|
Angiotensin Converting Enzyme, CSF
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3965999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$60.74 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$15.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.21
|
| Rate for Payer: Anthem Medicare Advantage |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.18
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.18
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.78
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$15.18
|
| Rate for Payer: The Alliance Commercial |
$60.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.18
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$15.18
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Angiotensin Converting Enzyme, CSF
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3965999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$66.81 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$15.18
|
| Rate for Payer: Anthem Medicare Advantage |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.18
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.18
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.78
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$15.18
|
| Rate for Payer: The Alliance Commercial |
$59.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.18
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$66.81
|
|
|
Angiotensin Converting Enzyme, CSF
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3965999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Angio Thoracic S&I
|
Facility
|
OP
|
$6,575.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
3052525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,282.24 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$6,154.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,880.68
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,444.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,419.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,282.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,624.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$1,972.50
|
| Rate for Payer: Cash Price |
$1,972.50
|
| Rate for Payer: Cigna Commercial |
$6,290.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,826.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$6,085.82
|
| Rate for Payer: HFN Commercial |
$6,290.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$5,470.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,290.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,350.62
|
| Rate for Payer: Quartz Commercial |
$4,444.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: WEA Trust Commercial |
$3,760.90
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$5,064.72
|
|
|
Angio Thoracic S&I
|
Facility
|
IP
|
$6,575.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
3052525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,350.62 |
| Max. Negotiated Rate |
$6,290.96 |
| Rate for Payer: Aetna Commercial |
$6,154.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,880.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,624.14
|
| Rate for Payer: Cash Price |
$1,972.50
|
| Rate for Payer: Cigna Commercial |
$6,290.96
|
| Rate for Payer: Health EOS Commercial |
$6,085.82
|
| Rate for Payer: HFN Commercial |
$6,290.96
|
| Rate for Payer: Multiplan Commercial |
$5,470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,290.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,350.62
|
| Rate for Payer: Quartz Commercial |
$4,102.80
|
| Rate for Payer: WEA Trust Commercial |
$3,760.90
|
| Rate for Payer: WPS Commercial |
$5,064.72
|
|
|
Angio UE/LE Bilateral S&I
|
Facility
|
OP
|
$5,082.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
3052527
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,536.93 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$4,756.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,545.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,435.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,642.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,536.93
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,801.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cigna Commercial |
$4,862.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,957.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$4,703.90
|
| Rate for Payer: HFN Commercial |
$4,862.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$4,228.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,862.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.79
|
| Rate for Payer: Quartz Commercial |
$3,435.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$2,906.90
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$3,914.66
|
|
|
Angio UE/LE Bilateral S&I
|
Facility
|
IP
|
$5,082.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
3052527
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,589.79 |
| Max. Negotiated Rate |
$4,862.46 |
| Rate for Payer: Aetna Commercial |
$4,756.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,545.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,801.20
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cigna Commercial |
$4,862.46
|
| Rate for Payer: Health EOS Commercial |
$4,703.90
|
| Rate for Payer: HFN Commercial |
$4,862.46
|
| Rate for Payer: Multiplan Commercial |
$4,228.22
|
| Rate for Payer: Preferred Network Access Commercial |
$4,862.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,589.79
|
| Rate for Payer: Quartz Commercial |
$3,171.17
|
| Rate for Payer: WEA Trust Commercial |
$2,906.90
|
| Rate for Payer: WPS Commercial |
$3,914.66
|
|
|
Angio UE/LE Uni S&/I
|
Facility
|
OP
|
$4,410.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
3052526
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,201.47 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$4,127.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.30
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,981.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,293.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,201.47
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,430.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,219.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,566.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$4,081.90
|
| Rate for Payer: HFN Commercial |
$4,219.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$3,669.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,219.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.34
|
| Rate for Payer: Quartz Commercial |
$2,981.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$2,522.52
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$3,397.02
|
|
|
Angio UE/LE Uni S&/I
|
Facility
|
IP
|
$4,410.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
3052526
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,247.34 |
| Max. Negotiated Rate |
$4,219.49 |
| Rate for Payer: Aetna Commercial |
$4,127.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,944.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,430.79
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,219.49
|
| Rate for Payer: Health EOS Commercial |
$4,081.90
|
| Rate for Payer: HFN Commercial |
$4,219.49
|
| Rate for Payer: Multiplan Commercial |
$3,669.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,219.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.34
|
| Rate for Payer: Quartz Commercial |
$2,751.84
|
| Rate for Payer: WEA Trust Commercial |
$2,522.52
|
| Rate for Payer: WPS Commercial |
$3,397.02
|
|
|
Angio Vertebral UNI w/wo Arch
|
Facility
|
IP
|
$4,592.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
