|
CV Aortogram Abdominal w/ Serialography
|
Facility
|
OP
|
$6,466.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
1412920
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$5,819.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,560.76
|
| 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 |
$3,426.98
|
| 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 |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$5,948.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,618.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$5,754.74
|
| Rate for Payer: HFN Commercial |
$5,948.72
|
| 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 |
$5,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,948.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,168.34
|
| Rate for Payer: Quartz Commercial |
$4,202.90
|
| 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 |
$3,556.30
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,789.37
|
|
|
CV Aortogram Abdominal w/ Serialography
|
Facility
|
IP
|
$6,466.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
1412920
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,168.34 |
| Max. Negotiated Rate |
$5,948.72 |
| Rate for Payer: Aetna Commercial |
$5,819.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,560.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,426.98
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$5,948.72
|
| Rate for Payer: Health EOS Commercial |
$5,754.74
|
| Rate for Payer: HFN Commercial |
$5,948.72
|
| Rate for Payer: Multiplan Commercial |
$5,172.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,879.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,948.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,168.34
|
| Rate for Payer: Quartz Commercial |
$3,879.60
|
| Rate for Payer: WEA Trust Commercial |
$3,556.30
|
| Rate for Payer: WPS Commercial |
$4,789.37
|
|
|
CV Arch Aortography
|
Facility
|
IP
|
$9,946.00
|
|
| Hospital Charge Code |
1482835
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,873.54 |
| Max. Negotiated Rate |
$9,150.32 |
| Rate for Payer: Aetna Commercial |
$8,951.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,553.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,271.38
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cigna Commercial |
$9,150.32
|
| Rate for Payer: Health EOS Commercial |
$8,851.94
|
| Rate for Payer: HFN Commercial |
$9,150.32
|
| Rate for Payer: Multiplan Commercial |
$7,956.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,967.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,150.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,873.54
|
| Rate for Payer: Quartz Commercial |
$5,967.60
|
| Rate for Payer: WEA Trust Commercial |
$5,470.30
|
| Rate for Payer: WPS Commercial |
$7,367.00
|
|
|
CV Arch Aortography
|
Facility
|
OP
|
$9,946.00
|
|
| Hospital Charge Code |
1482835
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$39,784.00 |
| Rate for Payer: Aetna Commercial |
$8,951.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,553.56
|
| Rate for Payer: Aetna Managed Medicare |
$2,784.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,464.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,973.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,774.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,271.38
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cigna Commercial |
$9,150.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,565.78
|
| Rate for Payer: Health EOS Commercial |
$8,851.94
|
| Rate for Payer: HFN Commercial |
$9,150.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,459.50
|
| Rate for Payer: Multiplan Commercial |
$7,956.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,967.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,150.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,873.54
|
| Rate for Payer: Quartz Commercial |
$6,464.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5,967.60
|
| Rate for Payer: The Alliance Commercial |
$39,784.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$5,470.30
|
| Rate for Payer: WPS Commercial |
$7,367.00
|
|
|
CV Arch Aortography
|
Professional
|
Both
|
$9,946.00
|
|
| Hospital Charge Code |
1482835
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,376.24 |
| Max. Negotiated Rate |
$9,448.70 |
| Rate for Payer: Aetna Commercial |
$9,448.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,553.56
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cigna Commercial |
$9,448.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,973.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,967.60
|
| Rate for Payer: Health EOS Commercial |
$9,050.86
|
| Rate for Payer: HFN Commercial |
$9,448.70
|
| Rate for Payer: Multiplan Commercial |
$7,956.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,448.70
|
| Rate for Payer: Quartz Beloit One Network |
$4,376.24
|
| Rate for Payer: Quartz Commercial |
$5,669.22
|
| Rate for Payer: The Alliance Commercial |
$4,973.00
|
| Rate for Payer: WEA Trust Commercial |
$5,470.30
|
| Rate for Payer: WPS Commercial |
$7,367.00
|
|
|
CV Implant Loop Recorder
|
Facility
|
IP
|
$9,741.00
|
|
|
Service Code
|
CPT 33282
|
| Hospital Charge Code |
1483024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,773.09 |
| Max. Negotiated Rate |
$8,961.72 |
| Rate for Payer: Aetna Commercial |
$8,766.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,377.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,162.73
|
| Rate for Payer: Cash Price |
$2,922.30
|
| Rate for Payer: Cigna Commercial |
$8,961.72
|
| Rate for Payer: Health EOS Commercial |
