|
CV Angiogram Pelvis
|
Facility
|
OP
|
$9,707.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
1412904
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$8,736.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,348.02
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,368.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,294.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,480.17
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,144.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cigna Commercial |
$8,930.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,432.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$8,639.23
|
| Rate for Payer: HFN Commercial |
$8,930.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$7,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,930.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,756.43
|
| Rate for Payer: Quartz Commercial |
$6,309.55
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,338.85
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$7,189.97
|
|
|
CV Angiogram Pelvis
|
Facility
|
IP
|
$9,707.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
1412904
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,756.43 |
| Max. Negotiated Rate |
$8,930.44 |
| Rate for Payer: Aetna Commercial |
$8,736.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,348.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,144.71
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cigna Commercial |
$8,930.44
|
| Rate for Payer: Health EOS Commercial |
$8,639.23
|
| Rate for Payer: HFN Commercial |
$8,930.44
|
| Rate for Payer: Multiplan Commercial |
$7,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,824.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,930.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,756.43
|
| Rate for Payer: Quartz Commercial |
$5,824.20
|
| Rate for Payer: WEA Trust Commercial |
$5,338.85
|
| Rate for Payer: WPS Commercial |
$7,189.97
|
|
|
CV Angiogram Pelvis
|
Professional
|
Both
|
$9,707.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
1412904
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$9,221.65 |
| Rate for Payer: Aetna Commercial |
$9,221.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,348.02
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cigna Commercial |
$9,221.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,853.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,824.20
|
| Rate for Payer: Health EOS Commercial |
$8,833.37
|
| Rate for Payer: HFN Commercial |
$9,221.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.84
|
| Rate for Payer: Multiplan Commercial |
$7,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,221.65
|
| Rate for Payer: Quartz Beloit One Network |
$4,271.08
|
| Rate for Payer: Quartz Commercial |
$5,532.99
|
| Rate for Payer: The Alliance Commercial |
$4,853.50
|
| Rate for Payer: WEA Trust Commercial |
$5,338.85
|
| Rate for Payer: WPS Commercial |
$7,189.97
|
|
|
CV Angiogram Renal Bilateral
|
Facility
|
IP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 LT
|
| Hospital Charge Code |
1412906
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,766.05 |
| Max. Negotiated Rate |
$5,193.40 |
| Rate for Payer: Aetna Commercial |
$5,080.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,991.85
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,193.40
|
| Rate for Payer: Health EOS Commercial |
$5,024.05
|
| Rate for Payer: HFN Commercial |
$5,193.40
|
| Rate for Payer: Multiplan Commercial |
$4,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,193.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,766.05
|
| Rate for Payer: Quartz Commercial |
$3,387.00
|
| Rate for Payer: WEA Trust Commercial |
$3,104.75
|
| Rate for Payer: WPS Commercial |
$4,181.25
|
|
|
CV Angiogram Renal Bilateral
|
Professional
|
Both
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 LT
|
| Hospital Charge Code |
1412906
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,145.27 |
| Max. Negotiated Rate |
$5,362.75 |
| Rate for Payer: Aetna Commercial |
$5,362.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.70
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,362.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,227.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,387.00
|
| Rate for Payer: Health EOS Commercial |
$5,136.95
|
| Rate for Payer: HFN Commercial |
$5,362.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,145.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,145.27
|
| Rate for Payer: Multiplan Commercial |
$4,516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,362.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.80
|
| Rate for Payer: Quartz Commercial |
$3,217.65
|
| Rate for Payer: The Alliance Commercial |
$2,822.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,227.91
|
| Rate for Payer: WEA Trust Commercial |
$3,104.75
|
| Rate for Payer: WPS Commercial |
$4,181.25
|
|
|
CV Angiogram Renal Bilateral
|
Facility
|
OP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 LT
|
| Hospital Charge Code |
1412906
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$5,080.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,669.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,822.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,709.60
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,991.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,193.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$5,024.05
|
| Rate for Payer: HFN Commercial |
$5,193.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$4,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,193.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,766.05
|
| Rate for Payer: Quartz Commercial |
$3,669.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,104.75
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,181.25
|
|
|
CV Angiogram Renal Left
|
Facility
|
IP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 LT
|
| Hospital Charge Code |
1412910
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,307.19 |
| Max. Negotiated Rate |
$9,964.52 |
| Rate for Payer: Aetna Commercial |
$9,747.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,314.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,740.43
