|
CT Angiography Lower Extremity Left
|
Facility
|
OP
|
$10,096.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240843
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$9,659.85 |
| Rate for Payer: Aetna Commercial |
$9,449.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,029.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,939.96
|
| 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 |
$5,564.92
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cigna Commercial |
$9,659.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,875.87
|
| Rate for Payer: Health EOS Commercial |
$9,344.86
|
| Rate for Payer: HFN Commercial |
$9,659.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,874.88
|
| Rate for Payer: Multiplan Commercial |
$8,399.87
|
| Rate for Payer: NAPHCARE Commercial |
$6,299.90
|
| Rate for Payer: Preferred Network Access Commercial |
$9,659.85
|
| Rate for Payer: Quartz Beloit One Network |
$5,144.92
|
| Rate for Payer: Quartz Commercial |
$6,824.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6,299.90
|
| Rate for Payer: The Alliance Commercial |
$5,249.92
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$5,774.91
|
| Rate for Payer: WPS Commercial |
$7,776.95
|
|
|
CT Angiography Lower Extremity Left
|
Professional
|
Both
|
$10,096.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240843
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,249.86 |
| Max. Negotiated Rate |
$9,974.85 |
| Rate for Payer: Aetna Commercial |
$9,974.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,029.86
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cigna Commercial |
$9,974.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,249.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,299.90
|
| Rate for Payer: Health EOS Commercial |
$9,554.85
|
| Rate for Payer: HFN Commercial |
$9,974.85
|
| 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 |
$8,399.87
|
| Rate for Payer: Preferred Network Access Commercial |
$9,974.85
|
| Rate for Payer: Quartz Beloit One Network |
$4,619.93
|
| Rate for Payer: Quartz Commercial |
$5,984.91
|
| Rate for Payer: The Alliance Commercial |
$5,249.92
|
| Rate for Payer: WEA Trust Commercial |
$5,774.91
|
| Rate for Payer: WPS Commercial |
$7,776.95
|
|
|
CT Angiography Lower Extremity Left
|
Facility
|
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629766
|
| Min. Negotiated Rate |
$184.59 |
| 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: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,593.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,533.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,392.06
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,745.40
|
| 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 |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,501.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,954.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$6,289.45
|
| Rate for Payer: HFN Commercial |
$6,501.46
|
| 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 |
$5,653.44
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| 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 |
$4,593.42
|
| 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 |
$3,886.74
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$5,234.19
|
|
|
CT Angiography Lower Extremity Left
|
Facility
|
IP
|
$10,096.00
|
|
|
Service Code
|
CPT 73706 LT,TC
|
| Hospital Charge Code |
1240843
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$5,144.92 |
| Max. Negotiated Rate |
$9,659.85 |
| Rate for Payer: Aetna Commercial |
$9,449.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,029.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,564.92
|
| Rate for Payer: Cash Price |
$3,028.80
|
| Rate for Payer: Cigna Commercial |
$9,659.85
|
| Rate for Payer: Health EOS Commercial |
$9,344.86
|
| Rate for Payer: HFN Commercial |
$9,659.85
|
| Rate for Payer: Multiplan Commercial |
$8,399.87
|
| Rate for Payer: Preferred Network Access Commercial |
$9,659.85
|
| Rate for Payer: Quartz Beloit One Network |
$5,144.92
|
| Rate for Payer: Quartz Commercial |
$6,299.90
|
| Rate for Payer: WEA Trust Commercial |
$5,774.91
|
| Rate for Payer: WPS Commercial |
$7,776.95
|
|
|
CT Angiography Lower Extremity Right
|
Professional
|
Both
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 RT,TC
|
| Hospital Charge Code |
1240845
|
|
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 Right
|
Professional
|
Both
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 TC,RT
|
| Hospital Charge Code |
2980090
|
|
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 Right
|
Facility
|
IP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 TC,RT
|
| Hospital Charge Code |
2980090
|
|
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 Right
|
Facility
|
IP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 RT,TC
|
| Hospital Charge Code |
1240845
|
|
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 Right
|
Facility
|
OP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 TC,RT
|
| Hospital Charge Code |
2980090
|
|
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 Right
|
Facility
|
OP
|
$6,796.00
|
|
|
Service Code
|
CPT 73706 RT,TC
|
| Hospital Charge Code |
1240845
|
|
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 Right
|
Professional
|
Both
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629768
|
| 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
|
|
|
CT Angiography Lower Extremity Right
|
Facility
|
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629768
|
| Min. Negotiated Rate |
$184.59 |
| 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: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,593.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,533.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,392.06
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,745.40
|
| 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 |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,501.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,954.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$6,289.45
|
| Rate for Payer: HFN Commercial |
$6,501.46
|
| 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 |
$5,653.44
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| 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 |
$4,593.42
|
| 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 |
$3,886.74
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$5,234.19
|
|
|
CT Angiography Lower Extremity Right
|
Facility
|
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 73706
|
| Hospital Charge Code |
629768
|
| 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 Neck
|
Facility
|
OP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
5426664
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$769.35 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,331.37
|
| 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 |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,660.90
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,566.16
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,852.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$3,090.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,852.93
|
| Rate for Payer: The Alliance Commercial |
$769.35
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$1,346.36
|
|
|
CT Angiography Neck
|
Facility
|
OP
|
$4,075.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
629770
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| 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 |
$1,222.50
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| 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 |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| 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 |
$2,330.90
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,138.97
|
|
|
CT Angiography Neck
|
Facility
|
IP
|
$4,075.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
629770
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,138.97
|
|
|
