|
zzANA, IFA Panel Comprehensive
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.00
|
| Rate for Payer: Health EOS Commercial |
$227.50
|
| Rate for Payer: HFN Commercial |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Preferred Network Access Commercial |
$237.50
|
| Rate for Payer: Quartz Beloit One Network |
$110.00
|
| Rate for Payer: Quartz Commercial |
$142.50
|
| Rate for Payer: The Alliance Commercial |
$125.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
zzANA, IFA Panel Comprehensive
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Aetna Managed Medicare |
$70.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$125.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.90
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$162.50
|
| Rate for Payer: Quartz Medicare Advantage |
$150.00
|
| Rate for Payer: The Alliance Commercial |
$1,000.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
zzANA, IFA Panel Comprehensive
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
zzANA, IFA, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
980021
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.00
|
| Rate for Payer: Health EOS Commercial |
$227.50
|
| Rate for Payer: HFN Commercial |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Preferred Network Access Commercial |
$237.50
|
| Rate for Payer: Quartz Beloit One Network |
$110.00
|
| Rate for Payer: Quartz Commercial |
$142.50
|
| Rate for Payer: The Alliance Commercial |
$125.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
zzANA, IFA, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
980021
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
zzANA, IFA, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
980021
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: The Alliance Commercial |
$1,000.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Aetna Managed Medicare |
$70.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$125.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$120.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.90
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.50
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$162.50
|
| Rate for Payer: Quartz Medicare Advantage |
$150.00
|
|
|
zzCV Angiogram Carotid Cerebral Bilateral
|
Facility
|
OP
|
$8,228.00
|
|
| Hospital Charge Code |
629646
|
| Min. Negotiated Rate |
$2,303.84 |
| Max. Negotiated Rate |
$32,912.00 |
| Rate for Payer: Aetna Commercial |
$7,405.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,348.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,114.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,949.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,360.84
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cigna Commercial |
$7,569.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,604.39
|
| Rate for Payer: Health EOS Commercial |
$7,322.92
|
| Rate for Payer: HFN Commercial |
$7,569.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,171.00
|
| Rate for Payer: Multiplan Commercial |
$6,582.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,936.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,569.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.72
|
| Rate for Payer: Quartz Commercial |
$5,348.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,936.80
|
| Rate for Payer: The Alliance Commercial |
$32,912.00
|
| Rate for Payer: WEA Trust Commercial |
$4,525.40
|
| Rate for Payer: WPS Commercial |
$6,094.48
|
|
|
zzCV Angiogram Carotid Cerebral Bilateral
|
Facility
|
IP
|
$8,228.00
|
|
| Hospital Charge Code |
629646
|
| Min. Negotiated Rate |
$4,031.72 |
| Max. Negotiated Rate |
$7,569.76 |
| Rate for Payer: Aetna Commercial |
$7,405.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,360.84
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cigna Commercial |
$7,569.76
|
| Rate for Payer: Health EOS Commercial |
$7,322.92
|
| Rate for Payer: HFN Commercial |
$7,569.76
|
| Rate for Payer: Multiplan Commercial |
$6,582.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,936.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,569.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.72
|
| Rate for Payer: Quartz Commercial |
$4,936.80
|
| Rate for Payer: WEA Trust Commercial |
$4,525.40
|
| Rate for Payer: WPS Commercial |
$6,094.48
|
|
|
zzCV Angiogram Carotid Cerebral Left
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629648
|
| Min. Negotiated Rate |
$2,345.14 |
| Max. Negotiated Rate |
$4,403.12 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$2,871.60
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cerebral Left
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629648
|
| Min. Negotiated Rate |
$1,340.08 |
| Max. Negotiated Rate |
$19,144.00 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,110.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.25
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.50
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$3,110.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,871.60
|
| Rate for Payer: The Alliance Commercial |
$19,144.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cerebral Right
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629650
|
| Min. Negotiated Rate |
$2,345.14 |
| Max. Negotiated Rate |
$4,403.12 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$2,871.60
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cerebral Right
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629650
|
| Min. Negotiated Rate |
$1,340.08 |
| Max. Negotiated Rate |
$19,144.00 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,110.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.25
