|
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 |
$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 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 |
$3,764.42 |
| 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 w/ + w/o Contrast
|
Professional
|
Both
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240828
|
|
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 Coronary Artery w/ Eval
|
Facility
|
OP
|
$4,883.00
|
|
|
Service Code
|
CPT 75574 TC
|
| Hospital Charge Code |
1240833
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$853.63 |
| Max. Negotiated Rate |
$4,672.05 |
| Rate for Payer: Aetna Commercial |
$4,570.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,367.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,421.93
|
| 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 |
$2,691.51
|
| Rate for Payer: Cash Price |
$1,464.90
|
| Rate for Payer: Cash Price |
$1,464.90
|
| Rate for Payer: Cash Price |
$1,464.90
|
| Rate for Payer: Cash Price |
$1,464.90
|
| Rate for Payer: Cigna Commercial |
$4,672.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,841.91
|
| Rate for Payer: Health EOS Commercial |
$4,519.70
|
| Rate for Payer: HFN Commercial |
$4,672.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,808.74
|
| Rate for Payer: Multiplan Commercial |
$4,062.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,046.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,672.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,488.38
|
| Rate for Payer: Quartz Commercial |
$3,300.91
|
| Rate for Payer: Quartz Medicare Advantage |
$3,046.99
|
| Rate for Payer: The Alliance Commercial |
$853.63
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,793.08
|
| Rate for Payer: WPS Commercial |
$1,493.86
|
|
|
CT Angiography Coronary Artery w/ Eval
|
Facility
|
IP
|
$4,883.00
|
|
|
Service Code
|
CPT 75574 TC
|
| Hospital Charge Code |
1240833
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,488.38 |
| Max. Negotiated Rate |
$4,672.05 |
| Rate for Payer: Aetna Commercial |
$4,570.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,367.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,691.51
|
| Rate for Payer: Cash Price |
$1,464.90
|
| Rate for Payer: Cigna Commercial |
$4,672.05
|
| Rate for Payer: Health EOS Commercial |
$4,519.70
|
| Rate for Payer: HFN Commercial |
$4,672.05
|
| Rate for Payer: Multiplan Commercial |
$4,062.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,672.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,488.38
|
| Rate for Payer: Quartz Commercial |
$3,046.99
|
| Rate for Payer: WEA Trust Commercial |
$2,793.08
|
| Rate for Payer: WPS Commercial |
$3,761.37
|
|
|
CT Angiography Coronary Artery w/o Eval
|
Professional
|
Both
|
$258.00
|
|
| Hospital Charge Code |
711746
|
| Min. Negotiated Rate |
$118.06 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$254.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.99
|
| Rate for Payer: Health EOS Commercial |
$244.17
|
| Rate for Payer: HFN Commercial |
$254.90
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$254.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.06
|
| Rate for Payer: Quartz Commercial |
$152.94
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CT Angiography Coronary Artery w/o Eval
|
Facility
|
IP
|
$258.00
|
|
| Hospital Charge Code |
711746
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CT Angiography Coronary Artery w/o Eval
|
Facility
|
OP
|
$258.00
|
|
| Hospital Charge Code |
711746
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
CT Angiography Head
|
Professional
|
Both
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
5426663
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$5,326.31 |
| Rate for Payer: Aetna Commercial |
$5,326.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Aetna Managed Medicare |
$192.34
|
| Rate for Payer: Anthem Medicare Advantage |
$192.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$192.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$192.34
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,326.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,803.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.34
|
| Rate for Payer: Health EOS Commercial |
$5,102.04
|
| Rate for Payer: HFN Commercial |
$5,326.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$746.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$746.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$192.34
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: NAPHCARE Commercial |
$288.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,326.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,466.92
|
| Rate for Payer: Quartz Commercial |
$3,195.78
|
| Rate for Payer: Quartz Medicare Advantage |
$192.34
|
| Rate for Payer: The Alliance Commercial |
$730.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.34
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$961.69
|
|
|
CT Angiography Head
|
Facility
|
IP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
5426663
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,747.25 |
| Max. Negotiated Rate |
$5,158.11 |
| Rate for Payer: Aetna Commercial |
$5,045.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,971.52
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,158.11
|
| Rate for Payer: Health EOS Commercial |
$4,989.91
|
| Rate for Payer: HFN Commercial |
$5,158.11
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.25
|
| Rate for Payer: Quartz Commercial |
$3,363.98
