|
CT Angiography Chest
|
Professional
|
Both
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$6,561.31 |
| Rate for Payer: Aetna Commercial |
$6,561.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,939.71
|
| Rate for Payer: Aetna Managed Medicare |
$278.96
|
| Rate for Payer: Anthem Medicare Advantage |
$278.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$278.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$278.96
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,561.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,453.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.96
|
| Rate for Payer: Health EOS Commercial |
$6,285.04
|
| Rate for Payer: HFN Commercial |
$6,561.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,071.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$278.96
|
| Rate for Payer: Multiplan Commercial |
$5,525.31
|
| Rate for Payer: NAPHCARE Commercial |
$418.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,561.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,038.92
|
| Rate for Payer: Quartz Commercial |
$3,936.78
|
| Rate for Payer: Quartz Medicare Advantage |
$278.96
|
| Rate for Payer: The Alliance Commercial |
$1,060.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$278.96
|
| Rate for Payer: WEA Trust Commercial |
$3,798.65
|
| Rate for Payer: WPS Commercial |
$1,394.80
|
|
|
CT Angiography Chest
|
Facility
|
IP
|
$6,641.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
629700
|
| Min. Negotiated Rate |
$3,384.25 |
| Max. Negotiated Rate |
$6,354.11 |
| Rate for Payer: Aetna Commercial |
$6,215.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,939.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,660.52
|
| Rate for Payer: Cash Price |
$1,992.30
|
| Rate for Payer: Cigna Commercial |
$6,354.11
|
| Rate for Payer: Health EOS Commercial |
$6,146.91
|
| Rate for Payer: HFN Commercial |
$6,354.11
|
| Rate for Payer: Multiplan Commercial |
$5,525.31
|
| Rate for Payer: Preferred Network Access Commercial |
$6,354.11
|
| Rate for Payer: Quartz Beloit One Network |
$3,384.25
|
| Rate for Payer: Quartz Commercial |
$4,143.98
|
| Rate for Payer: WEA Trust Commercial |
$3,798.65
|
| Rate for Payer: WPS Commercial |
$5,115.56
|
|
|
CT Angiography Chest, Abd + Iliofemoral
|
Facility
|
IP
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
6182015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,764.42 |
| Max. Negotiated Rate |
$7,067.88 |
| Rate for Payer: Aetna Commercial |
$6,914.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,071.71
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$7,067.88
|
| Rate for Payer: Health EOS Commercial |
$6,837.41
|
| Rate for Payer: HFN Commercial |
$7,067.88
|
| Rate for Payer: Multiplan Commercial |
$6,145.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,067.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.42
|
| Rate for Payer: Quartz Commercial |
$4,609.49
|
| Rate for Payer: WEA Trust Commercial |
$4,225.36
|
| Rate for Payer: WPS Commercial |
$5,690.21
|
|
|
CT Angiography Chest, Abd + Iliofemoral
|
Facility
|
OP
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
6182015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$782.66 |
| Max. Negotiated Rate |
$7,067.88 |
| Rate for Payer: Aetna Commercial |
$6,914.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.93
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,071.71
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$7,067.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.23
|
| Rate for Payer: Health EOS Commercial |
$6,837.41
|
| Rate for Payer: HFN Commercial |
$7,067.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,761.86
|
| Rate for Payer: Multiplan Commercial |
$6,145.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,609.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,067.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.42
|
| Rate for Payer: Quartz Commercial |
$4,993.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4,609.49
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$4,225.36
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
|
CT Angiography Chest, Abd + Iliofemoral
|
Professional
|
Both
|
$7,387.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
6182015
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.67 |
| Max. Negotiated Rate |
$7,298.36 |
| Rate for Payer: Aetna Commercial |
$7,298.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,606.93
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cash Price |
$2,216.10
|
| Rate for Payer: Cigna Commercial |
$7,298.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,841.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$6,991.06
|
| Rate for Payer: HFN Commercial |
$7,298.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$6,145.98
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,298.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,380.29
|
| Rate for Payer: Quartz Commercial |
$4,379.01
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$4,225.36
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
CT Angiography Chest, Abdomen w/ Con
|
Facility
|
OP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240830
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$782.66 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,416.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,830.27
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,793.14
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,034.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,287.39
|
| Rate for Payer: Quartz Medicare Advantage |
$3,034.51
|
| Rate for Payer: The Alliance Commercial |
$782.66
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$1,369.66
|
|
|
CT Angiography Chest, Abdomen w/ Con
|
Facility
|
IP
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240830
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,478.18 |
| Max. Negotiated Rate |
$4,652.92 |
| Rate for Payer: Aetna Commercial |
$4,551.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.49
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,652.92
|
| Rate for Payer: Health EOS Commercial |
$4,501.19
|
| Rate for Payer: HFN Commercial |
$4,652.92
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,652.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.18
|
| Rate for Payer: Quartz Commercial |
$3,034.51
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$3,745.97
|
|
|
CT Angiography Chest, Abdomen w/ Con
|
Professional
|
Both
|
$4,863.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
1240830
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$195.67 |
| Max. Negotiated Rate |
$4,804.64 |
| Rate for Payer: Aetna Commercial |
$4,804.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.47
|
| Rate for Payer: Aetna Managed Medicare |
$195.67
|
| Rate for Payer: Anthem Medicare Advantage |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.67
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cash Price |
$1,458.90
|
| Rate for Payer: Cigna Commercial |
$4,804.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,528.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.67
|
| Rate for Payer: Health EOS Commercial |
$4,602.34
|
| Rate for Payer: HFN Commercial |
$4,804.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$756.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$756.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.67
|
| Rate for Payer: Multiplan Commercial |
$4,046.02
|
| Rate for Payer: NAPHCARE Commercial |
$293.50
|
| Rate for Payer: Preferred Network Access Commercial |
$4,804.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,225.31
|
| Rate for Payer: Quartz Commercial |
$2,882.79
|
| Rate for Payer: Quartz Medicare Advantage |
$195.67
|
| Rate for Payer: The Alliance Commercial |
$743.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.67
|
| Rate for Payer: WEA Trust Commercial |
$2,781.64
|
| Rate for Payer: WPS Commercial |
$978.33
|
|
|
CT Angiography Chest 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 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 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
|
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 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 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
|
$5,029.00
|
|
|
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
|
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
|
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
|
$5,391.00
|
|
|
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 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 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
|
|