$8,669.49
|
| Rate for Payer: HFN Commercial |
$8,961.72
|
| Rate for Payer: Multiplan Commercial |
$7,792.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,844.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,961.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,773.09
|
| Rate for Payer: Quartz Commercial |
$5,844.60
|
| Rate for Payer: WEA Trust Commercial |
$5,357.55
|
| Rate for Payer: WPS Commercial |
$7,215.16
|
|
|
CV Implant Loop Recorder
|
Professional
|
Both
|
$9,741.00
|
|
|
Service Code
|
CPT 33282
|
| Hospital Charge Code |
1483024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,286.04 |
| Max. Negotiated Rate |
$9,253.95 |
| Rate for Payer: Aetna Commercial |
$9,253.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,377.26
|
| Rate for Payer: Cash Price |
$2,922.30
|
| Rate for Payer: Cash Price |
$2,922.30
|
| Rate for Payer: Cigna Commercial |
$9,253.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,870.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,844.60
|
| Rate for Payer: Health EOS Commercial |
$8,864.31
|
| Rate for Payer: HFN Commercial |
$9,253.95
|
| Rate for Payer: Multiplan Commercial |
$7,792.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,253.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,286.04
|
| Rate for Payer: Quartz Commercial |
$5,552.37
|
| Rate for Payer: The Alliance Commercial |
$4,870.50
|
| Rate for Payer: WEA Trust Commercial |
$5,357.55
|
| Rate for Payer: WPS Commercial |
$7,215.16
|
|
|
CV Implant Loop Recorder
|
Facility
|
OP
|
$9,741.00
|
|
|
Service Code
|
CPT 33282
|
| Hospital Charge Code |
1483024
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,727.48 |
| Max. Negotiated Rate |
$38,964.00 |
| Rate for Payer: Aetna Commercial |
$8,766.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,377.26
|
| Rate for Payer: Aetna Managed Medicare |
$2,727.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,331.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,870.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,675.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,162.73
|
| Rate for Payer: Cash Price |
$2,922.30
|
| Rate for Payer: Cash Price |
$2,922.30
|
| Rate for Payer: Cigna Commercial |
$8,961.72
|
| Rate for Payer: Health EOS Commercial |
$8,669.49
|
| Rate for Payer: HFN Commercial |
$8,961.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,305.75
|
| Rate for Payer: Multiplan Commercial |
$7,792.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,844.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,961.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,773.09
|
| Rate for Payer: Quartz Commercial |
$6,331.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,844.60
|
| Rate for Payer: The Alliance Commercial |
$38,964.00
|
| Rate for Payer: WEA Trust Commercial |
$5,357.55
|
| Rate for Payer: WPS Commercial |
$7,215.16
|
|
|
CV insertion Venous Catheter w port
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
1483198
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| 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 |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| 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 |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$833.30
|
| 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 |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
CV insertion Venous Catheter w port
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
1483198
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.08 |
| Max. Negotiated Rate |
$1,217.90 |
| Rate for Payer: Aetna Commercial |
$1,217.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,217.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,082.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$769.20
|
| Rate for Payer: Health EOS Commercial |
$1,166.62
|
| Rate for Payer: HFN Commercial |
$1,217.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,023.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,023.88
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,217.90
|
| Rate for Payer: Quartz Beloit One Network |
$564.08
|
| Rate for Payer: Quartz Commercial |
$730.74
|
| Rate for Payer: The Alliance Commercial |
$641.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,082.17
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
CV insertion Venous Catheter w port
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 36571
|
| Hospital Charge Code |
1483198
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$1,179.44 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$769.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
CV Insert of IABP
|
Facility
|
OP
|
$10,972.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
1483048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,072.16 |
| Max. Negotiated Rate |
$43,888.00 |
| Rate for Payer: Aetna Commercial |
$9,874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,435.92
|
| Rate for Payer: Aetna Managed Medicare |
$3,072.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,131.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,486.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,266.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,815.16
|
| Rate for Payer: Cash Price |
$3,291.60
|
| Rate for Payer: Cash Price |
$3,291.60
|
| Rate for Payer: Cigna Commercial |
$10,094.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$9,765.08
|
| Rate for Payer: HFN Commercial |
$10,094.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,229.00
|
| Rate for Payer: Multiplan Commercial |
