|
CV Angiogram Carotid Cerebral Left
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412878
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,027.48 |
| Max. Negotiated Rate |
$6,536.61 |
| Rate for Payer: Aetna Commercial |
$6,536.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,536.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,440.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.38
|
| Rate for Payer: Health EOS Commercial |
$6,261.38
|
| Rate for Payer: HFN Commercial |
$6,536.61
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,536.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.48
|
| Rate for Payer: Quartz Commercial |
$3,921.96
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cerebral Left
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412878
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.51
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.48
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,472.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.38
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cerebral Left
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412878
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,371.51 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,128.38
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412880
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,371.51 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,128.38
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cerebral Right
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412880
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,027.48 |
| Max. Negotiated Rate |
$6,536.61 |
| Rate for Payer: Aetna Commercial |
$6,536.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,536.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,440.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.38
|
| Rate for Payer: Health EOS Commercial |
$6,261.38
|
| Rate for Payer: HFN Commercial |
$6,536.61
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,536.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.48
|
| Rate for Payer: Quartz Commercial |
$3,921.96
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412880
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.51
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.48
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,472.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.38
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
IP
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,898.10 |
| Max. Negotiated Rate |
$5,441.32 |
| Rate for Payer: Aetna Commercial |
$5,323.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,134.67
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,441.32
|
| Rate for Payer: Health EOS Commercial |
$5,263.89
|
| Rate for Payer: HFN Commercial |
$5,441.32
|
| Rate for Payer: Multiplan Commercial |
$4,731.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,441.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,898.10
|
| Rate for Payer: Quartz Commercial |
$3,548.69
|
| Rate for Payer: WEA Trust Commercial |
$3,252.96
|
| Rate for Payer: WPS Commercial |
$4,380.70
|
|
|
CV Angiogram Carotid Cerebral Right
|
Professional
|
Both
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,602.37 |
| Max. Negotiated Rate |
$5,618.76 |
| Rate for Payer: Aetna Commercial |
$5,618.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.45
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,618.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,957.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,548.69
|
| Rate for Payer: Health EOS Commercial |
$5,382.18
|
| Rate for Payer: HFN Commercial |
$5,618.76
|
| Rate for Payer: Multiplan Commercial |
$4,731.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,618.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,602.37
|
| Rate for Payer: Quartz Commercial |
$3,371.25
|
| Rate for Payer: The Alliance Commercial |
$2,957.24
|
| Rate for Payer: WEA Trust Commercial |
$3,252.96
|
| Rate for Payer: WPS Commercial |
$4,380.70
|
|
|
CV Angiogram Carotid Cerebral Right
|
Facility
|
OP
|
$5,687.00
|
|
| Hospital Charge Code |
2980123
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,441.32 |
| Rate for Payer: Aetna Commercial |
$5,323.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,086.45
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,844.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,957.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,134.67
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cash Price |
$1,706.10
|
| Rate for Payer: Cigna Commercial |
$5,441.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,309.83
|
| Rate for Payer: Health EOS Commercial |
$5,263.89
|
| Rate for Payer: HFN Commercial |
$5,441.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,435.86
