|
CV Angiogram Renal Bilateral
|
Facility
|
IP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 LT
|
| Hospital Charge Code |
1412906
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,876.69 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,111.52
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,401.14
|
| Rate for Payer: Health EOS Commercial |
$5,225.01
|
| Rate for Payer: HFN Commercial |
$5,401.14
|
| Rate for Payer: Multiplan Commercial |
$4,696.64
|
| 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 |
$3,522.48
|
| Rate for Payer: WEA Trust Commercial |
$3,228.94
|
| Rate for Payer: WPS Commercial |
$4,348.34
|
|
|
CV Angiogram Renal Bilateral
|
Professional
|
Both
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 LT
|
| Hospital Charge Code |
1412906
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,191.08 |
| Max. Negotiated Rate |
$5,577.26 |
| Rate for Payer: Aetna Commercial |
$5,577.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,048.89
|
| 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 |
$5,577.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,277.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,522.48
|
| Rate for Payer: Health EOS Commercial |
$5,342.43
|
| Rate for Payer: HFN Commercial |
$5,577.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,191.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,191.08
|
| Rate for Payer: Multiplan Commercial |
$4,696.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.26
|
| Rate for Payer: Quartz Beloit One Network |
$2,583.15
|
| Rate for Payer: Quartz Commercial |
$3,346.36
|
| Rate for Payer: The Alliance Commercial |
$2,935.40
|
| Rate for Payer: United Healthcare Medicaid |
$1,277.03
|
| Rate for Payer: WEA Trust Commercial |
$3,228.94
|
| Rate for Payer: WPS Commercial |
$4,348.34
|
|
|
CV Angiogram Renal Left
|
Facility
|
OP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 LT
|
| Hospital Charge Code |
1412910
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,363.10 |
| Rate for Payer: Aetna Commercial |
$10,137.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,687.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,153.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,321.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,632.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,406.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,970.05
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,363.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$10,025.17
|
| Rate for Payer: HFN Commercial |
$10,363.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,448.18
|
| Rate for Payer: Multiplan Commercial |
$9,011.39
|
| Rate for Payer: NAPHCARE Commercial |
$6,758.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,363.10
|
| Rate for Payer: Quartz Beloit One Network |
$5,519.48
|
| Rate for Payer: Quartz Commercial |
$7,321.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6,758.54
|
| Rate for Payer: The Alliance Commercial |
$5,632.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$6,195.33
|
| Rate for Payer: WPS Commercial |
$8,343.12
|
|
|
CV Angiogram Renal Left
|
Facility
|
IP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 LT
|
| Hospital Charge Code |
1412910
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,519.48 |
| Max. Negotiated Rate |
$10,363.10 |
| Rate for Payer: Aetna Commercial |
$10,137.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,687.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,970.05
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,363.10
|
| Rate for Payer: Health EOS Commercial |
$10,025.17
|
| Rate for Payer: HFN Commercial |
$10,363.10
|
| Rate for Payer: Multiplan Commercial |
$9,011.39
|
| Rate for Payer: Preferred Network Access Commercial |
$10,363.10
|
| Rate for Payer: Quartz Beloit One Network |
$5,519.48
|
| Rate for Payer: Quartz Commercial |
$6,758.54
|
| Rate for Payer: WEA Trust Commercial |
$6,195.33
|
| Rate for Payer: WPS Commercial |
$8,343.12
|
|
|
CV Angiogram Renal Left
|
Professional
|
Both
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 LT
|
| Hospital Charge Code |
1412910
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$868.13 |
| Max. Negotiated Rate |
$10,701.03 |
| Rate for Payer: Aetna Commercial |
$10,701.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,687.25
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,701.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,164.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,758.54
|
| Rate for Payer: Health EOS Commercial |
$10,250.46
|
| Rate for Payer: HFN Commercial |
$10,701.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$868.13
|
| Rate for Payer: Multiplan Commercial |
$9,011.39
|
| Rate for Payer: Preferred Network Access Commercial |
$10,701.03
|
| Rate for Payer: Quartz Beloit One Network |
$4,956.27
|
| Rate for Payer: Quartz Commercial |
$6,420.62
|
| Rate for Payer: The Alliance Commercial |
$5,632.12
|
| Rate for Payer: United Healthcare Medicaid |
$1,164.76
|
| Rate for Payer: WEA Trust Commercial |
$6,195.33
|
| Rate for Payer: WPS Commercial |
$8,343.12
|
|
|
CV Angiogram Renal Right
|
Facility
|