$8,777.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,094.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,376.28
|
| Rate for Payer: Quartz Commercial |
$7,131.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,583.20
|
| Rate for Payer: The Alliance Commercial |
$43,888.00
|
| Rate for Payer: WEA Trust Commercial |
$6,034.60
|
| Rate for Payer: WPS Commercial |
$8,126.96
|
|
|
CV Insert of IABP
|
Professional
|
Both
|
$10,972.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
1483048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$10,423.40 |
| Rate for Payer: Aetna Commercial |
$10,423.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,435.92
|
| Rate for Payer: Cash Price |
$3,291.60
|
| Rate for Payer: Cash Price |
$3,291.60
|
| Rate for Payer: Cigna Commercial |
$10,423.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,583.20
|
| Rate for Payer: Health EOS Commercial |
$9,984.52
|
| Rate for Payer: HFN Commercial |
$10,423.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$827.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$827.33
|
| Rate for Payer: Multiplan Commercial |
$8,777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,423.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,827.68
|
| Rate for Payer: Quartz Commercial |
$6,254.04
|
| Rate for Payer: The Alliance Commercial |
$5,486.00
|
| Rate for Payer: United Healthcare Medicaid |
$245.56
|
| Rate for Payer: WEA Trust Commercial |
$6,034.60
|
| Rate for Payer: WPS Commercial |
$8,126.96
|
|
|
CV Insert of IABP
|
Facility
|
IP
|
$10,972.00
|
|
|
Service Code
|
CPT 33967
|
| Hospital Charge Code |
1483048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,376.28 |
| Max. Negotiated Rate |
$10,094.24 |
| Rate for Payer: Aetna Commercial |
$9,874.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,435.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,815.16
|
| Rate for Payer: Cash Price |
$3,291.60
|
| Rate for Payer: Cigna Commercial |
$10,094.24
|
| Rate for Payer: Health EOS Commercial |
$9,765.08
|
| Rate for Payer: HFN Commercial |
$10,094.24
|
| Rate for Payer: Multiplan Commercial |
$8,777.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,094.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,376.28
|
| Rate for Payer: Quartz Commercial |
$6,583.20
|
| Rate for Payer: WEA Trust Commercial |
$6,034.60
|
| Rate for Payer: WPS Commercial |
$8,126.96
|
|
|
CV Insert Vena Cava Filter inc Filming
|
Professional
|
Both
|
$20,105.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
1483045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$731.70 |
| Max. Negotiated Rate |
$19,099.75 |
| Rate for Payer: Aetna Commercial |
$19,099.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,290.30
|
| Rate for Payer: Cash Price |
$6,031.50
|
| Rate for Payer: Cash Price |
$6,031.50
|
| Rate for Payer: Cigna Commercial |
$19,099.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,044.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,063.00
|
| Rate for Payer: Health EOS Commercial |
$18,295.55
|
| Rate for Payer: HFN Commercial |
$19,099.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$731.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$731.70
|
| Rate for Payer: Multiplan Commercial |
$16,084.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19,099.75
|
| Rate for Payer: Quartz Beloit One Network |
$8,846.20
|
| Rate for Payer: Quartz Commercial |
$11,459.85
|
| Rate for Payer: The Alliance Commercial |
$10,052.50
|
| Rate for Payer: United Healthcare Medicaid |
$2,044.34
|
| Rate for Payer: WEA Trust Commercial |
$11,057.75
|
| Rate for Payer: WPS Commercial |
$14,891.77
|
|
|
CV Insert Vena Cava Filter inc Filming
|
Facility
|
OP
|
$20,105.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
1483045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$18,094.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,290.30
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,068.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,052.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,650.40
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,655.65
|
| 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 |
$6,031.50
|
| Rate for Payer: Cash Price |
$6,031.50
|
| Rate for Payer: Cash Price |
$6,031.50
|
| Rate for Payer: Cigna Commercial |
$18,496.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$17,893.45
|
| Rate for Payer: HFN Commercial |
$18,496.60
|
| 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 |
$16,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$18,496.60
|
| Rate for Payer: Quartz Beloit One Network |
$9,851.45
|
| Rate for Payer: Quartz Commercial |
$13,068.25
|
| 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 |
$11,057.75
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$14,891.77
|
|
|
CV Insert Vena Cava Filter inc Filming
|
Facility
|
IP
|
$20,105.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
1483045
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9,851.45 |
| Max. Negotiated Rate |
$18,496.60 |
| Rate for Payer: Aetna Commercial |
$18,094.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,290.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,655.65
|
| Rate for Payer: Cash Price |
$6,031.50
|
| Rate for Payer: Cigna Commercial |
$18,496.60
|
| Rate for Payer: Health EOS Commercial |
$17,893.45
|
| Rate for Payer: HFN Commercial |
$18,496.60
|
| Rate for Payer: Multiplan Commercial |
$16,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$12,063.00
|
| Rate for Payer: Preferred Network Access Commercial |
$18,496.60
|
| Rate for Payer: Quartz Beloit One Network |
$9,851.45
|
| Rate for Payer: Quartz Commercial |
