|
Zurpaz Steerable Sheath
|
Facility
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
4534617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,303.58 |
| Max. Negotiated Rate |
$6,202.64 |
| Rate for Payer: Aetna Commercial |
$6,067.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,573.26
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$6,202.64
|
| Rate for Payer: Health EOS Commercial |
$6,000.38
|
| Rate for Payer: HFN Commercial |
$6,202.64
|
| Rate for Payer: Multiplan Commercial |
$5,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,045.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,202.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,303.58
|
| Rate for Payer: Quartz Commercial |
$4,045.20
|
| Rate for Payer: WEA Trust Commercial |
$3,708.10
|
| Rate for Payer: WPS Commercial |
$4,993.80
|
|
|
Zurpaz Steerable Sheath
|
Facility
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
4534617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,887.76 |
| Max. Negotiated Rate |
$6,202.64 |
| Rate for Payer: Aetna Commercial |
$6,067.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,798.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,887.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,382.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,371.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,236.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,573.26
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$6,202.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,772.82
|
| Rate for Payer: Health EOS Commercial |
$6,000.38
|
| Rate for Payer: HFN Commercial |
$6,202.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,056.50
|
| Rate for Payer: Multiplan Commercial |
$5,393.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,045.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,202.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,303.58
|
| Rate for Payer: Quartz Commercial |
$4,382.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,045.20
|
| Rate for Payer: WEA Trust Commercial |
$3,708.10
|
| Rate for Payer: WPS Commercial |
$4,993.80
|
|
|
ZYGOMATIC COMPLEX FRACTURE
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2950465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
ZYGOMATIC COMPLEX FRACTURE
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2950465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
zzAlbumin CSF
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1114851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
zzAlbumin CSF
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1114851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
zzAlbumin Serum (Quest)
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1114854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
zzAlbumin Serum (Quest)
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1114854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$5.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicaid |
$5.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
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: 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 Panel Comprehensive
|
Professional
|
$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: 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, 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: 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, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Professional
|
$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: 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: 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
|
|
|
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: 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: 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: 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: 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
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: 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 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 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: 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
|
|