IP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 RT
|
| Hospital Charge Code |
2980128
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,876.69 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,111.52
|
| Rate for Payer: Cash Price |
$1,693.50
|
| Rate for Payer: Cigna Commercial |
$5,401.14
|
| Rate for Payer: Health EOS Commercial |
$5,225.01
|
| Rate for Payer: HFN Commercial |
$5,401.14
|
| Rate for Payer: Multiplan Commercial |
$4,696.64
|
| 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 |
$3,522.48
|
| Rate for Payer: WEA Trust Commercial |
$3,228.94
|
| Rate for Payer: WPS Commercial |
$4,348.34
|
|
|
CV Angiogram Renal Right
|
Facility
|
OP
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 RT
|
| Hospital Charge Code |
2980128
|
|
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
|
|
|
CV Angiogram Renal Right
|
Facility
|
OP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 RT
|
| Hospital Charge Code |
1412912
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$10,363.10 |
| Rate for Payer: Aetna Commercial |
$10,137.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,687.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,153.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,321.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,632.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,406.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,970.05
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,363.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$10,025.17
|
| Rate for Payer: HFN Commercial |
$10,363.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,448.18
|
| Rate for Payer: Multiplan Commercial |
$9,011.39
|
| Rate for Payer: NAPHCARE Commercial |
$6,758.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,363.10
|
| Rate for Payer: Quartz Beloit One Network |
$5,519.48
|
| Rate for Payer: Quartz Commercial |
$7,321.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6,758.54
|
| Rate for Payer: The Alliance Commercial |
$5,632.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$6,195.33
|
| Rate for Payer: WPS Commercial |
$8,343.12
|
|
|
CV Angiogram Renal Right
|
Professional
|
Both
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 RT
|
| Hospital Charge Code |
1412912
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$868.13 |
| Max. Negotiated Rate |
$10,701.03 |
| Rate for Payer: Aetna Commercial |
$10,701.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,687.25
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,701.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,164.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,758.54
|
| Rate for Payer: Health EOS Commercial |
$10,250.46
|
| Rate for Payer: HFN Commercial |
$10,701.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$868.13
|
| Rate for Payer: Multiplan Commercial |
$9,011.39
|
| Rate for Payer: Preferred Network Access Commercial |
$10,701.03
|
| Rate for Payer: Quartz Beloit One Network |
$4,956.27
|
| Rate for Payer: Quartz Commercial |
$6,420.62
|
| Rate for Payer: The Alliance Commercial |
$5,632.12
|
| Rate for Payer: United Healthcare Medicaid |
$1,164.76
|
| Rate for Payer: WEA Trust Commercial |
$6,195.33
|
| Rate for Payer: WPS Commercial |
$8,343.12
|
|
|
CV Angiogram Renal Right
|
Professional
|
Both
|
$5,645.00
|
|
|
Service Code
|
CPT 36252 RT
|
| Hospital Charge Code |
2980128
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,191.08 |
| Max. Negotiated Rate |
$5,577.26 |
| Rate for Payer: Aetna Commercial |
$5,577.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,048.89
|
| 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 |
$5,577.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,277.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,522.48
|
| Rate for Payer: Health EOS Commercial |
$5,342.43
|
| Rate for Payer: HFN Commercial |
$5,577.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,191.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,191.08
|
| Rate for Payer: Multiplan Commercial |
$4,696.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,577.26
|
| Rate for Payer: Quartz Beloit One Network |
$2,583.15
|
| Rate for Payer: Quartz Commercial |
$3,346.36
|
| Rate for Payer: The Alliance Commercial |
$2,935.40
|
| Rate for Payer: United Healthcare Medicaid |
$1,277.03
|
| Rate for Payer: WEA Trust Commercial |
$3,228.94
|
| Rate for Payer: WPS Commercial |
$4,348.34
|
|
|
CV Angiogram Renal Right
|
Facility
|
IP
|
$10,831.00
|
|
|
Service Code
|
CPT 36251 RT
|
| Hospital Charge Code |
1412912
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,519.48 |
| Max. Negotiated Rate |
$10,363.10 |
| Rate for Payer: Aetna Commercial |
$10,137.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,687.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,970.05
|
| Rate for Payer: Cash Price |
$3,249.30
|
| Rate for Payer: Cigna Commercial |
$10,363.10
|
| Rate for Payer: Health EOS Commercial |
$10,025.17
|
| Rate for Payer: HFN Commercial |
$10,363.10
|
| Rate for Payer: Multiplan Commercial |
$9,011.39
|
| Rate for Payer: Preferred Network Access Commercial |
$10,363.10
|
| Rate for Payer: Quartz Beloit One Network |
$5,519.48
|
| Rate for Payer: Quartz Commercial |