$12,063.00
|
| Rate for Payer: WEA Trust Commercial |
$11,057.75
|
| Rate for Payer: WPS Commercial |
$14,891.77
|
|
|
CV NM Myo SPECT Multi R/S Acquisition
|
Facility
|
OP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5383326
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,180.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,855.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
|
CV NM Myo SPECT Multi R/S Acquisition
|
Facility
|
IP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5383326
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,660.30 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,482.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,482.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
|
CV Removal Loop Recorder
|
Facility
|
IP
|
$3,829.00
|
|
|
Service Code
|
CPT 33284
|
| Hospital Charge Code |
1483246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,876.21 |
| Max. Negotiated Rate |
$3,522.68 |
| Rate for Payer: Aetna Commercial |
$3,446.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,292.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,029.37
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cigna Commercial |
$3,522.68
|
| Rate for Payer: Health EOS Commercial |
$3,407.81
|
| Rate for Payer: HFN Commercial |
$3,522.68
|
| Rate for Payer: Multiplan Commercial |
$3,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,297.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,522.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,876.21
|
| Rate for Payer: Quartz Commercial |
$2,297.40
|
| Rate for Payer: WEA Trust Commercial |
$2,105.95
|
| Rate for Payer: WPS Commercial |
$2,836.14
|
|
|
CV Removal Loop Recorder
|
Professional
|
Both
|
$3,829.00
|
|
|
Service Code
|
CPT 33284
|
| Hospital Charge Code |
1483246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,684.76 |
| Max. Negotiated Rate |
$3,637.55 |
| Rate for Payer: Aetna Commercial |
$3,637.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,292.94
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cigna Commercial |
$3,637.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,914.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,297.40
|
| Rate for Payer: Health EOS Commercial |
$3,484.39
|
| Rate for Payer: HFN Commercial |
$3,637.55
|
| Rate for Payer: Multiplan Commercial |
$3,063.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,637.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,684.76
|
| Rate for Payer: Quartz Commercial |
$2,182.53
|
| Rate for Payer: The Alliance Commercial |
$1,914.50
|
| Rate for Payer: WEA Trust Commercial |
$2,105.95
|
| Rate for Payer: WPS Commercial |
$2,836.14
|
|
|
CV Removal Loop Recorder
|
Facility
|
OP
|
$3,829.00
|
|
|
Service Code
|
CPT 33284
|
| Hospital Charge Code |
1483246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,072.12 |
| Max. Negotiated Rate |
$15,316.00 |
| Rate for Payer: Aetna Commercial |
$3,446.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,292.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,072.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,488.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,914.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,837.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,029.37
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cigna Commercial |
$3,522.68
|
| Rate for Payer: Health EOS Commercial |
$3,407.81
|
| Rate for Payer: HFN Commercial |
$3,522.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,871.75
|
| Rate for Payer: Multiplan Commercial |
$3,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,297.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,522.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,876.21
|
| Rate for Payer: Quartz Commercial |
$2,488.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,297.40
|
| Rate for Payer: The Alliance Commercial |
$15,316.00
|
| Rate for Payer: WEA Trust Commercial |
$2,105.95
|
| Rate for Payer: WPS Commercial |
$2,836.14
|
|
|
CV Removal of IABP
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1483252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$324.24 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Aetna Managed Medicare |
$324.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.50
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$752.70
|
| Rate for Payer: Quartz Medicare Advantage |
$694.80
|
| Rate for Payer: The Alliance Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
CV Removal of IABP
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1483252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$567.42 |
| Max. Negotiated Rate |
$1,065.36 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$694.80
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
CV Removal of IABP
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1483252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$41.53 |
| Max. Negotiated Rate |
$1,100.10 |
| Rate for Payer: Aetna Commercial |
$1,100.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,100.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$694.80
|
| Rate for Payer: Health EOS Commercial |
$1,053.78
|
| Rate for Payer: HFN Commercial |
$1,100.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.30
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,100.10
|
| Rate for Payer: Quartz Beloit One Network |
$509.52
|
| Rate for Payer: Quartz Commercial |
$660.06
|
| Rate for Payer: The Alliance Commercial |
$579.00
|
| Rate for Payer: United Healthcare Medicaid |
$41.53
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
