CPT 71275
The standard charge for CT Angiogram Chest with and without Contrast is $4,371.00. However, the price you pay depends on the rate negotiated by your insurance plan and what portion your insurance plan requires you to contribute towards that amount. Enter your info below to start your estimate.
To calculate an estimate of your cost, you will need two things:
LOCATION
1969 West Hart Road, Beloit, WI, 53511CONTACT
(608) 364-5011 Visit WebsiteBeloit Memorial Hospital is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.
In compliance with federal law, Beloit Memorial Hospital provides a list of standard charges. These are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient’s unique needs.
I understand that the list of standard charges includes only hospital services and does not contain professional fees for non-Beloit Memorial Hospital physicians or advanced practice providers. It does not contain professional fees for anesthesia, physicians or advanced practice providers.
I understand that a single line item charge may not represent a complete medical service. In general, multiple charge line items are necessary to represent all components of a service (e.g. procedures, supplies, and drugs).
I understand that the list of standard charges is not intended for media use.
I understand prices are the list price of all hospital charges and not necessarily what my insurance company will pay or what I will owe to the hospital. My actual bill may include one or more of list price charges.
The hospital typically accepts a rate that is less than the list charges. Your insurer will determine what you will owe after they have paid their agreed upon amount.
We know that the billing and payment processes may seem overwhelming at times. Please contact our team at 608-364-5011.
Choose a plan to view the insurance rate estimate.
Total estimated charges
$4,371.00Insurance Discount
-$279.74Price Negotiated by Insurer
$4,091.26Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$195.62Comprehensive Metabolic Panel
$315.43EKG Acquisition
$344.45Legal Blood Draw
$42.12Level 5 - 99285
$2,955.89OMNIPAQUE 180 10ml VIAL [MED]
$152.57Troponin T/34483
$71.14This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$461.58Price Negotiated by Insurer
$3,909.42Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$186.93Comprehensive Metabolic Panel
$301.41EKG Acquisition
$329.14Legal Blood Draw
$40.25Level 5 - 99285
$2,824.52OMNIPAQUE 180 10ml VIAL [MED]
$145.79Troponin T/34483
$67.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74OMNIPAQUE 180 10ml VIAL [MED]
$47.47Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$1,416.20Price Negotiated by Insurer
$2,954.80Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$30.30Comprehensive Metabolic Panel
$41.18EKG Acquisition
$248.77Legal Blood Draw
$30.42Level 5 - 99285
$4,546.88OMNIPAQUE 180 10ml VIAL [MED]
$110.19Troponin T/34483
$48.63This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$2,098.08Price Negotiated by Insurer
$2,272.92Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$14.14Comprehensive Metabolic Panel
$19.22EKG Acquisition
$191.36Legal Blood Draw
$23.40Level 5 - 99285
$3,434.08OMNIPAQUE 180 10ml VIAL [MED]
$84.76Troponin T/34483
$22.70This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$2,189.00Price Negotiated by Insurer
$2,182.00Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$13.41Comprehensive Metabolic Panel
$18.23EKG Acquisition
$183.71Legal Blood Draw
$22.46Level 5 - 99285
$3,263.52OMNIPAQUE 180 10ml VIAL [MED]
$81.37Troponin T/34483
$21.53This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$1,961.70Price Negotiated by Insurer
$2,409.30Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$115.20Comprehensive Metabolic Panel
$185.75EKG Acquisition
$202.84Legal Blood Draw
$24.80Level 5 - 99285
$1,740.69OMNIPAQUE 180 10ml VIAL [MED]
$89.85Troponin T/34483
$41.89This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$3,059.70Price Negotiated by Insurer
$1,311.30Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$62.70Comprehensive Metabolic Panel
$101.10EKG Acquisition
$110.40Legal Blood Draw
$13.50Level 5 - 99285
$947.40OMNIPAQUE 180 10ml VIAL [MED]
$48.90Troponin T/34483
$22.80This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$188.83Price Negotiated by Insurer
$4,182.17Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$199.97Comprehensive Metabolic Panel
$322.44EKG Acquisition
$352.10Legal Blood Draw
$43.06Level 5 - 99285
$3,021.57OMNIPAQUE 180 10ml VIAL [MED]
$155.96Troponin T/34483
$72.72This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$1,827.08Price Negotiated by Insurer
$2,543.92Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$121.64Comprehensive Metabolic Panel
$196.13EKG Acquisition
$214.18Level 5 - 99285
$1,837.96OMNIPAQUE 180 10ml VIAL [MED]
