|
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 |
$1,362.47 |
| Max. Negotiated Rate |
$7,147.30 |
| Rate for Payer: Aetna Commercial |
$6,991.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,681.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,117.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| 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 |
$7,147.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,347.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$6,914.23
|
| Rate for Payer: HFN Commercial |
$7,147.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$6,215.04
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,147.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.71
|
| Rate for Payer: Quartz Commercial |
$5,049.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$4,272.84
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$5,754.14
|
|
|
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 |
$3,806.71 |
| Max. Negotiated Rate |
$7,147.30 |
| Rate for Payer: Aetna Commercial |
$6,991.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,681.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,117.46
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$7,147.30
|
| Rate for Payer: Health EOS Commercial |
$6,914.23
|
| Rate for Payer: HFN Commercial |
$7,147.30
|
| Rate for Payer: Multiplan Commercial |
$6,215.04
|
| Rate for Payer: Preferred Network Access Commercial |
$7,147.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.71
|
| Rate for Payer: Quartz Commercial |
$4,661.28
|
| Rate for Payer: WEA Trust Commercial |
$4,272.84
|
| Rate for Payer: WPS Commercial |
$5,754.14
|
|
|
CV Removal Loop Recorder
|
Facility
|
IP
|
$3,829.00
|
|
|
Service Code
|
CPT 33284
|
| Hospital Charge Code |
1483246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,951.26 |
| Max. Negotiated Rate |
$3,663.59 |
| Rate for Payer: Aetna Commercial |
$3,583.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,424.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,110.54
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cigna Commercial |
$3,663.59
|
| Rate for Payer: Health EOS Commercial |
$3,544.12
|
| Rate for Payer: HFN Commercial |
$3,663.59
|
| Rate for Payer: Multiplan Commercial |
$3,185.73
|
| Rate for Payer: Preferred Network Access Commercial |
$3,663.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,951.26
|
| Rate for Payer: Quartz Commercial |
$2,389.30
|
| Rate for Payer: WEA Trust Commercial |
$2,190.19
|
| Rate for Payer: WPS Commercial |
$2,949.48
|
|
|
CV Removal Loop Recorder
|
Professional
|
Both
|
$3,829.00
|
|
|
Service Code
|
CPT 33284
|
| Hospital Charge Code |
1483246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,752.15 |
| Max. Negotiated Rate |
$3,783.05 |
| Rate for Payer: Aetna Commercial |
$3,783.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,424.66
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cigna Commercial |
$3,783.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,991.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,389.30
|
| Rate for Payer: Health EOS Commercial |
$3,623.77
|
| Rate for Payer: HFN Commercial |
$3,783.05
|
| Rate for Payer: Multiplan Commercial |
$3,185.73
|
| Rate for Payer: Preferred Network Access Commercial |
$3,783.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,752.15
|
| Rate for Payer: Quartz Commercial |
$2,269.83
|
| Rate for Payer: The Alliance Commercial |
$1,991.08
|
| Rate for Payer: WEA Trust Commercial |
$2,190.19
|
| Rate for Payer: WPS Commercial |
$2,949.48
|
|
|
CV Removal Loop Recorder
|
Facility
|
OP
|
$3,829.00
|
|
|
Service Code
|
CPT 33284
|
| Hospital Charge Code |
1483246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,115.00 |
| Max. Negotiated Rate |
$3,663.59 |
| Rate for Payer: Aetna Commercial |
$3,583.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,424.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,115.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,588.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,991.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,911.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,110.54
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cash Price |
$1,148.70
|
| Rate for Payer: Cigna Commercial |
$3,663.59
|
| Rate for Payer: Health EOS Commercial |
$3,544.12
|
| Rate for Payer: HFN Commercial |
$3,663.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,986.62
|
| Rate for Payer: Multiplan Commercial |
$3,185.73
|
| Rate for Payer: NAPHCARE Commercial |
$2,389.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,663.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,951.26
|
| Rate for Payer: Quartz Commercial |
$2,588.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,389.30
|
| Rate for Payer: The Alliance Commercial |
$1,991.08
|
| Rate for Payer: WEA Trust Commercial |
$2,190.19
|
| Rate for Payer: WPS Commercial |
$2,949.48
|
|
|
CV Removal of IABP
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1483252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$1,144.10 |
| Rate for Payer: Aetna Commercial |
$1,144.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Aetna Managed Medicare |
$27.36
|
| Rate for Payer: Anthem Medicare Advantage |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.36
|
| 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 |
$1,144.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.36
|
| Rate for Payer: Health EOS Commercial |
$1,095.93
|
| Rate for Payer: HFN Commercial |
$1,144.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.36
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: NAPHCARE Commercial |
$41.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.10
|
| Rate for Payer: Quartz Beloit One Network |
$529.90
|
| Rate for Payer: Quartz Commercial |
$686.46
|
| Rate for Payer: Quartz Medicare Advantage |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$116.29
