|
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
|
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
|
|
|
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
|
|
|
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 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 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
|
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 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 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
|
|
|
zzCV Angiogram Carotid Cervical Left
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629654
|
| 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 Cervical Right
|
Facility
|
IP
|
$4,786.00
|
|
| Hospital Charge Code |
629656
|
| 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 Cervical Right
|
Facility
|
OP
|
$4,786.00
|
|
| Hospital Charge Code |
629656
|
| 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 Lower Extremity Bilateral
|
Facility
|
OP
|
$19,805.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
630319
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$18,949.42 |
| Rate for Payer: Aetna Commercial |
$18,537.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,713.59
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,388.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,298.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,886.66
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,916.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$5,941.50
|
| Rate for Payer: Cash Price |
$5,941.50
|
| Rate for Payer: Cigna Commercial |
$18,949.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,526.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$18,331.51
|
| Rate for Payer: HFN Commercial |
$18,949.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$16,477.76
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$18,949.42
|
| Rate for Payer: Quartz Beloit One Network |
$10,092.63
|
| Rate for Payer: Quartz Commercial |
$13,388.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$11,328.46
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$15,255.79
|
|
|
zzCV Angiogram Lower Extremity Bilateral
|
Facility
|
IP
|
$19,805.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
630319
|
| Min. Negotiated Rate |
$10,092.63 |
| Max. Negotiated Rate |
$18,949.42 |
| Rate for Payer: Aetna Commercial |
$18,537.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,713.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,916.52
|
| Rate for Payer: Cash Price |
$5,941.50
|
| Rate for Payer: Cigna Commercial |
$18,949.42
|
| Rate for Payer: Health EOS Commercial |
$18,331.51
|
| Rate for Payer: HFN Commercial |
$18,949.42
|
| Rate for Payer: Multiplan Commercial |
$16,477.76
|
| Rate for Payer: Preferred Network Access Commercial |
$18,949.42
|
| Rate for Payer: Quartz Beloit One Network |
$10,092.63
|
| Rate for Payer: Quartz Commercial |
$12,358.32
|
| Rate for Payer: WEA Trust Commercial |
$11,328.46
|
| Rate for Payer: WPS Commercial |
$15,255.79
|
|
|
zzCV Angiogram LowerExtremity Left
|
Facility
|
OP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630329
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$9,270.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,858.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,695.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,150.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,944.08
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,459.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,476.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,764.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$9,167.14
|
| Rate for Payer: HFN Commercial |
$9,476.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$8,240.13
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,476.15
|
| Rate for Payer: Quartz Beloit One Network |
$5,047.08
|
| Rate for Payer: Quartz Commercial |
$6,695.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$5,665.09
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$7,629.05
|
|
|
zzCV Angiogram LowerExtremity Left
|
Facility
|
IP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630329
|
| Min. Negotiated Rate |
$5,047.08 |
| Max. Negotiated Rate |
$9,476.15 |
| Rate for Payer: Aetna Commercial |
$9,270.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,858.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,459.08
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,476.15
|
| Rate for Payer: Health EOS Commercial |
$9,167.14
|
| Rate for Payer: HFN Commercial |
$9,476.15
|
| Rate for Payer: Multiplan Commercial |
$8,240.13
|
| Rate for Payer: Preferred Network Access Commercial |
$9,476.15
|
| Rate for Payer: Quartz Beloit One Network |
$5,047.08
|
| Rate for Payer: Quartz Commercial |
$6,180.10
|
| Rate for Payer: WEA Trust Commercial |
$5,665.09
|
| Rate for Payer: WPS Commercial |
$7,629.05
|
|
|
zzCV Angiogram Lower Extremity Right
|
Facility
|
IP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630331
|
| Min. Negotiated Rate |
$5,047.08 |
| Max. Negotiated Rate |
$9,476.15 |
| Rate for Payer: Aetna Commercial |
$9,270.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,858.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,459.08
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,476.15
|
| Rate for Payer: Health EOS Commercial |
$9,167.14
|
| Rate for Payer: HFN Commercial |
$9,476.15
|
| Rate for Payer: Multiplan Commercial |
$8,240.13
|
| Rate for Payer: Preferred Network Access Commercial |
$9,476.15
|
| Rate for Payer: Quartz Beloit One Network |
$5,047.08
|
| Rate for Payer: Quartz Commercial |
$6,180.10
|
| Rate for Payer: WEA Trust Commercial |
$5,665.09
|
| Rate for Payer: WPS Commercial |
$7,629.05
|
|
|
zzCV Angiogram Lower Extremity Right
|
Facility
|
OP
|
$9,904.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
630331
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$9,270.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,858.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,695.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,150.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,944.08
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,459.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cash Price |
$2,971.20
|
| Rate for Payer: Cigna Commercial |
$9,476.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,764.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$9,167.14
|
| Rate for Payer: HFN Commercial |
$9,476.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$8,240.13
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,476.15
|
| Rate for Payer: Quartz Beloit One Network |
$5,047.08
|
| Rate for Payer: Quartz Commercial |
$6,695.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$5,665.09
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$7,629.05
|
|
|
zzCV Angiogram Pelvis
|
Facility
|
OP
|
$7,023.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
630356
|
| Min. Negotiated Rate |
$3,505.88 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$6,573.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,281.37
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,747.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,651.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,505.88
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,871.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$2,106.90
|
| Rate for Payer: Cash Price |
$2,106.90
|
| Rate for Payer: Cigna Commercial |
$6,719.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,087.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$6,500.49
|
| Rate for Payer: HFN Commercial |
$6,719.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$5,843.14
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,719.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,578.92
|
| Rate for Payer: Quartz Commercial |
$4,747.55
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: WEA Trust Commercial |
$4,017.16
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$5,409.82
|
|
|
zzCV Angiogram Pelvis
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
630356
|
| Min. Negotiated Rate |
$3,578.92 |
| Max. Negotiated Rate |
$6,719.61 |
| Rate for Payer: Aetna Commercial |
$6,573.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,281.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,871.08
|
| Rate for Payer: Cash Price |
$2,106.90
|
| Rate for Payer: Cigna Commercial |
$6,719.61
|
| Rate for Payer: Health EOS Commercial |
$6,500.49
|
| Rate for Payer: HFN Commercial |
$6,719.61
|
| Rate for Payer: Multiplan Commercial |
$5,843.14
|
| Rate for Payer: Preferred Network Access Commercial |
$6,719.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,578.92
|
| Rate for Payer: Quartz Commercial |
$4,382.35
|
| Rate for Payer: WEA Trust Commercial |
$4,017.16
|
| Rate for Payer: WPS Commercial |
$5,409.82
|
|
|
zzCV Angiogram Renal Bilateral
|
Facility
|
OP
|
$8,165.00
|
|
|
Service Code
|
CPT 36252
|
| Hospital Charge Code |
630375
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$7,642.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,302.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,519.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,245.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,075.97
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,500.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,449.50
|
| Rate for Payer: Cash Price |
$2,449.50
|
| Rate for Payer: Cigna Commercial |
$7,812.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$7,557.52
|
| Rate for Payer: HFN Commercial |
$7,812.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$6,793.28
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$7,812.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,160.88
|
| Rate for Payer: Quartz Commercial |
$5,519.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$4,670.38
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$6,289.50
|
|
