|
Z-PLASTY WOUND REVISION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Z-PLASTY WOUND REVISION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Zurpaz Steerable Sheath
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
4534617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,435.72 |
| Max. Negotiated Rate |
$6,450.75 |
| Rate for Payer: Aetna Commercial |
$6,310.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,030.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,716.19
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$6,450.75
|
| Rate for Payer: Health EOS Commercial |
$6,240.40
|
| Rate for Payer: HFN Commercial |
$6,450.75
|
| Rate for Payer: Multiplan Commercial |
$5,609.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,450.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,435.72
|
| Rate for Payer: Quartz Commercial |
$4,207.01
|
| Rate for Payer: WEA Trust Commercial |
$3,856.42
|
| Rate for Payer: WPS Commercial |
$5,193.36
|
|
|
Zurpaz Steerable Sheath
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
4534617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,963.27 |
| Max. Negotiated Rate |
$6,450.75 |
| Rate for Payer: Aetna Commercial |
$6,310.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,030.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,963.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,557.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,505.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,365.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,716.19
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$6,450.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,923.84
|
| Rate for Payer: Health EOS Commercial |
$6,240.40
|
| Rate for Payer: HFN Commercial |
$6,450.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,258.76
|
| Rate for Payer: Multiplan Commercial |
$5,609.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,207.01
|
| Rate for Payer: Preferred Network Access Commercial |
$6,450.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,435.72
|
| Rate for Payer: Quartz Commercial |
$4,557.59
|
| Rate for Payer: Quartz Medicare Advantage |
$4,207.01
|
| Rate for Payer: The Alliance Commercial |
$3,505.84
|
| Rate for Payer: WEA Trust Commercial |
$3,856.42
|
| Rate for Payer: WPS Commercial |
$5,193.36
|
|
|
ZYGOMATIC COMPLEX FRACTURE
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2950465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
ZYGOMATIC COMPLEX FRACTURE
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2950465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
zzAlbumin CSF
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1114851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$8.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.43
|
| Rate for Payer: Anthem Medicare Advantage |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.09
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$8.09
|
| Rate for Payer: The Alliance Commercial |
$32.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
zzAlbumin CSF
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1114851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
zzAlbumin Serum (Quest)
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1114854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
zzAlbumin Serum (Quest)
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1114854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
zzANA, IFA Panel Comprehensive
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzANA, IFA Panel Comprehensive
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzANA, IFA Panel Comprehensive
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.00
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzANA, IFA, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
980021
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzANA, IFA, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Professional
|
Both
|
$250.00
|
|
| Hospital Charge Code |
980021
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.00
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzANA, IFA, Rfx Titer/Ptrn/Mixed Cont Tiss
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
980021
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzCV Angiogram Carotid Cerebral Bilateral
|
Facility
|
OP
|
$8,228.00
|
|
| Hospital Charge Code |
629646
|
| Min. Negotiated Rate |
$2,395.99 |
| Max. Negotiated Rate |
$7,872.55 |
| Rate for Payer: Aetna Commercial |
$7,701.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,359.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,395.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,562.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,278.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,107.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,535.27
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cigna Commercial |
$7,872.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,788.70
|
| Rate for Payer: Health EOS Commercial |
$7,615.84
|
| Rate for Payer: HFN Commercial |
$7,872.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,417.84
|
| Rate for Payer: Multiplan Commercial |
$6,845.70
|
| Rate for Payer: NAPHCARE Commercial |
$5,134.27
|
| Rate for Payer: Preferred Network Access Commercial |
$7,872.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,192.99
|
| Rate for Payer: Quartz Commercial |
$5,562.13
|
| Rate for Payer: Quartz Medicare Advantage |
$5,134.27
|
| Rate for Payer: The Alliance Commercial |
$4,278.56
|
| Rate for Payer: WEA Trust Commercial |
$4,706.42
|
| Rate for Payer: WPS Commercial |
$6,338.03
|
|
|
zzCV Angiogram Carotid Cerebral Bilateral
|
Facility
|
IP
|
$8,228.00
|
|
| Hospital Charge Code |
629646
|
| Min. Negotiated Rate |
$4,192.99 |
| Max. Negotiated Rate |
$7,872.55 |
| Rate for Payer: Aetna Commercial |
$7,701.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,359.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,535.27
|
| Rate for Payer: Cash Price |
$2,468.40
|
| Rate for Payer: Cigna Commercial |
$7,872.55
|
| Rate for Payer: Health EOS Commercial |
$7,615.84
|
| Rate for Payer: HFN Commercial |
$7,872.55
|
| Rate for Payer: Multiplan Commercial |
$6,845.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,872.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,192.99
|
| Rate for Payer: Quartz Commercial |
$5,134.27
|
| Rate for Payer: WEA Trust Commercial |
$4,706.42
|
| Rate for Payer: WPS Commercial |
$6,338.03
|
|
|
zzCV Angiogram Carotid Cerebral Left
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629648
|
| Min. Negotiated Rate |
$2,438.95 |
| Max. Negotiated Rate |
$4,579.24 |
| Rate for Payer: Aetna Commercial |
$4,479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,280.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.04
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,579.24