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$9,964.52
|
| Rate for Payer: Health EOS Commercial |
$9,639.59
|
| Rate for Payer: HFN Commercial |
$9,964.52
|
| Rate for Payer: Multiplan Commercial |
$8,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,964.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,307.19
|
| Rate for Payer: Quartz Commercial |
$6,498.60
|
| Rate for Payer: WEA Trust Commercial |
$5,957.05
|
| Rate for Payer: WPS Commercial |
$8,022.52
|
|
|
CV Angiogram Renal Left
|
Professional
|
Both
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 LT
|
| Hospital Charge Code |
1412910
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$834.74 |
| Max. Negotiated Rate |
$10,289.45 |
| Rate for Payer: Aetna Commercial |
$10,289.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,314.66
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,289.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,119.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,498.60
|
| Rate for Payer: Health EOS Commercial |
$9,856.21
|
| Rate for Payer: HFN Commercial |
$10,289.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$834.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$834.74
|
| Rate for Payer: Multiplan Commercial |
$8,664.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,289.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,765.64
|
| Rate for Payer: Quartz Commercial |
$6,173.67
|
| Rate for Payer: The Alliance Commercial |
$5,415.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,119.96
|
| Rate for Payer: WEA Trust Commercial |
$5,957.05
|
| Rate for Payer: WPS Commercial |
$8,022.52
|
|
|
CV Angiogram Renal Left
|
Facility
|
OP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 LT
|
| Hospital Charge Code |
1412910
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$9,747.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,314.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,040.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,415.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,198.88
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,740.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$9,964.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$9,639.59
|
| Rate for Payer: HFN Commercial |
$9,964.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,964.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,307.19
|
| Rate for Payer: Quartz Commercial |
$7,040.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,957.05
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$8,022.52
|
|
|
CV Angiogram Renal Right
|
Facility
|
OP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 RT
|
| Hospital Charge Code |
2980128
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$5,080.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,669.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,822.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,709.60
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,991.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,193.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$5,024.05
|
| Rate for Payer: HFN Commercial |
$5,193.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$4,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,193.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,766.05
|
| Rate for Payer: Quartz Commercial |
$3,669.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$3,104.75
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,181.25
|
|
|
CV Angiogram Renal Right
|
Facility
|
IP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 RT
|
| Hospital Charge Code |
2980128
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,766.05 |
| Max. Negotiated Rate |
$5,193.40 |
| Rate for Payer: Aetna Commercial |
$5,080.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,991.85
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,193.40
|
| Rate for Payer: Health EOS Commercial |
$5,024.05
|
| Rate for Payer: HFN Commercial |
$5,193.40
|
| Rate for Payer: Multiplan Commercial |
$4,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,387.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,193.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,766.05
|
| Rate for Payer: Quartz Commercial |
$3,387.00
|
| Rate for Payer: WEA Trust Commercial |
$3,104.75
|
| Rate for Payer: WPS Commercial |
$4,181.25
|
|
|
CV Angiogram Renal Right
|
Professional
|
Both
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 RT
|
| Hospital Charge Code |
2980128
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,145.27 |
| Max. Negotiated Rate |
$5,362.75 |
| Rate for Payer: Aetna Commercial |
$5,362.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.70
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,362.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,227.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,387.00
|
| Rate for Payer: Health EOS Commercial |
$5,136.95
|
| Rate for Payer: HFN Commercial |
$5,362.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,145.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,145.27
|
| Rate for Payer: Multiplan Commercial |
$4,516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,362.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.80
|
| Rate for Payer: Quartz Commercial |
$3,217.65
|
| Rate for Payer: The Alliance Commercial |
$2,822.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,227.91
|
| Rate for Payer: WEA Trust Commercial |
$3,104.75
|
| Rate for Payer: WPS Commercial |
$4,181.25
|
|
|
CV Angiogram Renal Right
|
Facility
|
OP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 RT
|
| Hospital Charge Code |
1412912
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$9,747.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,314.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,040.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,415.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,198.88
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,740.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$9,964.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$9,639.59
|