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.50
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$3,110.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,871.60
|
| Rate for Payer: The Alliance Commercial |
$19,144.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cervical Bilateral
|
Facility
|
OP
|
$8,909.00
|
|
| Hospital Charge Code |
629652
|
| Min. Negotiated Rate |
$2,494.52 |
| Max. Negotiated Rate |
$35,636.00 |
| Rate for Payer: Aetna Commercial |
$8,018.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,661.74
|
| Rate for Payer: Aetna Managed Medicare |
$2,494.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,790.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,454.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,276.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,721.77
|
| Rate for Payer: Cash Price |
$2,672.70
|
| Rate for Payer: Cigna Commercial |
$8,196.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,985.48
|
| Rate for Payer: Health EOS Commercial |
$7,929.01
|
| Rate for Payer: HFN Commercial |
$8,196.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,681.75
|
| Rate for Payer: Multiplan Commercial |
$7,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,345.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,196.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,365.41
|
| Rate for Payer: Quartz Commercial |
$5,790.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,345.40
|
| Rate for Payer: The Alliance Commercial |
$35,636.00
|
| Rate for Payer: WEA Trust Commercial |
$4,899.95
|
| Rate for Payer: WPS Commercial |
$6,598.90
|
|
|
zzCV Angiogram Carotid Cervical Bilateral
|
Facility
|
IP
|
$8,909.00
|
|
| Hospital Charge Code |
629652
|
| Min. Negotiated Rate |
$4,365.41 |
| Max. Negotiated Rate |
$8,196.28 |
| Rate for Payer: Aetna Commercial |
$8,018.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,661.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,721.77
|
| Rate for Payer: Cash Price |
$2,672.70
|
| Rate for Payer: Cigna Commercial |
$8,196.28
|
| Rate for Payer: Health EOS Commercial |
$7,929.01
|
| Rate for Payer: HFN Commercial |
$8,196.28
|
| Rate for Payer: Multiplan Commercial |
$7,127.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,345.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,196.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,365.41
|
| Rate for Payer: Quartz Commercial |
$5,345.40
|
| Rate for Payer: WEA Trust Commercial |
$4,899.95
|
| Rate for Payer: WPS Commercial |
$6,598.90
|
|
|
zzCV Angiogram Carotid Cervical Left
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629654
|
| Min. Negotiated Rate |
$1,340.08 |
| Max. Negotiated Rate |
$19,144.00 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,110.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.25
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.50
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$3,110.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,871.60
|
| Rate for Payer: The Alliance Commercial |
$19,144.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cervical Left
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629654
|
| Min. Negotiated Rate |
$2,345.14 |
| Max. Negotiated Rate |
$4,403.12 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$2,871.60
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cervical Right
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629656
|
| Min. Negotiated Rate |
$1,340.08 |
| Max. Negotiated Rate |
$19,144.00 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,110.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.25
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.50
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$3,110.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,871.60
|
| Rate for Payer: The Alliance Commercial |
$19,144.00
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Carotid Cervical Right
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629656
|
| Min. Negotiated Rate |
$2,345.14 |
| Max. Negotiated Rate |
$4,403.12 |
| Rate for Payer: Aetna Commercial |
$4,307.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,115.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.58
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,403.12
|
| Rate for Payer: Health EOS Commercial |
$4,259.54
|
| Rate for Payer: HFN Commercial |
$4,403.12
|
| Rate for Payer: Multiplan Commercial |
$3,828.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.14
|
| Rate for Payer: Quartz Commercial |
$2,871.60
|
| Rate for Payer: WEA Trust Commercial |
$2,632.30
|
| Rate for Payer: WPS Commercial |
$3,544.99
|
|
|
zzCV Angiogram Lower Extremity Bilateral
|
Facility
|
IP
|
$19,805.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
630319
|
| Min. Negotiated Rate |
$9,704.45 |
| Max. Negotiated Rate |
$18,220.60 |
| Rate for Payer: Aetna Commercial |
$17,824.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,032.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,496.65
|
| Rate for Payer: Cash Price |
$5,941.50
|
| Rate for Payer: Cigna Commercial |
$18,220.60
|
| Rate for Payer: Health EOS Commercial |
$17,626.45
|
| Rate for Payer: HFN Commercial |
$18,220.60
|
| Rate for Payer: Multiplan Commercial |
$15,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,883.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18,220.60
|
| Rate for Payer: Quartz Beloit One Network |
$9,704.45
|
| Rate for Payer: Quartz Commercial |
$11,883.00
|
| Rate for Payer: WEA Trust Commercial |
$10,892.75
|
| Rate for Payer: WPS Commercial |
$14,669.56
|
|
|
zzCV Angiogram Lower Extremity Bilateral
|
Facility
|
OP
|
$19,805.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