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$4,152.69
|
|
|
CT Angiography Head
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
629762
|
| Min. Negotiated Rate |
$2,562.78 |
| Max. Negotiated Rate |
$4,811.75 |
| Rate for Payer: Aetna Commercial |
$4,707.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.98
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,811.75
|
| Rate for Payer: Health EOS Commercial |
$4,654.84
|
| Rate for Payer: HFN Commercial |
$4,811.75
|
| Rate for Payer: Multiplan Commercial |
$4,184.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,811.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.78
|
| Rate for Payer: Quartz Commercial |
$3,138.10
|
| Rate for Payer: WEA Trust Commercial |
$2,876.59
|
| Rate for Payer: WPS Commercial |
$3,873.84
|
|
|
CT Angiography Head
|
Professional
|
Both
|
$5,029.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
629762
|
| Min. Negotiated Rate |
$272.67 |
| Max. Negotiated Rate |
$4,968.65 |
| Rate for Payer: Aetna Commercial |
$4,968.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.94
|
| Rate for Payer: Aetna Managed Medicare |
$272.67
|
| Rate for Payer: Anthem Medicare Advantage |
$272.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.67
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,968.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,615.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.67
|
| Rate for Payer: Health EOS Commercial |
$4,759.45
|
| Rate for Payer: HFN Commercial |
$4,968.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,048.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,048.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.67
|
| Rate for Payer: Multiplan Commercial |
$4,184.13
|
| Rate for Payer: NAPHCARE Commercial |
$409.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,968.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,301.27
|
| Rate for Payer: Quartz Commercial |
$2,981.19
|
| Rate for Payer: Quartz Medicare Advantage |
$272.67
|
| Rate for Payer: The Alliance Commercial |
$1,036.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.67
|
| Rate for Payer: WEA Trust Commercial |
$2,876.59
|
| Rate for Payer: WPS Commercial |
$1,363.34
|
|
|
CT Angiography Head
|
Facility
|
OP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
5426663
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$769.35 |
| Max. Negotiated Rate |
$5,158.11 |
| Rate for Payer: Aetna Commercial |
$5,045.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.86
|
| 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 |
$2,971.52
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,158.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,137.56
|
| Rate for Payer: Health EOS Commercial |
$4,989.91
|
| Rate for Payer: HFN Commercial |
$5,158.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,204.98
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.25
|
| Rate for Payer: Quartz Commercial |
$3,644.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.98
|
| Rate for Payer: The Alliance Commercial |
$769.35
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$1,346.36
|
|
|
CT Angiography Head
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
629762
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,811.75 |
| Rate for Payer: Aetna Commercial |
$4,707.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.94
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,399.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,615.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,510.48
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,811.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,926.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$4,654.84
|
| Rate for Payer: HFN Commercial |
$4,811.75
|
| 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 |
$4,184.13
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,811.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.78
|
| Rate for Payer: Quartz Commercial |
$3,399.60
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,876.59
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,873.84
|
|
|
CT Angiography Head w/ + w/o Contrast
|
Facility
|
IP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
1240839
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,747.25 |
| Max. Negotiated Rate |
$5,158.11 |
| Rate for Payer: Aetna Commercial |
$5,045.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,971.52
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,158.11
|
| Rate for Payer: Health EOS Commercial |
$4,989.91
|
| Rate for Payer: HFN Commercial |
$5,158.11
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.25
|
| Rate for Payer: Quartz Commercial |
$3,363.98
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$4,152.69
|
|
|
CT Angiography Head w/ + w/o Contrast
|
Professional
|
Both
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
1240839
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$5,326.31 |
| Rate for Payer: Aetna Commercial |
$5,326.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Aetna Managed Medicare |
$192.34
|
| Rate for Payer: Anthem Medicare Advantage |
$192.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$192.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$192.34
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,326.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,803.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.34
|
| Rate for Payer: Health EOS Commercial |
$5,102.04
|
| Rate for Payer: HFN Commercial |