| Rate for Payer: HFN Commercial |
$9,964.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,964.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,307.19
|
| Rate for Payer: Quartz Commercial |
$7,040.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,957.05
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$8,022.52
|
|
|
CV Angiogram Renal Right
|
Facility
|
IP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 RT
|
| Hospital Charge Code |
1412912
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,307.19 |
| Max. Negotiated Rate |
$9,964.52 |
| Rate for Payer: Aetna Commercial |
$9,747.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,314.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,740.43
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$9,964.52
|
| Rate for Payer: Health EOS Commercial |
$9,639.59
|
| Rate for Payer: HFN Commercial |
$9,964.52
|
| Rate for Payer: Multiplan Commercial |
$8,664.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,498.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,964.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,307.19
|
| Rate for Payer: Quartz Commercial |
$6,498.60
|
| Rate for Payer: WEA Trust Commercial |
$5,957.05
|
| Rate for Payer: WPS Commercial |
$8,022.52
|
|
|
CV Angiogram Renal Right
|
Professional
|
Both
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 RT
|
| Hospital Charge Code |
1412912
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$834.74 |
| Max. Negotiated Rate |
$10,289.45 |
| Rate for Payer: Aetna Commercial |
$10,289.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,314.66
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,289.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,119.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,498.60
|
| Rate for Payer: Health EOS Commercial |
$9,856.21
|
| Rate for Payer: HFN Commercial |
$10,289.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$834.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$834.74
|
| Rate for Payer: Multiplan Commercial |
$8,664.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,289.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,765.64
|
| Rate for Payer: Quartz Commercial |
$6,173.67
|
| Rate for Payer: The Alliance Commercial |
$5,415.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,119.96
|
| Rate for Payer: WEA Trust Commercial |
$5,957.05
|
| Rate for Payer: WPS Commercial |
$8,022.52
|
|
|
CV Angiogram Vertebral
|
Professional
|
Both
|
$10,036.00
|
|
| Hospital Charge Code |
1412914
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,415.84 |
| Max. Negotiated Rate |
$9,534.20 |
| Rate for Payer: Aetna Commercial |
$9,534.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,630.96
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,534.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,018.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,021.60
|
| Rate for Payer: Health EOS Commercial |
$9,132.76
|
| Rate for Payer: HFN Commercial |
$9,534.20
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,534.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,415.84
|
| Rate for Payer: Quartz Commercial |
$5,720.52
|
| Rate for Payer: The Alliance Commercial |
$5,018.00
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
CV Angiogram Vertebral
|
Facility
|
OP
|
$10,036.00
|
|
| Hospital Charge Code |
1412914
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$40,144.00 |
| Rate for Payer: Aetna Commercial |
$9,032.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,630.96
|
| Rate for Payer: Aetna Managed Medicare |
$2,810.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,523.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,018.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,817.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,319.08
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,233.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,616.15
|
| Rate for Payer: Health EOS Commercial |
$8,932.04
|
| Rate for Payer: HFN Commercial |
$9,233.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,527.00
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,021.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,233.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,917.64
|
| Rate for Payer: Quartz Commercial |
$6,523.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,021.60
|
| Rate for Payer: The Alliance Commercial |
$40,144.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
CV Angiogram Vertebral
|
Facility
|
IP
|
$10,036.00
|
|
| Hospital Charge Code |
1412914
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,917.64 |
| Max. Negotiated Rate |
$9,233.12 |
| Rate for Payer: Aetna Commercial |
$9,032.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,630.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,319.08
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,233.12
|
| Rate for Payer: Health EOS Commercial |
$8,932.04
|
| Rate for Payer: HFN Commercial |
$9,233.12
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,021.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,233.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,917.64
|
| Rate for Payer: Quartz Commercial |
$6,021.60
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
CV Angio Through Existing Catheter
|
Professional
|
Both
|
$9,546.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
1412860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$438.64 |
| Max. Negotiated Rate |
$9,068.70 |
| Rate for Payer: Aetna Commercial |
$9,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,209.56
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cigna Commercial |
$9,068.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,773.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,727.60
|
| Rate for Payer: Health EOS Commercial |
$8,686.86
|
| Rate for Payer: HFN Commercial |
$9,068.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$438.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$438.64
|
| Rate for Payer: Multiplan Commercial |
$7,636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,068.70
|
| Rate for Payer: Quartz Beloit One Network |
$4,200.24
|
| Rate for Payer: Quartz Commercial |
$5,441.22
|