|
| Rate for Payer: Multiplan Commercial |
$4,731.58
|
| Rate for Payer: NAPHCARE Commercial |
$3,548.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,441.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,898.10
|
| Rate for Payer: Quartz Commercial |
$3,844.41
|
| Rate for Payer: Quartz Medicare Advantage |
$3,548.69
|
| Rate for Payer: The Alliance Commercial |
$2,957.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,252.96
|
| Rate for Payer: WPS Commercial |
$4,380.70
|
|
|
CV Angiogram Carotid Cervical Bilateral
|
Facility
|
OP
|
$6,158.00
|
|
| Hospital Charge Code |
1412882
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,891.97 |
| Rate for Payer: Aetna Commercial |
$5,763.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,162.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,202.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,074.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.29
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,891.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,583.96
|
| Rate for Payer: Health EOS Commercial |
$5,699.84
|
| Rate for Payer: HFN Commercial |
$5,891.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,803.24
|
| Rate for Payer: Multiplan Commercial |
$5,123.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,842.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,891.97
|
| Rate for Payer: Quartz Beloit One Network |
$3,138.12
|
| Rate for Payer: Quartz Commercial |
$4,162.81
|
| Rate for Payer: Quartz Medicare Advantage |
$3,842.59
|
| Rate for Payer: The Alliance Commercial |
$3,202.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,522.38
|
| Rate for Payer: WPS Commercial |
$4,743.51
|
|
|
CV Angiogram Carotid Cervical Bilateral
|
Facility
|
IP
|
$6,158.00
|
|
| Hospital Charge Code |
1412882
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,138.12 |
| Max. Negotiated Rate |
$5,891.97 |
| Rate for Payer: Aetna Commercial |
$5,763.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.29
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,891.97
|
| Rate for Payer: Health EOS Commercial |
$5,699.84
|
| Rate for Payer: HFN Commercial |
$5,891.97
|
| Rate for Payer: Multiplan Commercial |
$5,123.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,891.97
|
| Rate for Payer: Quartz Beloit One Network |
$3,138.12
|
| Rate for Payer: Quartz Commercial |
$3,842.59
|
| Rate for Payer: WEA Trust Commercial |
$3,522.38
|
| Rate for Payer: WPS Commercial |
$4,743.51
|
|
|
CV Angiogram Carotid Cervical Bilateral
|
Professional
|
Both
|
$6,158.00
|
|
| Hospital Charge Code |
1412882
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,817.90 |
| Max. Negotiated Rate |
$6,084.10 |
| Rate for Payer: Aetna Commercial |
$6,084.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.72
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$6,084.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,202.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,842.59
|
| Rate for Payer: Health EOS Commercial |
$5,827.93
|
| Rate for Payer: HFN Commercial |
$6,084.10
|
| Rate for Payer: Multiplan Commercial |
$5,123.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,084.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,817.90
|
| Rate for Payer: Quartz Commercial |
$3,650.46
|
| Rate for Payer: The Alliance Commercial |
$3,202.16
|
| Rate for Payer: WEA Trust Commercial |
$3,522.38
|
| Rate for Payer: WPS Commercial |
$4,743.51
|
|
|
CV Angiogram Carotid Cervical Left
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412884
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.51
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.48
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,472.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.38
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cervical Left
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412884
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,027.48 |
| Max. Negotiated Rate |
$6,536.61 |
| Rate for Payer: Aetna Commercial |
$6,536.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,536.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,440.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.38
|
| Rate for Payer: Health EOS Commercial |
$6,261.38
|
| Rate for Payer: HFN Commercial |
$6,536.61
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,536.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.48
|
| Rate for Payer: Quartz Commercial |
$3,921.96
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cervical Left
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412884
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,371.51 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,128.38
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
IP
|
$6,158.00
|
|
| Hospital Charge Code |
2980124
