|
CT Angiography Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$5,302.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
1240849
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$879.84 |
| Max. Negotiated Rate |
$5,072.95 |
| Rate for Payer: Aetna Commercial |
$4,962.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,742.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,543.94
|
| 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 |
$2,922.46
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna Commercial |
$5,072.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,085.76
|
| Rate for Payer: Health EOS Commercial |
$4,907.53
|
| Rate for Payer: HFN Commercial |
$5,072.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,135.56
|
| Rate for Payer: Multiplan Commercial |
$4,411.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,308.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,072.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,701.90
|
| Rate for Payer: Quartz Commercial |
$3,584.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,308.45
|
| Rate for Payer: The Alliance Commercial |
$879.84
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,032.74
|
| Rate for Payer: WPS Commercial |
$1,539.72
|
|
|
CT Angiography Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$5,302.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
1240849
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,701.90 |
| Max. Negotiated Rate |
$5,072.95 |
| Rate for Payer: Aetna Commercial |
$4,962.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,742.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,922.46
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna Commercial |
$5,072.95
|
| Rate for Payer: Health EOS Commercial |
$4,907.53
|
| Rate for Payer: HFN Commercial |
$5,072.95
|
| Rate for Payer: Multiplan Commercial |
$4,411.26
|
| Rate for Payer: Preferred Network Access Commercial |
$5,072.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,701.90
|
| Rate for Payer: Quartz Commercial |
$3,308.45
|
| Rate for Payer: WEA Trust Commercial |
$3,032.74
|
| Rate for Payer: WPS Commercial |
$4,084.13
|
|
|
CT Angiography Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$5,302.00
|
|
|
Service Code
|
CPT 72191 TC
|
| Hospital Charge Code |
1240849
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$219.96 |
| Max. Negotiated Rate |
$5,238.38 |
| Rate for Payer: Aetna Commercial |
$5,238.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,742.11
|
| Rate for Payer: Aetna Managed Medicare |
$219.96
|
| Rate for Payer: Anthem Medicare Advantage |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.96
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cash Price |
$1,590.60
|
| Rate for Payer: Cigna Commercial |
$5,238.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,757.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.96
|
| Rate for Payer: Health EOS Commercial |
$5,017.81
|
| Rate for Payer: HFN Commercial |
$5,238.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$852.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$852.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.96
|
| Rate for Payer: Multiplan Commercial |
$4,411.26
|
| Rate for Payer: NAPHCARE Commercial |
$329.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,238.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,426.20
|
| Rate for Payer: Quartz Commercial |
$3,143.03
|
| Rate for Payer: Quartz Medicare Advantage |
$219.96
|
| Rate for Payer: The Alliance Commercial |
$835.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.96
|
| Rate for Payer: WEA Trust Commercial |
$3,032.74
|
| Rate for Payer: WPS Commercial |
$1,099.80
|
|
|
CT Angiography Upper Extremity Bilat
|
Professional
|
Both
|
$3,269.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240851
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,153.89 |
| Max. Negotiated Rate |
$3,229.77 |
| Rate for Payer: Aetna Commercial |
$3,229.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,923.79
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cigna Commercial |
$3,229.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,699.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,039.86
|
| Rate for Payer: Health EOS Commercial |
$3,093.78
|
| Rate for Payer: HFN Commercial |
$3,229.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,153.89
|
| Rate for Payer: Multiplan Commercial |
$2,719.81
|
| Rate for Payer: Preferred Network Access Commercial |
$3,229.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,495.89
|
| Rate for Payer: Quartz Commercial |
$1,937.86
|
| Rate for Payer: The Alliance Commercial |
$1,699.88
|
| Rate for Payer: WEA Trust Commercial |
$1,869.87
|
| Rate for Payer: WPS Commercial |
$2,518.11
|
|
|
CT Angiography Upper Extremity Bilat
|
Facility
|
IP
|
$3,269.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240851
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,665.88 |
| Max. Negotiated Rate |
$3,127.78 |
| Rate for Payer: Aetna Commercial |
$3,059.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,923.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,801.87
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cigna Commercial |
$3,127.78
|
| Rate for Payer: Health EOS Commercial |
$3,025.79
|
| Rate for Payer: HFN Commercial |
$3,127.78
|
| Rate for Payer: Multiplan Commercial |
$2,719.81
|
| Rate for Payer: Preferred Network Access Commercial |
$3,127.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,665.88
|
| Rate for Payer: Quartz Commercial |
$2,039.86
|
| Rate for Payer: WEA Trust Commercial |
$1,869.87
|
| Rate for Payer: WPS Commercial |
$2,518.11
|
|
|
CT Angiography Upper Extremity Bilat
|
Facility
|
OP
|
$3,269.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240851
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$951.93 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,059.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,923.79
|
| Rate for Payer: Aetna Managed Medicare |
$951.93
|
| 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 |
$1,801.87
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cash Price |
$980.70
|
| Rate for Payer: Cigna Commercial |
$3,127.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,902.56
