|
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 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 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
|
$6,158.00
|
|
| 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
|
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 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
|
$6,616.00
|
|
| 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
|
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 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 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 Left
|
Facility
|
IP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
1412894
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,976.42 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,545.93
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$13,098.59
|
| Rate for Payer: Health EOS Commercial |
$12,671.46
|
| Rate for Payer: HFN Commercial |
$13,098.59
|
| Rate for Payer: Multiplan Commercial |
$11,390.08
|
| 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 |
$8,542.56
|
| Rate for Payer: WEA Trust Commercial |
$7,830.68
|
| Rate for Payer: WPS Commercial |
$10,545.41
|
|
|
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
|
|
|
CV Angiogram Extremity Left
|
Professional
|
Both
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 LT
|
| Hospital Charge Code |
1412894
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$553.87 |
| Max. Negotiated Rate |
$13,525.72 |
| Rate for Payer: Aetna Commercial |
$13,525.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,244.34
|
| 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 |
$13,525.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,118.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,542.56
|
| Rate for Payer: Health EOS Commercial |
$12,956.22
|
| Rate for Payer: HFN Commercial |
$13,525.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$553.87
|
| Rate for Payer: Multiplan Commercial |
$11,390.08
|
| Rate for Payer: Preferred Network Access Commercial |
$13,525.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,264.54
|
| Rate for Payer: Quartz Commercial |
$8,115.43
|
| Rate for Payer: The Alliance Commercial |
$7,118.80
|
| Rate for Payer: WEA Trust Commercial |
$7,830.68
|
| Rate for Payer: WPS Commercial |
$10,545.41
|
|
|
CV Angiogram Extremity Right
|
Facility
|
IP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 RT
|
| Hospital Charge Code |
2980127
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$5,366.09 |
| Max. Negotiated Rate |
$10,075.10 |
| Rate for Payer: Quartz Commercial |
$6,570.72
|
| 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: WEA Trust Commercial |
$6,023.16
|
| Rate for Payer: WPS Commercial |
$8,111.26
|
|
|
CV Angiogram Extremity Right
|
Facility
|
OP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
1412896
|
|
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
|
|
|
CV Angiogram Extremity Right
|
Professional
|
Both
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
1412896
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$553.87 |
| Max. Negotiated Rate |
$13,525.72 |
| Rate for Payer: Aetna Commercial |
$13,525.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,244.34
|
| 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 |
$13,525.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,118.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,542.56
|
| Rate for Payer: Health EOS Commercial |
$12,956.22
|
| Rate for Payer: HFN Commercial |
$13,525.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$553.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$553.87
|
| Rate for Payer: Multiplan Commercial |
$11,390.08
|
| Rate for Payer: Preferred Network Access Commercial |
$13,525.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,264.54
|
| Rate for Payer: Quartz Commercial |
$8,115.43
|
| Rate for Payer: The Alliance Commercial |
$7,118.80
|
| Rate for Payer: WEA Trust Commercial |
$7,830.68
|
| Rate for Payer: WPS Commercial |
$10,545.41
|
|
|
CV Angiogram Extremity Right
|
Facility
|
IP
|
$13,690.00
|
|
|
Service Code
|
CPT 75710 RT
|
| Hospital Charge Code |
1412896
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$6,976.42 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,545.93
|
| Rate for Payer: Cash Price |
$4,107.00
|
| Rate for Payer: Cigna Commercial |
$13,098.59
|
| Rate for Payer: Health EOS Commercial |
$12,671.46
|
| Rate for Payer: HFN Commercial |
$13,098.59
|
| Rate for Payer: Multiplan Commercial |
$11,390.08
|
| 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 |
$8,542.56
|
| Rate for Payer: WEA Trust Commercial |
$7,830.68
|
| Rate for Payer: WPS Commercial |
$10,545.41
|
|
|
CV Angiogram Extremity Right
|
Facility
|
OP
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 RT
|
| Hospital Charge Code |
2980127
|
|
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 Right
|
Professional
|
Both
|
$10,530.00
|
|
|
Service Code
|
CPT 75716 RT
|
| Hospital Charge Code |
2980127
|
|
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 Pelvis
|
Professional
|
Both
|
$9,707.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
1412904
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$9,590.52 |
| Rate for Payer: Aetna Commercial |
$9,590.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,681.94
|
| Rate for Payer: Aetna Managed Medicare |
$141.90
|
| Rate for Payer: Anthem Medicare Advantage |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.90
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cigna Commercial |
$9,590.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,047.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.90
|
| Rate for Payer: Health EOS Commercial |
$9,186.70
|
| Rate for Payer: HFN Commercial |
$9,590.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$514.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$514.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.90
|
| Rate for Payer: Multiplan Commercial |
$8,076.22
|
| Rate for Payer: NAPHCARE Commercial |
$212.85
|
| Rate for Payer: Preferred Network Access Commercial |
$9,590.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,441.92
|
| Rate for Payer: Quartz Commercial |
$5,754.31
|
| Rate for Payer: Quartz Medicare Advantage |
$141.90
|
| Rate for Payer: The Alliance Commercial |
$539.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.90
|
| Rate for Payer: WEA Trust Commercial |
$5,552.40
|
| Rate for Payer: WPS Commercial |
$709.49
|
|
|
CV Angiogram Pelvis
|
Facility
|
OP
|
$9,707.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
1412904
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$9,085.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,681.94
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,183.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,946.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,099.38
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,350.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cigna Commercial |
$9,287.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,649.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$8,984.80
|
| Rate for Payer: HFN Commercial |
$9,287.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$8,076.22
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$9,287.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,946.69
|
| Rate for Payer: Quartz Commercial |
$6,561.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,552.40
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$7,477.30
|
|
|
CV Angiogram Pelvis
|
Facility
|
IP
|
$9,707.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
1412904
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,946.69 |
| Max. Negotiated Rate |
$9,287.66 |
| Rate for Payer: Aetna Commercial |
$9,085.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,681.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,350.50
|
| Rate for Payer: Cash Price |
$2,912.10
|
| Rate for Payer: Cigna Commercial |
$9,287.66
|
| Rate for Payer: Health EOS Commercial |
$8,984.80
|
| Rate for Payer: HFN Commercial |
$9,287.66
|
| Rate for Payer: Multiplan Commercial |
$8,076.22
|
| Rate for Payer: Preferred Network Access Commercial |
$9,287.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,946.69
|
| Rate for Payer: Quartz Commercial |
$6,057.17
|
| Rate for Payer: WEA Trust Commercial |
$5,552.40
|
| Rate for Payer: WPS Commercial |
$7,477.30
|
|
|
CV Angiogram Renal Bilateral
|
Facility
|
OP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 LT
|
| Hospital Charge Code |
1412906
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$5,401.14 |
| Rate for Payer: Aetna Commercial |
$5,283.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,048.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,643.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,816.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,935.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,817.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,111.52
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,401.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$5,225.01
|
| Rate for Payer: HFN Commercial |
$5,401.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,403.10
|
| Rate for Payer: Multiplan Commercial |
$4,696.64
|
| Rate for Payer: NAPHCARE Commercial |
$3,522.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,401.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,876.69
|
| Rate for Payer: Quartz Commercial |
$3,816.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,522.48
|
| Rate for Payer: The Alliance Commercial |
$2,935.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,228.94
|
| Rate for Payer: WPS Commercial |
$4,348.34
|
|