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,138.12 |
| Max. Negotiated Rate |
$5,891.97 |
| Rate for Payer: Aetna Commercial |
$5,763.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.29
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,891.97
|
| Rate for Payer: Health EOS Commercial |
$5,699.84
|
| Rate for Payer: HFN Commercial |
$5,891.97
|
| Rate for Payer: Multiplan Commercial |
$5,123.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,891.97
|
| Rate for Payer: Quartz Beloit One Network |
$3,138.12
|
| Rate for Payer: Quartz Commercial |
$3,842.59
|
| Rate for Payer: WEA Trust Commercial |
$3,522.38
|
| Rate for Payer: WPS Commercial |
$4,743.51
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
OP
|
$6,616.00
|
|
| Hospital Charge Code |
1412886
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,926.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,472.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,440.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,302.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,850.51
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,160.48
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,128.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,472.42
|
| Rate for Payer: Quartz Medicare Advantage |
$4,128.38
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cervical Right
|
Professional
|
Both
|
$6,616.00
|
|
| Hospital Charge Code |
1412886
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,027.48 |
| Max. Negotiated Rate |
$6,536.61 |
| Rate for Payer: Aetna Commercial |
$6,536.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,536.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,440.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.38
|
| Rate for Payer: Health EOS Commercial |
$6,261.38
|
| Rate for Payer: HFN Commercial |
$6,536.61
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,536.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.48
|
| Rate for Payer: Quartz Commercial |
$3,921.96
|
| Rate for Payer: The Alliance Commercial |
$3,440.32
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
OP
|
$6,158.00
|
|
| Hospital Charge Code |
2980124
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,891.97 |
| Rate for Payer: Aetna Commercial |
$5,763.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,162.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,202.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,074.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.29
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$5,891.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,583.96
|
| Rate for Payer: Health EOS Commercial |
$5,699.84
|
| Rate for Payer: HFN Commercial |
$5,891.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,803.24
|
| Rate for Payer: Multiplan Commercial |
$5,123.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,842.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,891.97
|
| Rate for Payer: Quartz Beloit One Network |
$3,138.12
|
| Rate for Payer: Quartz Commercial |
$4,162.81
|
| Rate for Payer: Quartz Medicare Advantage |
$3,842.59
|
| Rate for Payer: The Alliance Commercial |
$3,202.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,522.38
|
| Rate for Payer: WPS Commercial |
$4,743.51
|
|
|
CV Angiogram Carotid Cervical Right
|
Facility
|
IP
|
$6,616.00
|
|
| Hospital Charge Code |
1412886
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,371.51 |
| Max. Negotiated Rate |
$6,330.19 |
| Rate for Payer: Aetna Commercial |
$6,192.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,917.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,646.74
|
| Rate for Payer: Cash Price |
$1,984.80
|
| Rate for Payer: Cigna Commercial |
$6,330.19
|
| Rate for Payer: Health EOS Commercial |
$6,123.77
|
| Rate for Payer: HFN Commercial |
$6,330.19
|
| Rate for Payer: Multiplan Commercial |
$5,504.51
|
| Rate for Payer: Preferred Network Access Commercial |
$6,330.19
|
| Rate for Payer: Quartz Beloit One Network |
$3,371.51
|
| Rate for Payer: Quartz Commercial |
$4,128.38
|
| Rate for Payer: WEA Trust Commercial |
$3,784.35
|
| Rate for Payer: WPS Commercial |
$5,096.30
|
|
|
CV Angiogram Carotid Cervical Right
|
Professional
|
Both
|
$6,158.00
|
|
| Hospital Charge Code |
2980124
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,817.90 |
| Max. Negotiated Rate |
$6,084.10 |
| Rate for Payer: Aetna Commercial |
$6,084.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,507.72
|
| Rate for Payer: Cash Price |
$1,847.40
|
| Rate for Payer: Cigna Commercial |
$6,084.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,202.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,842.59
|
| Rate for Payer: Health EOS Commercial |
$5,827.93
|
| Rate for Payer: HFN Commercial |
$6,084.10
|
| Rate for Payer: Multiplan Commercial |