|
| Rate for Payer: United Healthcare Medicaid |
$43.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.36
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$123.13
|
|
|
CV Removal of IABP
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1483252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,083.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Aetna Managed Medicare |
$337.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.29
|
| 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 |
$1,107.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$1,071.84
|
| Rate for Payer: HFN Commercial |
$1,107.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.24
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: NAPHCARE Commercial |
$722.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.97
|
| Rate for Payer: Quartz Beloit One Network |
$590.12
|
| Rate for Payer: Quartz Commercial |
$782.81
|
| Rate for Payer: Quartz Medicare Advantage |
$722.59
|
| Rate for Payer: The Alliance Commercial |
$109.45
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$892.01
|
|
|
CV Removal of IABP
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
CPT 33968
|
| Hospital Charge Code |
1483252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$590.12 |
| Max. Negotiated Rate |
$1,107.97 |
| Rate for Payer: Aetna Commercial |
$1,083.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,035.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.29
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,107.97
|
| Rate for Payer: Health EOS Commercial |
$1,071.84
|
| Rate for Payer: HFN Commercial |
$1,107.97
|
| Rate for Payer: Multiplan Commercial |
$963.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,107.97
|
| Rate for Payer: Quartz Beloit One Network |
$590.12
|
| Rate for Payer: Quartz Commercial |
$722.59
|
| Rate for Payer: WEA Trust Commercial |
$662.38
|
| Rate for Payer: WPS Commercial |
$892.01
|
|
|
CV Reposition of Pace/ICD Lead
|
Facility
|
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
1483291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,403.45 |
| Max. Negotiated Rate |
$8,267.71 |
| Rate for Payer: Aetna Commercial |
$8,087.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,728.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,762.92
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cigna Commercial |
$8,267.71
|
| Rate for Payer: Health EOS Commercial |
$7,998.11
|
| Rate for Payer: HFN Commercial |
$8,267.71
|
| Rate for Payer: Multiplan Commercial |
$7,189.31
|
| Rate for Payer: Preferred Network Access Commercial |
$8,267.71
|
| Rate for Payer: Quartz Beloit One Network |
$4,403.45
|
| Rate for Payer: Quartz Commercial |
$5,391.98
|
| Rate for Payer: WEA Trust Commercial |
$4,942.65
|
| Rate for Payer: WPS Commercial |
$6,656.16
|
|
|
CV Reposition of Pace/ICD Lead
|
Facility
|
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
1483291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$8,087.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,728.51
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,762.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cigna Commercial |
$8,267.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$7,998.11
|
| Rate for Payer: HFN Commercial |
$8,267.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$7,189.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$8,267.71
|
| Rate for Payer: Quartz Beloit One Network |
$4,403.45
|
| Rate for Payer: Quartz Commercial |
$5,841.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$4,942.65
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$6,656.16
|
|
|
CV Reposition of Pace/ICD Lead
|
Professional
|
Both
|
$8,641.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
1483291
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$255.48 |
| Max. Negotiated Rate |
$8,537.31 |
| Rate for Payer: Aetna Commercial |
$8,537.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,728.51
|
| Rate for Payer: Aetna Managed Medicare |
$255.48
|
| Rate for Payer: Anthem Medicare Advantage |
$255.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$255.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$255.48
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cash Price |
$2,592.30
|
| Rate for Payer: Cigna Commercial |
$8,537.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$285.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.48
|
| Rate for Payer: Health EOS Commercial |
$8,177.84
|
| Rate for Payer: HFN Commercial |
$8,537.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,044.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,044.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$255.48
|
| Rate for Payer: Multiplan Commercial |
$7,189.31
|
| Rate for Payer: NAPHCARE Commercial |
$383.21
|
| Rate for Payer: Preferred Network Access Commercial |
$8,537.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,954.12
|
| Rate for Payer: Quartz Commercial |
$5,122.38
|
| Rate for Payer: Quartz Medicare Advantage |
$255.48
|
| Rate for Payer: The Alliance Commercial |
$1,085.77
|
| Rate for Payer: United Healthcare Medicaid |
$285.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.48
|
| Rate for Payer: WEA Trust Commercial |
$4,942.65
|
| Rate for Payer: WPS Commercial |
$1,149.64
|
|
|
CV Revision Pacemaker Pocket
|
Professional
|
Both
|
$8,238.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1483300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$290.76 |
| Max. Negotiated Rate |
$8,139.14 |
| Rate for Payer: Aetna Commercial |
$8,139.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Aetna Managed Medicare |
$290.76
|
| Rate for Payer: Anthem Medicare Advantage |
$290.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$290.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$290.76