|
| Rate for Payer: Health EOS Commercial |
$3,025.79
|
| Rate for Payer: HFN Commercial |
$3,127.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,549.82
|
| Rate for Payer: Multiplan Commercial |
$2,719.81
|
| Rate for Payer: NAPHCARE Commercial |
$2,039.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,127.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,665.88
|
| Rate for Payer: Quartz Commercial |
$2,209.84
|
| Rate for Payer: Quartz Medicare Advantage |
$2,039.86
|
| Rate for Payer: The Alliance Commercial |
$1,699.88
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,869.87
|
| Rate for Payer: WPS Commercial |
$2,518.11
|
|
|
CT Angiography Upper Extremity Left
|
Facility
|
OP
|
$3,396.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240853
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$988.92 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Aetna Managed Medicare |
$988.92
|
| 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 |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,976.47
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,648.88
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,119.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,295.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,119.10
|
| Rate for Payer: The Alliance Commercial |
$1,765.92
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
CT Angiography Upper Extremity Left
|
Professional
|
Both
|
$3,396.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240853
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,153.89 |
| Max. Negotiated Rate |
$3,355.25 |
| Rate for Payer: Aetna Commercial |
$3,355.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,355.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,765.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,119.10
|
| Rate for Payer: Health EOS Commercial |
$3,213.97
|
| Rate for Payer: HFN Commercial |
$3,355.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,153.89
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,355.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.01
|
| Rate for Payer: Quartz Commercial |
$2,013.15
|
| Rate for Payer: The Alliance Commercial |
$1,765.92
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
CT Angiography Upper Extremity Left
|
Facility
|
IP
|
$3,396.00
|
|
|
Service Code
|
CPT 73206 LT,TC
|
| Hospital Charge Code |
1240853
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,730.60 |
| Max. Negotiated Rate |
$3,249.29 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,119.10
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
CT Angiography Upper Extremity Right
|
Facility
|
OP
|
$2,974.00
|
|
|
Service Code
|
CPT 73206 TC,RT
|
| Hospital Charge Code |
1966799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$866.03 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,783.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,659.95
|
| Rate for Payer: Aetna Managed Medicare |
$866.03
|
| 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 |
$1,639.27
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cigna Commercial |
$2,845.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,730.87
|
| Rate for Payer: Health EOS Commercial |
$2,752.73
|
| Rate for Payer: HFN Commercial |
$2,845.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,319.72
|
| Rate for Payer: Multiplan Commercial |
$2,474.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,855.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,845.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,515.55
|
| Rate for Payer: Quartz Commercial |
$2,010.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,855.78
|
| Rate for Payer: The Alliance Commercial |
$1,546.48
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,701.13
|
| Rate for Payer: WPS Commercial |
$2,290.87
|
|
|
CT Angiography Upper Extremity Right
|
Professional
|
Both
|
$3,396.00
|
|
|
Service Code
|
CPT 73206 RT,TC
|
| Hospital Charge Code |
1240855
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,153.89 |
| Max. Negotiated Rate |
$3,355.25 |
| Rate for Payer: Aetna Commercial |
$3,355.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,355.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,765.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,119.10
|
| Rate for Payer: Health EOS Commercial |
$3,213.97
|
| Rate for Payer: HFN Commercial |
$3,355.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,153.89
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,355.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.01
|
| Rate for Payer: Quartz Commercial |
$2,013.15
|
| Rate for Payer: The Alliance Commercial |
$1,765.92
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
CT Angiography Upper Extremity Right
|
Facility
|
OP
|
$3,396.00
|
|
|
Service Code
|
CPT 73206 RT,TC
|
| Hospital Charge Code |
1240855
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$988.92 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Aetna Managed Medicare |
$988.92
|
| 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 |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,976.47
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,648.88
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,119.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,295.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,119.10
|
| Rate for Payer: The Alliance Commercial |
$1,765.92
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
CT Angiography Upper Extremity Right
|
Professional
|
Both
|
$2,974.00
|
|
|
Service Code
|
CPT 73206 TC,RT
|
| Hospital Charge Code |
1966799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,153.89 |
| Max. Negotiated Rate |
$2,938.31 |
| Rate for Payer: Aetna Commercial |
$2,938.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,659.95
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cigna Commercial |
$2,938.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,546.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,855.78
|
| Rate for Payer: Health EOS Commercial |
$2,814.59
|
| Rate for Payer: HFN Commercial |
$2,938.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,153.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,153.89
|