$6,758.54
|
| Rate for Payer: WEA Trust Commercial |
$6,195.33
|
| Rate for Payer: WPS Commercial |
$8,343.12
|
|
|
CV Angiogram Vertebral
|
Professional
|
Both
|
$10,036.00
|
|
| Hospital Charge Code |
1412914
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$4,592.47 |
| Max. Negotiated Rate |
$9,915.57 |
| Rate for Payer: Aetna Commercial |
$9,915.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,915.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,218.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,262.46
|
| Rate for Payer: Health EOS Commercial |
$9,498.07
|
| Rate for Payer: HFN Commercial |
$9,915.57
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: Preferred Network Access Commercial |
$9,915.57
|
| Rate for Payer: Quartz Beloit One Network |
$4,592.47
|
| Rate for Payer: Quartz Commercial |
$5,949.34
|
| Rate for Payer: The Alliance Commercial |
$5,218.72
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
CV Angiogram Vertebral
|
Facility
|
IP
|
$10,036.00
|
|
| Hospital Charge Code |
1412914
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,114.35 |
| Max. Negotiated Rate |
$9,602.44 |
| Rate for Payer: Aetna Commercial |
$9,393.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,531.84
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,602.44
|
| Rate for Payer: Health EOS Commercial |
$9,289.32
|
| Rate for Payer: HFN Commercial |
$9,602.44
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: Preferred Network Access Commercial |
$9,602.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,114.35
|
| Rate for Payer: Quartz Commercial |
$6,262.46
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
CV Angiogram Vertebral
|
Facility
|
OP
|
$10,036.00
|
|
| Hospital Charge Code |
1412914
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$9,602.44 |
| Rate for Payer: Aetna Commercial |
$9,393.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,922.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,784.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,218.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,009.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,531.84
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,602.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,840.95
|
| Rate for Payer: Health EOS Commercial |
$9,289.32
|
| Rate for Payer: HFN Commercial |
$9,602.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,828.08
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: NAPHCARE Commercial |
$6,262.46
|
| Rate for Payer: Preferred Network Access Commercial |
$9,602.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,114.35
|
| Rate for Payer: Quartz Commercial |
$6,784.34
|
| Rate for Payer: Quartz Medicare Advantage |
$6,262.46
|
| Rate for Payer: The Alliance Commercial |
$5,218.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
CV Angio Through Existing Catheter
|
Facility
|
OP
|
$9,546.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
1412860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$8,935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,537.94
|
| 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 |
$5,261.76
|
| 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 |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cigna Commercial |
$9,133.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,555.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$8,835.78
|
| Rate for Payer: HFN Commercial |
$9,133.61
|
| 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 |
$7,942.27
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,133.61
|
| Rate for Payer: Quartz Beloit One Network |
$4,864.64
|
| Rate for Payer: Quartz Commercial |
$6,453.10
|
| 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 |
$5,460.31
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$7,353.28
|
|
|
CV Angio Through Existing Catheter
|
Professional
|
Both
|
$9,546.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
1412860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.79 |
| Max. Negotiated Rate |
$9,431.45 |
| Rate for Payer: Aetna Commercial |
$9,431.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,537.94
|
| Rate for Payer: Aetna Managed Medicare |
$264.79
|
| Rate for Payer: Anthem Medicare Advantage |
$264.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$264.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$264.79
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cigna Commercial |
$9,431.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,963.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.79
|
| Rate for Payer: Health EOS Commercial |
$9,034.33
|
| Rate for Payer: HFN Commercial |
$9,431.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$456.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$456.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$264.79
|
| Rate for Payer: Multiplan Commercial |
$7,942.27
|
| Rate for Payer: NAPHCARE Commercial |
$397.19
|
| Rate for Payer: Preferred Network Access Commercial |
$9,431.45
|
| Rate for Payer: Quartz Beloit One Network |
$4,368.25
|
| Rate for Payer: Quartz Commercial |
$5,658.87
|
| Rate for Payer: Quartz Medicare Advantage |
$264.79
|