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$8,139.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$402.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.76
|
| Rate for Payer: Health EOS Commercial |
$7,796.44
|
| Rate for Payer: HFN Commercial |
$8,139.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,161.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,161.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$290.76
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: NAPHCARE Commercial |
$436.14
|
| Rate for Payer: Preferred Network Access Commercial |
$8,139.14
|
| Rate for Payer: Quartz Beloit One Network |
$3,769.71
|
| Rate for Payer: Quartz Commercial |
$4,883.49
|
| Rate for Payer: Quartz Medicare Advantage |
$290.76
|
| Rate for Payer: The Alliance Commercial |
$1,235.74
|
| Rate for Payer: United Healthcare Medicaid |
$402.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.76
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$1,308.43
|
|
|
CV Revision Pacemaker Pocket
|
Facility
|
IP
|
$8,238.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1483300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,198.08 |
| Max. Negotiated Rate |
$7,882.12 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,140.51
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
CV Revision Pacemaker Pocket
|
Facility
|
OP
|
$8,238.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
1483300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| 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: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,568.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
CV Temporary Pacemaker
|
Facility
|
IP
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$3,132.00 |
| Max. Negotiated Rate |
$5,880.49 |
| Rate for Payer: Aetna Commercial |
$5,752.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,387.68
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,880.49
|
| Rate for Payer: Health EOS Commercial |
$5,688.74
|
| Rate for Payer: HFN Commercial |
$5,880.49
|
| Rate for Payer: Multiplan Commercial |
$5,113.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,880.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.00
|
| Rate for Payer: Quartz Commercial |
$3,835.10
|
| Rate for Payer: WEA Trust Commercial |
$3,515.51
|
| Rate for Payer: WPS Commercial |
$4,734.26
|
|
|
CV Temporary Pacemaker
|
Facility
|
OP
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$3,068.08 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$5,752.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.98
|
| Rate for Payer: Aetna Managed Medicare |
$8,708.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,154.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,195.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,068.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,387.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.93
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$5,880.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.93
|
| Rate for Payer: Health EOS Commercial |
$5,688.74
|
| Rate for Payer: HFN Commercial |
$5,880.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,397.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.93
|
| Rate for Payer: Multiplan Commercial |
$5,113.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,880.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,132.00
|
| Rate for Payer: Quartz Commercial |
$4,154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.93
|
| Rate for Payer: The Alliance Commercial |
$34,835.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.93
|
| Rate for Payer: WEA Trust Commercial |
$3,515.51
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$4,734.26
|
|
|
CV Temporary Pacemaker
|
Professional
|
Both
|
$6,146.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
1483333
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$129.76 |
| Max. Negotiated Rate |
$6,072.25 |
| Rate for Payer: Aetna Commercial |
$6,072.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,496.98
|
| Rate for Payer: Aetna Managed Medicare |
$129.76
|
| Rate for Payer: Anthem Medicare Advantage |
$129.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.76
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cash Price |
$1,843.80
|
| Rate for Payer: Cigna Commercial |
$6,072.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.76
|
| Rate for Payer: Health EOS Commercial |
$5,816.57
|
| Rate for Payer: HFN Commercial |
$6,072.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.76
|
| Rate for Payer: Multiplan Commercial |
$5,113.47
|
| Rate for Payer: NAPHCARE Commercial |
$194.64
|
| Rate for Payer: Preferred Network Access Commercial |
$6,072.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,812.41
|
| Rate for Payer: Quartz Commercial |
$3,643.35
|
| Rate for Payer: Quartz Medicare Advantage |
$129.76
|
| Rate for Payer: The Alliance Commercial |
$551.48
|
| Rate for Payer: United Healthcare Medicaid |
$181.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.76
|
| Rate for Payer: WEA Trust Commercial |
$3,515.51
|
| Rate for Payer: WPS Commercial |
$583.92
|
|
|
CV Venogram Cava Inferior
|
Facility
|
IP
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$5,259.58 |
| Max. Negotiated Rate |
$9,875.13 |
| Rate for Payer: Aetna Commercial |
$9,660.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,231.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,688.94
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$9,875.13
|
| Rate for Payer: Health EOS Commercial |
$9,553.12
|
| Rate for Payer: HFN Commercial |
$9,875.13
|
| Rate for Payer: Multiplan Commercial |
$8,587.07
|
| Rate for Payer: Preferred Network Access Commercial |
$9,875.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,259.58
|
| Rate for Payer: Quartz Commercial |
$6,440.30
|
| Rate for Payer: WEA Trust Commercial |
$5,903.61
|
