|
CUTTING BUR 3MM
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.56 |
| Max. Negotiated Rate |
$6,408.00 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Aetna Managed Medicare |
$448.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,041.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$896.48
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.50
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$1,041.30
|
| Rate for Payer: Quartz Medicare Advantage |
$961.20
|
| Rate for Payer: The Alliance Commercial |
$6,408.00
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
CUTTING BUR 3MM
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.98 |
| Max. Negotiated Rate |
$1,473.84 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$961.20
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
CUTTING BUR 6.5MM
|
Facility
|
OP
|
$1,602.00
|
|
| Hospital Charge Code |
2964909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$448.56 |
| Max. Negotiated Rate |
$6,408.00 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Aetna Managed Medicare |
$448.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,041.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$768.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$896.48
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.50
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$1,041.30
|
| Rate for Payer: Quartz Medicare Advantage |
$961.20
|
| Rate for Payer: The Alliance Commercial |
$6,408.00
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
CUTTING BUR 6.5MM
|
Facility
|
IP
|
$1,602.00
|
|
| Hospital Charge Code |
2964909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$784.98 |
| Max. Negotiated Rate |
$1,473.84 |
| Rate for Payer: Aetna Commercial |
$1,441.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,377.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.06
|
| Rate for Payer: Cash Price |
$480.60
|
| Rate for Payer: Cigna Commercial |
$1,473.84
|
| Rate for Payer: Health EOS Commercial |
$1,425.78
|
| Rate for Payer: HFN Commercial |
$1,473.84
|
| Rate for Payer: Multiplan Commercial |
$1,281.60
|
| Rate for Payer: NAPHCARE Commercial |
$961.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,473.84
|
| Rate for Payer: Quartz Beloit One Network |
$784.98
|
| Rate for Payer: Quartz Commercial |
$961.20
|
| Rate for Payer: WEA Trust Commercial |
$881.10
|
| Rate for Payer: WPS Commercial |
$1,186.60
|
|
|
CUTTING BURR MICA 3 X 20MM LONG 57SC320L
|
Facility
|
IP
|
$3,083.00
|
|
| Hospital Charge Code |
6192959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,510.67 |
| Max. Negotiated Rate |
$2,836.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,651.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,633.99
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,836.36
|
| Rate for Payer: Health EOS Commercial |
$2,743.87
|
| Rate for Payer: HFN Commercial |
$2,836.36
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,849.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,836.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,510.67
|
| Rate for Payer: Quartz Commercial |
$1,849.80
|
| Rate for Payer: WEA Trust Commercial |
$1,695.65
|
| Rate for Payer: WPS Commercial |
$2,283.58
|
|
|
CUTTING BURR MICA 3 X 20MM LONG 57SC320L
|
Facility
|
OP
|
$3,083.00
|
|
| Hospital Charge Code |
6192959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$863.24 |
| Max. Negotiated Rate |
$12,332.00 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,651.38
|
| Rate for Payer: Aetna Managed Medicare |
$863.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,003.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,541.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,479.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,633.99
|
| Rate for Payer: Cash Price |
$924.90
|
| Rate for Payer: Cigna Commercial |
$2,836.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,725.25
|
| Rate for Payer: Health EOS Commercial |
$2,743.87
|
| Rate for Payer: HFN Commercial |
$2,836.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,312.25
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,849.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,836.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,510.67
|
| Rate for Payer: Quartz Commercial |
$2,003.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,849.80
|
| Rate for Payer: The Alliance Commercial |
$12,332.00
|
| Rate for Payer: WEA Trust Commercial |
$1,695.65
|
| Rate for Payer: WPS Commercial |
$2,283.58
|
|
|
CUTTING HEAD 4MM VALVULOTOME TIVH40
|
Facility
|
IP
|
$2,820.00
|
|
| Hospital Charge Code |
2973136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,381.80 |
| Max. Negotiated Rate |
$2,594.40 |
| Rate for Payer: Aetna Commercial |
$2,538.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.60
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,594.40
|
| Rate for Payer: Health EOS Commercial |
$2,509.80
|
| Rate for Payer: HFN Commercial |
$2,594.40
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,692.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,381.80
|
| Rate for Payer: Quartz Commercial |
$1,692.00
|
| Rate for Payer: WEA Trust Commercial |
$1,551.00
|
| Rate for Payer: WPS Commercial |
$2,088.77
|
|
|
CUTTING HEAD 4MM VALVULOTOME TIVH40
|
Facility
|
OP
|
$2,820.00
|
|
| Hospital Charge Code |
2973136
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$789.60 |
| Max. Negotiated Rate |
$11,280.00 |
| Rate for Payer: Aetna Commercial |
$2,538.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.20
|
| Rate for Payer: Aetna Managed Medicare |
$789.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,833.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,410.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,353.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.60
|
| Rate for Payer: Cash Price |
$846.00
|
| Rate for Payer: Cigna Commercial |
$2,594.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,578.07
|
| Rate for Payer: Health EOS Commercial |
$2,509.80
|
| Rate for Payer: HFN Commercial |
$2,594.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,115.00
|
| Rate for Payer: Multiplan Commercial |
$2,256.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,692.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,381.80
|
| Rate for Payer: Quartz Commercial |
$1,833.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.00
|
| Rate for Payer: The Alliance Commercial |
$11,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,551.00
|
| Rate for Payer: WPS Commercial |
$2,088.77
|
|
|
Cutting OTW 2.0mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Cutting OTW 2.0mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$7,616.00 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: The Alliance Commercial |
$7,616.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Cutting OTW 2.0mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$1,808.80 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$952.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,142.40
|
| Rate for Payer: Health EOS Commercial |
$1,732.64
|
| Rate for Payer: HFN Commercial |
$1,808.80
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,808.80
|
| Rate for Payer: Quartz Beloit One Network |
$837.76
|
| Rate for Payer: Quartz Commercial |
$1,085.28
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Cutting OTW 2.25mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$7,616.00 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: The Alliance Commercial |
$7,616.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Cutting OTW 2.25mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Cutting OTW 2.25mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$1,808.80 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$952.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,142.40
|
| Rate for Payer: Health EOS Commercial |
$1,732.64
|
| Rate for Payer: HFN Commercial |
$1,808.80
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,808.80
|
| Rate for Payer: Quartz Beloit One Network |
$837.76
|
| Rate for Payer: Quartz Commercial |
$1,085.28
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Professional
|
Both
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,502.28 |