CT Angiography Neck
|
Professional
|
Both
|
$4,075.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
629770
|
| Min. Negotiated Rate |
$272.67 |
| Max. Negotiated Rate |
$4,026.10 |
| Rate for Payer: Aetna Commercial |
$4,026.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| 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 |
$1,222.50
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$4,026.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,119.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.67
|
| Rate for Payer: Health EOS Commercial |
$3,856.58
|
| Rate for Payer: HFN Commercial |
$4,026.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,047.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,047.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.67
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$409.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,026.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.72
|
| Rate for Payer: Quartz Commercial |
$2,415.66
|
| 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 |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$1,363.34
|
|
|
CT Angiography Neck
|
Facility
|
IP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
5426664
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,329.89 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$2,852.93
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$3,521.81
|
|
|
CT Angiography Neck
|
Professional
|
Both
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
5426664
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$4,517.14 |
| Rate for Payer: Aetna Commercial |
$4,517.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| 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 |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,517.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,377.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.34
|
| Rate for Payer: Health EOS Commercial |
$4,326.94
|
| Rate for Payer: HFN Commercial |
$4,517.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$745.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$192.34
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: NAPHCARE Commercial |
$288.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.15
|
| Rate for Payer: Quartz Commercial |
$2,710.28
|
| 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 |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$961.69
|
|
|
CT Angiography Neck w/ + w/o Contrast
|
Facility
|
IP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
1240847
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,329.89 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$2,852.93
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$3,521.81
|
|
|
CT Angiography Neck w/ + w/o Contrast
|
Professional
|
Both
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
1240847
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$192.34 |
| Max. Negotiated Rate |
$4,517.14 |
| Rate for Payer: Aetna Commercial |
$4,517.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| 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 |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,517.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,377.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.34
|
| Rate for Payer: Health EOS Commercial |
$4,326.94
|
| Rate for Payer: HFN Commercial |
$4,517.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$745.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$192.34
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: NAPHCARE Commercial |
$288.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.15
|
| Rate for Payer: Quartz Commercial |
$2,710.28
|
| 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 |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$961.69
|
|
|
CT Angiography Neck w/ + w/o Contrast
|
Facility
|
OP
|
$4,572.00
|
|
|
Service Code
|
CPT 70498 TC
|
| Hospital Charge Code |
1240847
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$769.35 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,331.37
|
| 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 |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,660.90
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,566.16
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,852.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$3,090.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,852.93
|
| Rate for Payer: The Alliance Commercial |
$769.35
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$1,346.36
|
|
|
CT Angiography Pelvis
|
Facility
|
OP
|
$5,405.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
629772
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$5,171.50 |
| Rate for Payer: Aetna Commercial |
$5,059.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.23
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,653.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,810.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,698.18
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,979.24
|
| 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 |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$5,171.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,145.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$5,002.87
|
| Rate for Payer: HFN Commercial |
$5,171.50
|
| 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 |
$4,496.96
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,171.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,754.39
|
| Rate for Payer: Quartz Commercial |
$3,653.78
|
| 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 |
$3,091.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
|
CT Angiography Pelvis
|
Professional
|
Both
|
$5,405.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
629772
|
| Min. Negotiated Rate |
$302.23 |
| Max. Negotiated Rate |
$5,340.14 |
| Rate for Payer: Aetna Commercial |
$5,340.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.23
|
| Rate for Payer: Aetna Managed Medicare |
$302.23
|
| Rate for Payer: Anthem Medicare Advantage |
$302.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$302.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$302.23
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$5,340.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,810.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.23
|
| Rate for Payer: Health EOS Commercial |
$5,115.29
|
| Rate for Payer: HFN Commercial |
$5,340.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,163.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,163.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$302.23
|
| Rate for Payer: Multiplan Commercial |
$4,496.96
|
| Rate for Payer: NAPHCARE Commercial |
$453.35
|
| Rate for Payer: Preferred Network Access Commercial |
$5,340.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,473.33
|
| Rate for Payer: Quartz Commercial |
$3,204.08
|
| Rate for Payer: Quartz Medicare Advantage |
$302.23
|
| Rate for Payer: The Alliance Commercial |
$1,148.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$302.23
|
| Rate for Payer: WEA Trust Commercial |
$3,091.66
|
| Rate for Payer: WPS Commercial |
$1,511.17
|
|
|
CT Angiography Pelvis
|
Facility
|
IP
|
$5,405.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
629772
|
| Min. Negotiated Rate |
$2,754.39 |
| Max. Negotiated Rate |
$5,171.50 |
| Rate for Payer: Aetna Commercial |
$5,059.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,834.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,979.24
|
| Rate for Payer: Cash Price |
$1,621.50
|
| Rate for Payer: Cigna Commercial |
$5,171.50
|
| Rate for Payer: Health EOS Commercial |
$5,002.87
|
| Rate for Payer: HFN Commercial |
$5,171.50
|
| Rate for Payer: Multiplan Commercial |
$4,496.96
|
| Rate for Payer: Preferred Network Access Commercial |
$5,171.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,754.39
|
| Rate for Payer: Quartz Commercial |
$3,372.72
|
| Rate for Payer: WEA Trust Commercial |
$3,091.66
|
| Rate for Payer: WPS Commercial |
$4,163.47
|
|