630319
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$18,220.60 |
| Rate for Payer: Aetna Commercial |
$17,824.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,032.30
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,873.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,506.40
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,496.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$5,941.50
|
| Rate for Payer: Cash Price |
$5,941.50
|
| Rate for Payer: Cigna Commercial |
$18,220.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,082.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$17,626.45
|
| Rate for Payer: HFN Commercial |
$18,220.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$15,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$18,220.60
|
| Rate for Payer: Quartz Beloit One Network |
$9,704.45
|
| Rate for Payer: Quartz Commercial |
$12,873.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: WEA Trust Commercial |
$10,892.75
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$14,669.56
|
|
|
zzCV Angiogram LowerExtremity Left
|
Facility
|
IP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630329
|
| Min. Negotiated Rate |
$4,852.96 |
| Max. Negotiated Rate |
$9,111.68 |
| Rate for Payer: Aetna Commercial |
$8,913.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,517.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,249.12
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,111.68
|
| Rate for Payer: Health EOS Commercial |
$8,814.56
|
| Rate for Payer: HFN Commercial |
$9,111.68
|
| Rate for Payer: Multiplan Commercial |
$7,923.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,942.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,111.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,852.96
|
| Rate for Payer: Quartz Commercial |
$5,942.40
|
| Rate for Payer: WEA Trust Commercial |
$5,447.20
|
| Rate for Payer: WPS Commercial |
$7,335.89
|
|
|
zzCV Angiogram LowerExtremity Left
|
Facility
|
OP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630329
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$8,913.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,517.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,437.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,753.92
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,111.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,542.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$8,814.56
|
| Rate for Payer: HFN Commercial |
$9,111.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$7,923.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,111.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,852.96
|
| Rate for Payer: Quartz Commercial |
$6,437.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: WEA Trust Commercial |
$5,447.20
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$7,335.89
|
|
|
zzCV Angiogram Lower Extremity Right
|
Facility
|
IP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630331
|
| Min. Negotiated Rate |
$4,852.96 |
| Max. Negotiated Rate |
$9,111.68 |
| Rate for Payer: Aetna Commercial |
$8,913.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,517.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,249.12
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,111.68
|
| Rate for Payer: Health EOS Commercial |
$8,814.56
|
| Rate for Payer: HFN Commercial |
$9,111.68
|
| Rate for Payer: Multiplan Commercial |
$7,923.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,942.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,111.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,852.96
|
| Rate for Payer: Quartz Commercial |
$5,942.40
|
| Rate for Payer: WEA Trust Commercial |
$5,447.20
|
| Rate for Payer: WPS Commercial |
$7,335.89
|
|
|
zzCV Angiogram Lower Extremity Right
|
Facility
|
OP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630331
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$8,913.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,517.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,437.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,753.92
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,249.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,111.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,542.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$8,814.56
|
| Rate for Payer: HFN Commercial |
$9,111.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$7,923.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,111.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,852.96
|
| Rate for Payer: Quartz Commercial |
$6,437.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: WEA Trust Commercial |
$5,447.20
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$7,335.89
|
|
|
zzCV Angiogram Pelvis
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
630356
|
| Min. Negotiated Rate |
$3,441.27 |
| Max. Negotiated Rate |
$6,461.16 |
| Rate for Payer: Aetna Commercial |
$6,320.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,039.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,722.19
|
| Rate for Payer: Cash Price |
$2,106.90
|
| Rate for Payer: Cigna Commercial |
$6,461.16
|
| Rate for Payer: Health EOS Commercial |
$6,250.47
|
| Rate for Payer: HFN Commercial |
$6,461.16
|
| Rate for Payer: Multiplan Commercial |
$5,618.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,213.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,461.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,441.27
|
| Rate for Payer: Quartz Commercial |
$4,213.80
|
| Rate for Payer: WEA Trust Commercial |
$3,862.65
|
| Rate for Payer: WPS Commercial |
$5,201.94
|
|