$5,326.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$746.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$746.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$192.34
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: NAPHCARE Commercial |
$288.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,326.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,466.92
|
| Rate for Payer: Quartz Commercial |
$3,195.78
|
| Rate for Payer: Quartz Medicare Advantage |
$192.34
|
| Rate for Payer: The Alliance Commercial |
$730.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.34
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$961.69
|
|
|
CT Angiography Head w/ + w/o Contrast
|
Facility
|
OP
|
$5,391.00
|
|
|
Service Code
|
CPT 70496 TC
|
| Hospital Charge Code |
1240839
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$769.35 |
| Max. Negotiated Rate |
$5,158.11 |
| Rate for Payer: Aetna Commercial |
$5,045.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,821.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,569.86
|
| 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 |
$2,971.52
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cash Price |
$1,617.30
|
| Rate for Payer: Cigna Commercial |
$5,158.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,137.56
|
| Rate for Payer: Health EOS Commercial |
$4,989.91
|
| Rate for Payer: HFN Commercial |
$5,158.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,204.98
|
| Rate for Payer: Multiplan Commercial |
$4,485.31
|
| Rate for Payer: NAPHCARE Commercial |
$3,363.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,158.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,747.25
|
| Rate for Payer: Quartz Commercial |
$3,644.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,363.98
|
| Rate for Payer: The Alliance Commercial |
$769.35
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,083.65
|
| Rate for Payer: WPS Commercial |
$1,346.36
|
|
|
CT Angiography Lower Extremity Bilat
|
Professional
|
Both
|
$13,592.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629764
|
| Min. Negotiated Rate |
$319.55 |
| Max. Negotiated Rate |
$13,428.90 |
| Rate for Payer: Aetna Commercial |
$13,428.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,156.68
|
| Rate for Payer: Aetna Managed Medicare |
$319.55
|
| Rate for Payer: Anthem Medicare Advantage |
$319.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$319.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$319.55
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cigna Commercial |
$13,428.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,067.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.55
|
| Rate for Payer: Health EOS Commercial |
$12,863.47
|
| Rate for Payer: HFN Commercial |
$13,428.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,249.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$319.55
|
| Rate for Payer: Multiplan Commercial |
$11,308.54
|
| Rate for Payer: NAPHCARE Commercial |
$479.33
|
| Rate for Payer: Preferred Network Access Commercial |
$13,428.90
|
| Rate for Payer: Quartz Beloit One Network |
$6,219.70
|
| Rate for Payer: Quartz Commercial |
$8,057.34
|
| Rate for Payer: Quartz Medicare Advantage |
$319.55
|
| Rate for Payer: The Alliance Commercial |
$1,214.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$319.55
|
| Rate for Payer: WEA Trust Commercial |
$7,774.62
|
| Rate for Payer: WPS Commercial |
$1,597.75
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
|
OP
|
$13,592.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629764
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$13,004.83 |
| Rate for Payer: Aetna Commercial |
$12,722.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,156.68
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,188.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,067.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,785.13
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,491.91
|
| 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 |
$4,077.60
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cigna Commercial |
$13,004.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,910.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$12,580.76
|
| Rate for Payer: HFN Commercial |
$13,004.83
|
| 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 |
$11,308.54
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$13,004.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,926.48
|
| Rate for Payer: Quartz Commercial |
$9,188.19
|
| 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 |
$7,774.62
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$10,469.92
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
|
IP
|
$13,592.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629764
|
| Min. Negotiated Rate |
$6,926.48 |
| Max. Negotiated Rate |
$13,004.83 |
| Rate for Payer: Aetna Commercial |
$12,722.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,156.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,491.91
|
| Rate for Payer: Cash Price |
$4,077.60
|
| Rate for Payer: Cigna Commercial |
$13,004.83
|
| Rate for Payer: Health EOS Commercial |
$12,580.76
|
| Rate for Payer: HFN Commercial |
$13,004.83
|
| Rate for Payer: Multiplan Commercial |
$11,308.54
|
| Rate for Payer: Preferred Network Access Commercial |
$13,004.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,926.48
|
| Rate for Payer: Quartz Commercial |
$8,481.41
|
| Rate for Payer: WEA Trust Commercial |
$7,774.62
|
| Rate for Payer: WPS Commercial |