| Rate for Payer: Multiplan Commercial |
$2,474.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,938.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.90
|
| Rate for Payer: Quartz Commercial |
$1,762.99
|
| Rate for Payer: The Alliance Commercial |
$1,546.48
|
| Rate for Payer: WEA Trust Commercial |
$1,701.13
|
| Rate for Payer: WPS Commercial |
$2,290.87
|
|
|
CT Angiography Upper Extremity Right
|
Facility
|
IP
|
$2,974.00
|
|
|
Service Code
|
CPT 73206 TC,RT
|
| Hospital Charge Code |
1966799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,515.55 |
| Max. Negotiated Rate |
$2,845.52 |
| Rate for Payer: Aetna Commercial |
$2,783.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,659.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,639.27
|
| Rate for Payer: Cash Price |
$892.20
|
| Rate for Payer: Cigna Commercial |
$2,845.52
|
| Rate for Payer: Health EOS Commercial |
$2,752.73
|
| Rate for Payer: HFN Commercial |
$2,845.52
|
| Rate for Payer: Multiplan Commercial |
$2,474.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,845.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,515.55
|
| Rate for Payer: Quartz Commercial |
$1,855.78
|
| Rate for Payer: WEA Trust Commercial |
$1,701.13
|
| Rate for Payer: WPS Commercial |
$2,290.87
|
|
|
CT Angiography Upper Extremity Right
|
Facility
|
IP
|
$3,396.00
|
|
|
Service Code
|
CPT 73206 RT,TC
|
| Hospital Charge Code |
1240855
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,730.60 |
| Max. Negotiated Rate |
$3,249.29 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,119.10
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
CT Ankle w/ Contrast Bilateral
|
Professional
|
Both
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
625686
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$5,668.16 |
| Rate for Payer: Aetna Commercial |
$5,668.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,668.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,983.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$5,429.50
|
| Rate for Payer: HFN Commercial |
$5,668.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,668.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.25
|
| Rate for Payer: Quartz Commercial |
$3,400.89
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Ankle w/ Contrast Bilateral
|
Facility
|
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
625686
|
| Min. Negotiated Rate |
$2,923.58 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,579.89
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
|
CT Ankle w/ Contrast Bilateral
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1240863
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,430.96 |
| Max. Negotiated Rate |
$2,686.69 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Ankle w/ Contrast Bilateral
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1240863
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,774.30 |
| Rate for Payer: Aetna Commercial |
$2,774.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,774.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,460.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.19
|
| Rate for Payer: Health EOS Commercial |
$2,657.49
|
| Rate for Payer: HFN Commercial |
$2,774.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.94
|
| Rate for Payer: Quartz Commercial |
$1,664.58
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Ankle w/ Contrast Bilateral
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1240863
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.69
|
| 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 |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,634.26
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,190.24
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,898.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,752.19
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Ankle w/ Contrast Bilateral
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
625686
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,878.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,983.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.91
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| 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 |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| 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 |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,878.21
|
| 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 |
$3,281.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
|
CT Ankle w/ Contrast Left
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 TC,LT
|
| Hospital Charge Code |
1240865
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,790.03 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,819.58
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Ankle w/ Contrast Left
|
Facility
|
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
625688
|
| Min. Negotiated Rate |
$1,461.53 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,789.63
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Ankle w/ Contrast Left
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
625688
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,938.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,431.71
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| 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 |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| 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 |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,938.77
|
| 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 |
$1,640.50
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Ankle w/ Contrast Left
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
625688
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$2,833.58 |
| Rate for Payer: Aetna Commercial |
$2,833.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,833.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$2,714.28
|
| Rate for Payer: HFN Commercial |
$2,833.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,833.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,312.40
|
| Rate for Payer: Quartz Commercial |
$1,700.15
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