|
| Rate for Payer: Health EOS Commercial |
$4,429.92
|
| Rate for Payer: HFN Commercial |
$4,579.24
|
| Rate for Payer: Multiplan Commercial |
$3,981.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.95
|
| Rate for Payer: Quartz Commercial |
$2,986.46
|
| Rate for Payer: WEA Trust Commercial |
$2,737.59
|
| Rate for Payer: WPS Commercial |
$3,686.66
|
|
|
zzCV Angiogram Carotid Cerebral Left
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629648
|
| Min. Negotiated Rate |
$1,393.68 |
| Max. Negotiated Rate |
$4,579.24 |
| Rate for Payer: Aetna Commercial |
$4,479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,280.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,235.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,488.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.04
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,579.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,785.45
|
| Rate for Payer: Health EOS Commercial |
$4,429.92
|
| Rate for Payer: HFN Commercial |
$4,579.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.08
|
| Rate for Payer: Multiplan Commercial |
$3,981.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,986.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.95
|
| Rate for Payer: Quartz Commercial |
$3,235.34
|
| Rate for Payer: Quartz Medicare Advantage |
$2,986.46
|
| Rate for Payer: The Alliance Commercial |
$2,488.72
|
| Rate for Payer: WEA Trust Commercial |
$2,737.59
|
| Rate for Payer: WPS Commercial |
$3,686.66
|
|
|
zzCV Angiogram Carotid Cerebral Right
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629650
|
| Min. Negotiated Rate |
$2,438.95 |
| Max. Negotiated Rate |
$4,579.24 |
| Rate for Payer: Aetna Commercial |
$4,479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,280.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.04
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,579.24
|
| Rate for Payer: Health EOS Commercial |
$4,429.92
|
| Rate for Payer: HFN Commercial |
$4,579.24
|
| Rate for Payer: Multiplan Commercial |
$3,981.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.95
|
| Rate for Payer: Quartz Commercial |
$2,986.46
|
| Rate for Payer: WEA Trust Commercial |
$2,737.59
|
| Rate for Payer: WPS Commercial |
$3,686.66
|
|
|
zzCV Angiogram Carotid Cerebral Right
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629650
|
| Min. Negotiated Rate |
$1,393.68 |
| Max. Negotiated Rate |
$4,579.24 |
| Rate for Payer: Aetna Commercial |
$4,479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,280.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,235.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,488.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.04
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,579.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,785.45
|
| Rate for Payer: Health EOS Commercial |
$4,429.92
|
| Rate for Payer: HFN Commercial |
$4,579.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.08
|
| Rate for Payer: Multiplan Commercial |
$3,981.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,986.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.95
|
| Rate for Payer: Quartz Commercial |
$3,235.34
|
| Rate for Payer: Quartz Medicare Advantage |
$2,986.46
|
| Rate for Payer: The Alliance Commercial |
$2,488.72
|
| Rate for Payer: WEA Trust Commercial |
$2,737.59
|
| Rate for Payer: WPS Commercial |
$3,686.66
|
|
|
zzCV Angiogram Carotid Cervical Bilateral
|
Facility
|
IP
|
$8,909.00
|
|
| Hospital Charge Code |
629652
|
| Min. Negotiated Rate |
$4,540.03 |
| Max. Negotiated Rate |
$8,524.13 |
| Rate for Payer: Aetna Commercial |
$8,338.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,968.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,910.64
|
| Rate for Payer: Cash Price |
$2,672.70
|
| Rate for Payer: Cigna Commercial |
$8,524.13
|
| Rate for Payer: Health EOS Commercial |
$8,246.17
|
| Rate for Payer: HFN Commercial |
$8,524.13
|
| Rate for Payer: Multiplan Commercial |
$7,412.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,524.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,540.03
|
| Rate for Payer: Quartz Commercial |
$5,559.22
|
| Rate for Payer: WEA Trust Commercial |
$5,095.95
|
| Rate for Payer: WPS Commercial |
$6,862.60
|
|
|
zzCV Angiogram Carotid Cervical Bilateral
|
Facility
|
OP
|
$8,909.00
|
|
| Hospital Charge Code |
629652
|
| Min. Negotiated Rate |
$2,594.30 |
| Max. Negotiated Rate |
$8,524.13 |
| Rate for Payer: Aetna Commercial |
$8,338.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,968.21
|
| Rate for Payer: Aetna Managed Medicare |
$2,594.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,022.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,632.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,447.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,910.64
|
| Rate for Payer: Cash Price |
$2,672.70
|
| Rate for Payer: Cigna Commercial |
$8,524.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,185.04
|
| Rate for Payer: Health EOS Commercial |
$8,246.17
|
| Rate for Payer: HFN Commercial |
$8,524.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,949.02
|
| Rate for Payer: Multiplan Commercial |
$7,412.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,559.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,524.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,540.03
|
| Rate for Payer: Quartz Commercial |
$6,022.48
|
| Rate for Payer: Quartz Medicare Advantage |
$5,559.22
|
| Rate for Payer: The Alliance Commercial |
$4,632.68
|
| Rate for Payer: WEA Trust Commercial |
$5,095.95
|
| Rate for Payer: WPS Commercial |
$6,862.60
|
|
|
zzCV Angiogram Carotid Cervical Left
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629654
|
| Min. Negotiated Rate |
$1,393.68 |
| Max. Negotiated Rate |
$4,579.24 |
| Rate for Payer: Aetna Commercial |
$4,479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,280.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,393.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,235.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,488.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.04
|
| Rate for Payer: Cash Price |
$1,435.80
|
| Rate for Payer: Cigna Commercial |
$4,579.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,785.45
|
| Rate for Payer: Health EOS Commercial |
$4,429.92
|
| Rate for Payer: HFN Commercial |
$4,579.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,733.08
|
| Rate for Payer: Multiplan Commercial |
$3,981.95
|
| Rate for Payer: NAPHCARE Commercial |
$2,986.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,438.95
|
| Rate for Payer: Quartz Commercial |
$3,235.34
|
| Rate for Payer: Quartz Medicare Advantage |
$2,986.46
|
| Rate for Payer: The Alliance Commercial |
$2,488.72
|
| Rate for Payer: WEA Trust Commercial |
$2,737.59
|
| Rate for Payer: WPS Commercial |
$3,686.66
|
|
