|
Cutting OTW 2.0mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.0mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159106
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.25mm x 15mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.25mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting OTW 2.25mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159108
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CVA AND PRECEREBRAL OCCLUSION W INFARCT
|
Facility
|
OP
|
$51.87
|
|
|
Service Code
|
EAPG 00535
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$51.87 |
| Rate for Payer: Anthem Medicaid |
$49.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$49.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.87
|
| Rate for Payer: Dean Health Medicaid |
$49.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$49.87
|
| Rate for Payer: Managed Health Services Medicaid |
$51.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$49.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$49.87
|
| Rate for Payer: United Healthcare Medicaid |
$49.87
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$8,943.68
|
|
|
Service Code
|
APR-DRG 0452
|
| Min. Negotiated Rate |
$7,944.33 |
| Max. Negotiated Rate |
$8,943.68 |
| Rate for Payer: Anthem Medicaid |
$8,564.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,564.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,564.06
|
| Rate for Payer: Dean Health Medicaid |
$8,564.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,944.33
|
| Rate for Payer: Managed Health Services Medicaid |
$8,943.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,564.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,564.06
|
| Rate for Payer: United Healthcare Medicaid |
$8,564.06
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 0451
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$20,693.21
|
|
|
Service Code
|
APR-DRG 0454
|
| Min. Negotiated Rate |
$18,381.00 |
| Max. Negotiated Rate |
$20,693.21 |
| Rate for Payer: Anthem Medicaid |
$19,814.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,814.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,814.89
|
| Rate for Payer: Dean Health Medicaid |
$19,814.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,381.00
|
| Rate for Payer: Managed Health Services Medicaid |
$20,693.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,814.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,814.89
|
| Rate for Payer: United Healthcare Medicaid |
$19,814.89
|
|
|
CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION
|
Facility
|
IP
|
$12,451.00
|
|
|
Service Code
|
APR-DRG 0453
|
| Min. Negotiated Rate |
$11,059.76 |
| Max. Negotiated Rate |
$12,451.00 |
| Rate for Payer: Anthem Medicaid |
$11,922.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,922.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,922.52
|
| Rate for Payer: Dean Health Medicaid |
$11,922.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,059.76
|
| Rate for Payer: Managed Health Services Medicaid |
$12,451.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,922.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,922.52
|
| Rate for Payer: United Healthcare Medicaid |
$11,922.52
|
|
|
CV Angiogram Carotid Cerebral Bilateral
|
Professional
|
Both
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
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 Bilateral
|
Facility
|
IP
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
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 Bilateral
|
Facility
|
OP
|
$5,687.00
|
|
| Hospital Charge Code |
1412876
|
|
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 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
|
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 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 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
|
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
|
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: Quartz Commercial |
$3,371.25
|
| 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: 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
|
$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
|
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
|
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 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
|
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
|
|