$10,469.92
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
|
OP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240841
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,979.00 |
| Max. Negotiated Rate |
$6,502.41 |
| Rate for Payer: Aetna Commercial |
$6,361.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,078.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,979.00
|
| 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 |
$3,745.96
|
| 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 |
$6,502.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,955.27
|
| Rate for Payer: Health EOS Commercial |
$6,290.38
|
| Rate for Payer: HFN Commercial |
$6,502.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,300.88
|
| Rate for Payer: Multiplan Commercial |
$5,654.27
|
| Rate for Payer: NAPHCARE Commercial |
$4,240.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,502.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,463.24
|
| Rate for Payer: Quartz Commercial |
$4,594.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,240.70
|
| Rate for Payer: The Alliance Commercial |
$3,533.92
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,887.31
|
| Rate for Payer: WPS Commercial |
$5,234.96
|
|
|
CT Angiography Lower Extremity Bilat
|
Professional
|
Both
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240841
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,249.86 |
| Max. Negotiated Rate |
$6,714.45 |
| Rate for Payer: Aetna Commercial |
$6,714.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,078.34
|
| 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 |
$6,714.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,533.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,240.70
|
| Rate for Payer: Health EOS Commercial |
$6,431.73
|
| Rate for Payer: HFN Commercial |
$6,714.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,249.86
|
| Rate for Payer: Multiplan Commercial |
$5,654.27
|
| Rate for Payer: Preferred Network Access Commercial |
$6,714.45
|
| Rate for Payer: Quartz Beloit One Network |
$3,109.85
|
| Rate for Payer: Quartz Commercial |
$4,028.67
|
| Rate for Payer: The Alliance Commercial |
$3,533.92
|
| Rate for Payer: WEA Trust Commercial |
$3,887.31
|
| Rate for Payer: WPS Commercial |
$5,234.96
|
|
|
CT Angiography Lower Extremity Bilat
|
Facility
|
IP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240841
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,463.24 |
| Max. Negotiated Rate |
$6,502.41 |
| Rate for Payer: Aetna Commercial |
$6,361.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,078.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,745.96
|
| Rate for Payer: Cash Price |
$2,038.80
|
| Rate for Payer: Cigna Commercial |
$6,502.41
|
| Rate for Payer: Health EOS Commercial |
$6,290.38
|
| Rate for Payer: HFN Commercial |
$6,502.41
|
| Rate for Payer: Multiplan Commercial |
$5,654.27
|
| Rate for Payer: Preferred Network Access Commercial |
$6,502.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,463.24
|
| Rate for Payer: Quartz Commercial |
$4,240.70
|
| Rate for Payer: WEA Trust Commercial |
$3,887.31
|
| Rate for Payer: WPS Commercial |
$5,234.96
|
|
|
CT Angiography Lower Extremity Left
|
Facility
|
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629766
|
| Min. Negotiated Rate |
$3,462.73 |
| Max. Negotiated Rate |
$6,501.46 |
| Rate for Payer: Aetna Commercial |
$6,360.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,077.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,745.40
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,501.46
|
| Rate for Payer: Health EOS Commercial |
$6,289.45
|
| Rate for Payer: HFN Commercial |
$6,501.46
|
| Rate for Payer: Multiplan Commercial |
$5,653.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,501.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,462.73
|
| Rate for Payer: Quartz Commercial |
$4,240.08
|
| Rate for Payer: WEA Trust Commercial |
$3,886.74
|
| Rate for Payer: WPS Commercial |
$5,234.19
|
|
|
CT Angiography Lower Extremity Left
|
Professional
|
Both
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629766
|
| Min. Negotiated Rate |
$319.55 |
| Max. Negotiated Rate |
$6,713.46 |
| Rate for Payer: Aetna Commercial |
$6,713.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,077.45
|
| Rate for Payer: Aetna Managed Medicare |
$319.55
|
| Rate for Payer: Anthem Medicare Advantage |
$319.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$319.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$319.55
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,713.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,533.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.55
|
| Rate for Payer: Health EOS Commercial |
$6,430.79
|
| Rate for Payer: HFN Commercial |
$6,713.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,249.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,249.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$319.55
|
| Rate for Payer: Multiplan Commercial |
$5,653.44
|
| Rate for Payer: NAPHCARE Commercial |
$479.33
|
| Rate for Payer: Preferred Network Access Commercial |
$6,713.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,109.39
|
| Rate for Payer: Quartz Commercial |
$4,028.08
|
| Rate for Payer: Quartz Medicare Advantage |
$319.55
|
| Rate for Payer: The Alliance Commercial |
$1,214.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$319.55
|
| Rate for Payer: WEA Trust Commercial |
$3,886.74
|
| Rate for Payer: WPS Commercial |
$1,597.75
|
|