| Rate for Payer: WPS Commercial |
$7,950.27
|
|
|
CV Venogram Cava Inferior
|
Facility
|
OP
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$9,660.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,231.10
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,688.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$9,875.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,006.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$9,553.12
|
| Rate for Payer: HFN Commercial |
$9,875.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$8,587.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,875.13
|
| Rate for Payer: Quartz Beloit One Network |
$5,259.58
|
| Rate for Payer: Quartz Commercial |
$6,977.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,903.61
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$7,950.27
|
|
|
CV Venogram Cava Inferior
|
Professional
|
Both
|
$10,321.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
1412978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$10,197.15 |
| Rate for Payer: Aetna Commercial |
$10,197.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,231.10
|
| Rate for Payer: Aetna Managed Medicare |
$111.60
|
| Rate for Payer: Anthem Medicare Advantage |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.60
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cash Price |
$3,096.30
|
| Rate for Payer: Cigna Commercial |
$10,197.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,366.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$9,767.79
|
| Rate for Payer: HFN Commercial |
$10,197.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$424.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.60
|
| Rate for Payer: Multiplan Commercial |
$8,587.07
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,197.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,722.89
|
| Rate for Payer: Quartz Commercial |
$6,118.29
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$424.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$5,903.61
|
| Rate for Payer: WPS Commercial |
$558.01
|
|
|
CV Venogram Cava Superior
|
Professional
|
Both
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$8,935.47 |
| Rate for Payer: Aetna Commercial |
$8,935.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Aetna Managed Medicare |
$116.70
|
| Rate for Payer: Anthem Medicare Advantage |
$116.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.70
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,935.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,702.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.70
|
| Rate for Payer: Health EOS Commercial |
$8,559.24
|
| Rate for Payer: HFN Commercial |
$8,935.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$443.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.70
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: NAPHCARE Commercial |
$175.05
|
| Rate for Payer: Preferred Network Access Commercial |
$8,935.47
|
| Rate for Payer: Quartz Beloit One Network |
$4,138.53
|
| Rate for Payer: Quartz Commercial |
$5,361.28
|
| Rate for Payer: Quartz Medicare Advantage |
$116.70
|
| Rate for Payer: The Alliance Commercial |
$443.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.70
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: WPS Commercial |
$583.49
|
|
|
CV Venogram Cava Superior
|
Facility
|
OP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,653.30 |
| Rate for Payer: Aetna Commercial |
$8,465.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,173.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,938.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,691.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,985.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,653.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,263.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$8,371.13
|
| Rate for Payer: HFN Commercial |
$8,653.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,653.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,608.82
|
| Rate for Payer: Quartz Commercial |
$6,113.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$6,966.59
|
|
|
CV Venogram Cava Superior
|
Facility
|
IP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
1412980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,608.82 |
| Max. Negotiated Rate |
$8,653.30 |
| Rate for Payer: Aetna Commercial |
$8,465.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,985.05
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,653.30
|
| Rate for Payer: Health EOS Commercial |
$8,371.13
|
| Rate for Payer: HFN Commercial |
$8,653.30
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: Preferred Network Access Commercial |
$8,653.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,608.82
|
| Rate for Payer: Quartz Commercial |
$5,643.46
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: WPS Commercial |
$6,966.59
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Cyanocobalamin 1000 mcg Charge
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2958854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$0.67
|
| Rate for Payer: Anthem Medicare Advantage |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.67
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.48
|
| Rate for Payer: Health EOS Commercial |
$8.52
|
| Rate for Payer: HFN Commercial |
$8.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.67
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$1.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8.89
|
| Rate for Payer: Quartz Beloit One Network |
$4.12
|
| Rate for Payer: Quartz Commercial |
$5.34
|
| Rate for Payer: Quartz Medicare Advantage |
$0.67
|
| Rate for Payer: The Alliance Commercial |
$1.83
|
| Rate for Payer: United Healthcare Medicaid |
$0.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.67
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