| Rate for Payer: The Alliance Commercial |
$4,773.00
|
| Rate for Payer: WEA Trust Commercial |
$5,250.30
|
| Rate for Payer: WPS Commercial |
$7,070.72
|
|
|
CV Angio Through Existing Catheter
|
Facility
|
IP
|
$9,546.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
1412860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,677.54 |
| Max. Negotiated Rate |
$8,782.32 |
| Rate for Payer: Aetna Commercial |
$8,591.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,059.38
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cigna Commercial |
$8,782.32
|
| Rate for Payer: Health EOS Commercial |
$8,495.94
|
| Rate for Payer: HFN Commercial |
$8,782.32
|
| Rate for Payer: Multiplan Commercial |
$7,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,727.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,782.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,677.54
|
| Rate for Payer: Quartz Commercial |
$5,727.60
|
| Rate for Payer: WEA Trust Commercial |
$5,250.30
|
| Rate for Payer: WPS Commercial |
$7,070.72
|
|
|
CV Angio Through Existing Catheter
|
Facility
|
OP
|
$9,546.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
1412860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$8,591.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,209.56
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,814.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,451.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,979.01
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,059.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cigna Commercial |
$8,782.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,341.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$8,495.94
|
| Rate for Payer: HFN Commercial |
$8,782.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$7,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,782.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,677.54
|
| Rate for Payer: Quartz Commercial |
$6,204.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,250.30
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$7,070.72
|
|
|
CV Aortogram Abdominal + Iliofemoral
|
Professional
|
Both
|
$10,937.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
1412918
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$558.38 |
| Max. Negotiated Rate |
$10,390.15 |
| Rate for Payer: Aetna Commercial |
$10,390.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,405.82
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cigna Commercial |
$10,390.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,468.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,562.20
|
| Rate for Payer: Health EOS Commercial |
$9,952.67
|
| Rate for Payer: HFN Commercial |
$10,390.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$558.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$558.38
|
| Rate for Payer: Multiplan Commercial |
$8,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,390.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,812.28
|
| Rate for Payer: Quartz Commercial |
$6,234.09
|
| Rate for Payer: The Alliance Commercial |
$5,468.50
|
| Rate for Payer: WEA Trust Commercial |
$6,015.35
|
| Rate for Payer: WPS Commercial |
$8,101.04
|
|
|
CV Aortogram Abdominal + Iliofemoral
|
Facility
|
OP
|
$10,937.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
1412918
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$9,843.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,405.82
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,814.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,451.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,979.01
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,796.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cigna Commercial |
$10,062.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,120.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$9,733.93
|
| Rate for Payer: HFN Commercial |
$10,062.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,062.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,359.13
|
| Rate for Payer: Quartz Commercial |
$7,109.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$6,015.35
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$8,101.04
|
|
|
CV Aortogram Abdominal + Iliofemoral
|
Facility
|
IP
|
$10,937.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
1412918
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,359.13 |
| Max. Negotiated Rate |
$10,062.04 |
| Rate for Payer: Aetna Commercial |
$9,843.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,405.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,796.61
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cigna Commercial |
$10,062.04
|
| Rate for Payer: Health EOS Commercial |
$9,733.93
|
| Rate for Payer: HFN Commercial |
$10,062.04
|
| Rate for Payer: Multiplan Commercial |
$8,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,562.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,062.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,359.13
|
| Rate for Payer: Quartz Commercial |
$6,562.20
|
| Rate for Payer: WEA Trust Commercial |
$6,015.35
|
| Rate for Payer: WPS Commercial |
$8,101.04
|
|
|
CV Aortogram Abdominal w/ Serialography
|
Professional
|
Both
|
$6,466.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
1412920
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$450.36 |
| Max. Negotiated Rate |
$6,142.70 |
| Rate for Payer: Aetna Commercial |
$6,142.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,560.76
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$6,142.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,233.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,879.60
|
| Rate for Payer: Health EOS Commercial |
$5,884.06
|
| Rate for Payer: HFN Commercial |
$6,142.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$450.36
|
| Rate for Payer: Multiplan Commercial |
$5,172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,142.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,845.04
|
| Rate for Payer: Quartz Commercial |
$3,685.62
|
| Rate for Payer: The Alliance Commercial |
$3,233.00
|
| Rate for Payer: WEA Trust Commercial |
$3,556.30
|
| Rate for Payer: WPS Commercial |
$4,789.37
|
|