3052423
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,340.08 |
| Max. Negotiated Rate |
$4,393.63 |
| Rate for Payer: Aetna Commercial |
$4,298.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,107.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,531.11
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$4,393.63
|
| Rate for Payer: Health EOS Commercial |
$4,250.36
|
| Rate for Payer: HFN Commercial |
$4,393.63
|
| Rate for Payer: Multiplan Commercial |
$3,820.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,393.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,340.08
|
| Rate for Payer: Quartz Commercial |
$2,865.41
|
| Rate for Payer: WEA Trust Commercial |
$2,626.62
|
| Rate for Payer: WPS Commercial |
$3,537.22
|
|
|
Angio Vertebral UNI w/wo Arch
|
Facility
|
OP
|
$4,592.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
3052423
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,340.08 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$4,298.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,107.08
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,531.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$4,393.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$4,250.36
|
| Rate for Payer: HFN Commercial |
$4,393.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$3,820.54
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,393.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,340.08
|
| Rate for Payer: Quartz Commercial |
$3,104.19
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$2,626.62
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$3,537.22
|
|
|
Angio Visceral Select W/WO AO S&I
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
3052539
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,231.70 |
| Max. Negotiated Rate |
$2,312.59 |
| Rate for Payer: Aetna Commercial |
$2,262.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,161.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.25
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,312.59
|
| Rate for Payer: Health EOS Commercial |
$2,237.18
|
| Rate for Payer: HFN Commercial |
$2,312.59
|
| Rate for Payer: Multiplan Commercial |
$2,010.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,312.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,231.70
|
| Rate for Payer: Quartz Commercial |
$1,508.21
|
| Rate for Payer: WEA Trust Commercial |
$1,382.52
|
| Rate for Payer: WPS Commercial |
$1,861.82
|
|
|
Angio Visceral Select W/WO AO S&I
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
3052539
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,206.57 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$2,262.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,161.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,633.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,256.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,206.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,312.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,406.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$2,237.18
|
| Rate for Payer: HFN Commercial |
$2,312.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$2,010.94
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,312.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,231.70
|
| Rate for Payer: Quartz Commercial |
$1,633.89
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: WEA Trust Commercial |
$1,382.52
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$1,861.82
|
|
|
A niger / 34938
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
A niger / 34938
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
A niger / 34938
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
ANKLE ARTHRODESIS
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ANKLE ARTHRODESIS
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ANKLE ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,333.09 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Aetna Managed Medicare |
$2,333.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,416.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,166.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,662.98
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,249.36
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$5,416.11
|
| Rate for Payer: Quartz Medicare Advantage |
$4,999.49
|
| Rate for Payer: The Alliance Commercial |
$4,166.24
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
ANKLE ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,082.92 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$4,999.49
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
ANKLE ARTHROSCOPY
|
Facility
|
IP
|
$8,560.00
|
|
| Hospital Charge Code |
2959826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,362.18 |
| Max. Negotiated Rate |
$8,190.21 |
| Rate for Payer: Aetna Commercial |
$8,012.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,656.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,718.27
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$8,190.21
|
| Rate for Payer: Health EOS Commercial |
$7,923.14
|
| Rate for Payer: HFN Commercial |
$8,190.21
|
| Rate for Payer: Multiplan Commercial |
$7,121.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8,190.21
|
| Rate for Payer: Quartz Beloit One Network |
$4,362.18
|
| Rate for Payer: Quartz Commercial |
$5,341.44
|
| Rate for Payer: WEA Trust Commercial |
$4,896.32
|
| Rate for Payer: WPS Commercial |
$6,593.77
|
|
|
ANKLE ARTHROSCOPY
|
Facility
|
OP
|
$8,560.00
|
|
| Hospital Charge Code |
2959826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,492.67 |
| Max. Negotiated Rate |
$8,190.21 |
| Rate for Payer: Aetna Commercial |
$8,012.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,656.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,492.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,786.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,451.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,273.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,718.27
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$8,190.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,981.92
|
| Rate for Payer: Health EOS Commercial |
$7,923.14
|
| Rate for Payer: HFN Commercial |
$8,190.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,676.80
|
| Rate for Payer: Multiplan Commercial |
$7,121.92
|
| Rate for Payer: NAPHCARE Commercial |
$5,341.44
|
| Rate for Payer: Preferred Network Access Commercial |
$8,190.21
|
| Rate for Payer: Quartz Beloit One Network |
$4,362.18
|
| Rate for Payer: Quartz Commercial |
$5,786.56
|
| Rate for Payer: Quartz Medicare Advantage |
$5,341.44
|
| Rate for Payer: The Alliance Commercial |
$4,451.20
|
| Rate for Payer: WEA Trust Commercial |
$4,896.32
|
| Rate for Payer: WPS Commercial |
$6,593.77
|
|
|
ANKLE BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
ANKLE BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
ANKLE BRACE UNIVERSAL LIGHT
|
Facility
|
IP
|
$603.00
|
|
| Hospital Charge Code |
2971457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$307.29 |
| Max. Negotiated Rate |
$576.95 |
| Rate for Payer: Aetna Commercial |
$564.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$332.37
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$558.14
|
| Rate for Payer: HFN Commercial |
$576.95
|
| Rate for Payer: Multiplan Commercial |
$501.70
|
| Rate for Payer: Preferred Network Access Commercial |
$576.95
|
| Rate for Payer: Quartz Beloit One Network |
$307.29
|
| Rate for Payer: Quartz Commercial |
$376.27
|
| Rate for Payer: WEA Trust Commercial |
$344.92
|
| Rate for Payer: WPS Commercial |
$464.49
|
|