| Max. Negotiated Rate |
$5,402.65 |
| Rate for Payer: Aetna Commercial |
$5,402.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,402.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,843.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,412.20
|
| Rate for Payer: Health EOS Commercial |
$5,175.17
|
| Rate for Payer: HFN Commercial |
$5,402.65
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,402.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,502.28
|
| Rate for Payer: Quartz Commercial |
$3,241.59
|
| Rate for Payer: The Alliance Commercial |
$2,843.50
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Facility
|
OP
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$22,748.00 |
| Rate for Payer: Aetna Commercial |
$5,118.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,592.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,696.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,843.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,729.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,014.11
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,232.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,182.45
|
| Rate for Payer: Health EOS Commercial |
$5,061.43
|
| Rate for Payer: HFN Commercial |
$5,232.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,265.25
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,232.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,786.63
|
| Rate for Payer: Quartz Commercial |
$3,696.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,412.20
|
| Rate for Payer: The Alliance Commercial |
$22,748.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Facility
|
IP
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,786.63 |
| Max. Negotiated Rate |
$5,232.04 |
| Rate for Payer: Aetna Commercial |
$5,118.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,014.11
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,232.04
|
| Rate for Payer: Health EOS Commercial |
$5,061.43
|
| Rate for Payer: HFN Commercial |
$5,232.04
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,232.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,786.63
|
| Rate for Payer: Quartz Commercial |
$3,412.20
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
|
CV Angiogram Carotid Cerebral Left
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412878
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,911.04 |
| Max. Negotiated Rate |
$6,285.20 |
| Rate for Payer: Aetna Commercial |
$6,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,285.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.60
|
| Rate for Payer: Health EOS Commercial |
$6,020.56
|
| Rate for Payer: HFN Commercial |
$6,285.20
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,285.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,911.04
|
| Rate for Payer: Quartz Commercial |
$3,771.12
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cerebral Left
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412878
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,241.84 |
| Max. Negotiated Rate |
$6,086.72 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$3,969.60
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cerebral Left
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412878
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$26,464.00 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,852.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,300.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,175.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,702.31
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,962.00
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$4,300.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,969.60
|
| Rate for Payer: The Alliance Commercial |
$26,464.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
OP
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$22,748.00 |
| Rate for Payer: Aetna Commercial |
$5,118.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,592.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,696.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,843.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,729.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,014.11
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,232.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,182.45
|
| Rate for Payer: Health EOS Commercial |
$5,061.43
|
| Rate for Payer: HFN Commercial |
$5,232.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,265.25
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,232.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,786.63
|
| Rate for Payer: Quartz Commercial |
$3,696.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,412.20
|
| Rate for Payer: The Alliance Commercial |
$22,748.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
IP
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,786.63 |
| Max. Negotiated Rate |
$5,232.04 |
| Rate for Payer: Aetna Commercial |
$5,118.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,014.11
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,232.04
|
| Rate for Payer: Health EOS Commercial |
$5,061.43
|
| Rate for Payer: HFN Commercial |
$5,232.04
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,232.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,786.63
|
| Rate for Payer: Quartz Commercial |
$3,412.20
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
|
CV Angiogram Carotid Cerebral Right
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412880
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,911.04 |
| Max. Negotiated Rate |
$6,285.20 |
| Rate for Payer: Aetna Commercial |
$6,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,285.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,308.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.60
|
| Rate for Payer: Health EOS Commercial |
$6,020.56
|
| Rate for Payer: HFN Commercial |
$6,285.20
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,285.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,911.04
|
| Rate for Payer: Quartz Commercial |
$3,771.12
|
| Rate for Payer: The Alliance Commercial |
$3,308.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412880
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$26,464.00 |
| Rate for Payer: Aetna Commercial |
$5,954.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,689.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,852.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,300.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,175.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,506.48
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,086.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,702.31
|
| Rate for Payer: Health EOS Commercial |
$5,888.24
|
| Rate for Payer: HFN Commercial |
$6,086.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,962.00
|
| Rate for Payer: Multiplan Commercial |
$5,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,086.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,241.84
|
| Rate for Payer: Quartz Commercial |
$4,300.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,969.60
|
| Rate for Payer: The Alliance Commercial |
$26,464.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,638.80
|
| Rate for Payer: WPS Commercial |
$4,900.47
|
|
|
CV Angiogram Carotid Cerebral Right
|
Professional
|
Both
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,502.28 |
| Max. Negotiated Rate |
$5,402.65 |
| Rate for Payer: Aetna Commercial |
$5,402.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,890.82
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,402.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,843.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,412.20
|
| Rate for Payer: Health EOS Commercial |
$5,175.17
|
| Rate for Payer: HFN Commercial |
$5,402.65
|
| Rate for Payer: Multiplan Commercial |
$4,549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,402.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,502.28
|
| Rate for Payer: Quartz Commercial |
$3,241.59
|
| Rate for Payer: The Alliance Commercial |
$2,843.50
|
| Rate for Payer: WEA Trust Commercial |
$3,127.85
|
| Rate for Payer: WPS Commercial |
$4,212.36
|
|