$5,123.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,084.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,817.90
|
| Rate for Payer: Quartz Commercial |
$3,650.46
|
| Rate for Payer: The Alliance Commercial |
$3,202.16
|
| Rate for Payer: WEA Trust Commercial |
$3,522.38
|
| Rate for Payer: WPS Commercial |
$4,743.51
|
|
|
CV Angiogram Extremity Bilateral
|
Facility
|
OP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 LT
|
| Hospital Charge Code |
1412892
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$10,075.10 |
| Rate for Payer: Aetna Commercial |
$9,856.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,418.03
|
| Rate for Payer: Aetna Managed Medicare |
$3,066.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,804.14
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$10,075.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,128.46
|
| Rate for Payer: Health EOS Commercial |
$9,746.57
|
| Rate for Payer: HFN Commercial |
$10,075.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,213.40
|
| Rate for Payer: Multiplan Commercial |
$8,760.96
|
| Rate for Payer: NAPHCARE Commercial |
$6,570.72
|
| Rate for Payer: Preferred Network Access Commercial |
$10,075.10
|
| Rate for Payer: Quartz Beloit One Network |
$5,366.09
|
| Rate for Payer: Quartz Commercial |
$7,118.28
|
| Rate for Payer: Quartz Medicare Advantage |
$6,570.72
|
| Rate for Payer: The Alliance Commercial |
$5,475.60
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$6,023.16
|
| Rate for Payer: WPS Commercial |
$8,111.26
|
|
|
CV Angiogram Extremity Bilateral
|
Professional
|
Both
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 LT
|
| Hospital Charge Code |
1412892
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$597.74 |
| Max. Negotiated Rate |
$10,403.64 |
| Rate for Payer: Aetna Commercial |
$10,403.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,418.03
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$10,403.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,475.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,570.72
|
| Rate for Payer: Health EOS Commercial |
$9,965.59
|
| Rate for Payer: HFN Commercial |
$10,403.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$597.74
|
| Rate for Payer: Multiplan Commercial |
$8,760.96
|
| Rate for Payer: Preferred Network Access Commercial |
$10,403.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,818.53
|
| Rate for Payer: Quartz Commercial |
$6,242.18
|
| Rate for Payer: The Alliance Commercial |
$5,475.60
|
| Rate for Payer: WEA Trust Commercial |
$6,023.16
|
| Rate for Payer: WPS Commercial |
$8,111.26
|
|
|
CV Angiogram Extremity Bilateral
|
Facility
|
IP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 LT
|
| Hospital Charge Code |
1412892
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$5,366.09 |
| Max. Negotiated Rate |
$10,075.10 |
| Rate for Payer: Aetna Commercial |
$9,856.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,418.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,804.14
|
| Rate for Payer: Cash Price |
$3,159.00
|
| Rate for Payer: Cigna Commercial |
$10,075.10
|
| Rate for Payer: Health EOS Commercial |
$9,746.57
|
| Rate for Payer: HFN Commercial |
$10,075.10
|
| Rate for Payer: Multiplan Commercial |
$8,760.96
|
| Rate for Payer: Preferred Network Access Commercial |
$10,075.10
|
| Rate for Payer: Quartz Beloit One Network |
$5,366.09
|
| Rate for Payer: Quartz Commercial |
$6,570.72
|
| Rate for Payer: WEA Trust Commercial |
$6,023.16
|
| Rate for Payer: WPS Commercial |
$8,111.26
|
|
|
CV Angiogram Extremity Left
|
Facility
|
OP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
1412894
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,098.59 |
| Rate for Payer: Aetna Commercial |
$12,813.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,244.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,986.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,287.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,829.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,338.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,545.93
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$13,098.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,967.58
|
| Rate for Payer: Health EOS Commercial |
$12,671.46
|
| Rate for Payer: HFN Commercial |
$13,098.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,678.20
|
| Rate for Payer: Multiplan Commercial |
$11,390.08
|
| Rate for Payer: NAPHCARE Commercial |
$8,542.56
|
| Rate for Payer: Preferred Network Access Commercial |
$13,098.59
|
| Rate for Payer: Quartz Beloit One Network |
$6,976.42
|
| Rate for Payer: Quartz Commercial |
$9,254.44
|
| Rate for Payer: Quartz Medicare Advantage |
$8,542.56
|
| Rate for Payer: The Alliance Commercial |
$7,118.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$7,830.68
|
| Rate for Payer: WPS Commercial |
$10,545.41
|
|
