
$7,067.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.23
|
| Rate for Payer: Health EOS Commercial |
$6,837.41
|
| Rate for Payer: HFN Commercial |
$7,067.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,761.86
|
| Rate for Payer: Multiplan Commercial |
$6,145.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,609.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,067.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.42
|
| Rate for Payer: Quartz Commercial |
$4,993.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,609.49
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,225.36
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
|
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 |
$2,478.18 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,034.51
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$3,745.97
|
|
|
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 |
$195.67 |
| Max. Negotiated Rate |
$4,804.64 |
| Rate for Payer: Aetna Commercial |
$4,804.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| 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 |
$4,804.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,528.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$4,602.34
|
| Rate for Payer: HFN Commercial |
$4,804.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,804.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,225.31
|
| Rate for Payer: Quartz Commercial |
$2,882.79
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
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 |
$782.66 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,416.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.49
|
| 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 |
$4,652.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,830.27
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,793.14
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,034.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,287.39
|
| Rate for Payer: Quartz Medicare Advantage |
$3,034.51
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