$0.19Troponin T/34483
$44.23This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$325.20Price Negotiated by Insurer
$4,045.80Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$193.45Comprehensive Metabolic Panel
$311.93EKG Acquisition
$340.62Legal Blood Draw
$41.65Level 5 - 99285
$2,923.04OMNIPAQUE 180 10ml VIAL [MED]
$150.87Troponin T/34483
$70.35This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$188.83Price Negotiated by Insurer
$4,182.17Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$199.97Comprehensive Metabolic Panel
$322.44EKG Acquisition
$352.10Legal Blood Draw
$43.06Level 5 - 99285
$3,021.57OMNIPAQUE 180 10ml VIAL [MED]
$155.96Troponin T/34483
$72.72This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$3,684.33Price Negotiated by Insurer
$686.67Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$30.06Comprehensive Metabolic Panel
$40.85EKG Acquisition
$230.97Legal Blood Draw
$36.13Level 5 - 99285
$2,331.45OMNIPAQUE 180 10ml VIAL [MED]
$127.14Troponin T/34483
$48.24This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$734.33Price Negotiated by Insurer
$3,636.67Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$173.89Comprehensive Metabolic Panel
$280.38EKG Acquisition
$306.18Legal Blood Draw
$37.44Level 5 - 99285
$2,627.46OMNIPAQUE 180 10ml VIAL [MED]
$135.62Troponin T/34483
$63.23This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,094.12Price Negotiated by Insurer
$276.88Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$12.12Comprehensive Metabolic Panel
$16.47EKG Acquisition
$93.13Legal Blood Draw
$14.57Level 5 - 99285
$940.10OMNIPAQUE 180 10ml VIAL [MED]
$101.71Troponin T/34483
$19.45This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$188.83Price Negotiated by Insurer
$4,182.17Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$199.97Comprehensive Metabolic Panel
$322.44EKG Acquisition
$352.10Legal Blood Draw
$43.06Level 5 - 99285
$3,021.57OMNIPAQUE 180 10ml VIAL [MED]
$155.96Troponin T/34483
$72.72This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$2,143.54Price Negotiated by Insurer
$2,227.46Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$106.51Comprehensive Metabolic Panel
$171.74EKG Acquisition
$187.53Legal Blood Draw
$22.93Level 5 - 99285
$1,609.32OMNIPAQUE 180 10ml VIAL [MED]
$83.06Troponin T/34483
$38.73This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$1,416.20Price Negotiated by Insurer
$2,954.80Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$141.28Comprehensive Metabolic Panel
$227.81EKG Acquisition
$248.77Legal Blood Draw
$30.42Level 5 - 99285
$2,134.81OMNIPAQUE 180 10ml VIAL [MED]
$110.19Troponin T/34483
$51.38This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74OMNIPAQUE 180 10ml VIAL [MED]
$101.71Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$3,632.64Price Negotiated by Insurer
$738.36Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$32.32Comprehensive Metabolic Panel
$43.93EKG Acquisition
$248.35Legal Blood Draw
$38.85Level 5 - 99285
$2,506.94OMNIPAQUE 180 10ml VIAL [MED]
$0.62Troponin T/34483
$51.88This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$1,870.79Price Negotiated by Insurer
$2,500.21Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$119.55Comprehensive Metabolic Panel
$192.76EKG Acquisition
$210.50Legal Blood Draw
$25.74Level 5 - 99285
$1,806.38OMNIPAQUE 180 10ml VIAL [MED]
$93.24Troponin T/34483
$43.47This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$4,186.41Price Negotiated by Insurer
$184.59Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$8.08Comprehensive Metabolic Panel
$10.98EKG Acquisition
$62.09Legal Blood Draw
$9.71Level 5 - 99285
$626.74Troponin T/34483
$12.97This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.
Total estimated charges
$4,371.00Insurance Discount
-$1,004.02Price Negotiated by Insurer
$3,366.98Deductible Applied
-Copay
-Coinsurance
-Your insurance company will pay
-You will owe (Estimate)
Some services may incur additional charges based on the exact care required. Listed below are commonly associated charges with this service and the rate negotiated by your insurance plan. These charges are listed to give you an idea of what types of other services are often required, but not all patients will require these specific services.
.Auto Diff
$160.99Comprehensive Metabolic Panel
$259.59EKG Acquisition
$283.47Legal Blood Draw
$34.66Level 5 - 99285
$2,432.61OMNIPAQUE 180 10ml VIAL [MED]
$0.36Troponin T/34483
$58.54This calculation is an estimate based on the data that you have entered. For verification of pricing, you need to submit this estimate to Beloit Memorial Hospital so that your price and insurance eligibility can be confirmed.
To verify this rate and discuss any other associated charges to expect, please contact Beloit Memorial Hospital directly.