| Rate for Payer: The Alliance Commercial |
$1,006.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.79
|
| Rate for Payer: WEA Trust Commercial |
$5,460.31
|
| Rate for Payer: WPS Commercial |
$1,323.97
|
|
|
CV Angio Through Existing Catheter
|
Facility
|
IP
|
$9,546.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
1412860
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,864.64 |
| Max. Negotiated Rate |
$9,133.61 |
| Rate for Payer: Quartz Commercial |
$5,956.70
|
| Rate for Payer: Aetna Commercial |
$8,935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,537.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,261.76
|
| Rate for Payer: Cash Price |
$2,863.80
|
| Rate for Payer: Cigna Commercial |
$9,133.61
|
| Rate for Payer: Health EOS Commercial |
$8,835.78
|
| Rate for Payer: HFN Commercial |
$9,133.61
|
| Rate for Payer: Multiplan Commercial |
$7,942.27
|
| Rate for Payer: Preferred Network Access Commercial |
$9,133.61
|
| Rate for Payer: Quartz Beloit One Network |
$4,864.64
|
| Rate for Payer: WEA Trust Commercial |
$5,460.31
|
| Rate for Payer: WPS Commercial |
$7,353.28
|
|
|
CV Aortogram Abdominal + Iliofemoral
|
Facility
|
OP
|
$10,937.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
1412918
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$10,237.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,782.05
|
| 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 |
$6,028.47
|
| 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 |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cigna Commercial |
$10,464.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,365.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$10,123.29
|
| Rate for Payer: HFN Commercial |
$10,464.52
|
| 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 |
$9,099.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$10,464.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,573.50
|
| Rate for Payer: Quartz Commercial |
$7,393.41
|
| 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 |
$6,255.96
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$8,424.77
|
|
|
CV Aortogram Abdominal + Iliofemoral
|
Professional
|
Both
|
$10,937.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
1412918
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$152.72 |
| Max. Negotiated Rate |
$10,805.76 |
| Rate for Payer: Aetna Commercial |
$10,805.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,782.05
|
| Rate for Payer: Aetna Managed Medicare |
$152.72
|
| Rate for Payer: Anthem Medicare Advantage |
$152.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$152.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$152.72
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cigna Commercial |
$10,805.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.72
|
| Rate for Payer: Health EOS Commercial |
$10,350.78
|
| Rate for Payer: HFN Commercial |
$10,805.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$152.72
|
| Rate for Payer: Multiplan Commercial |
$9,099.58
|
| Rate for Payer: NAPHCARE Commercial |
$229.09
|
| Rate for Payer: Preferred Network Access Commercial |
$10,805.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,004.77
|
| Rate for Payer: Quartz Commercial |
$6,483.45
|
| Rate for Payer: Quartz Medicare Advantage |
$152.72
|
| Rate for Payer: The Alliance Commercial |
$580.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.72
|
| Rate for Payer: WEA Trust Commercial |
$6,255.96
|
| Rate for Payer: WPS Commercial |
$763.62
|
|
|
CV Aortogram Abdominal + Iliofemoral
|
Facility
|
IP
|
$10,937.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
1412918
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,573.50 |
| Max. Negotiated Rate |
$10,464.52 |
| Rate for Payer: Aetna Commercial |
$10,237.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,782.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,028.47
|
| Rate for Payer: Cash Price |
$3,281.10
|
| Rate for Payer: Cigna Commercial |
$10,464.52
|
| Rate for Payer: Health EOS Commercial |
$10,123.29
|
| Rate for Payer: HFN Commercial |
$10,464.52
|
| Rate for Payer: Multiplan Commercial |
$9,099.58
|
| Rate for Payer: Preferred Network Access Commercial |
$10,464.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,573.50
|
| Rate for Payer: Quartz Commercial |
$6,824.69
|
| Rate for Payer: WEA Trust Commercial |
$6,255.96
|
| Rate for Payer: WPS Commercial |
$8,424.77
|
|
|
CV Aortogram Abdominal w/ Serialography
|
Facility
|
IP
|
$6,466.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
1412920
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$3,295.07 |
| Max. Negotiated Rate |
$6,186.67 |
| Rate for Payer: Aetna Commercial |
$6,052.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,783.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,564.06
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$6,186.67
|
| Rate for Payer: Health EOS Commercial |
$5,984.93
|
| Rate for Payer: HFN Commercial |
$6,186.67
|
| Rate for Payer: Multiplan Commercial |
$5,379.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,186.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,295.07
|
| Rate for Payer: Quartz Commercial |
$4,034.78
|
| Rate for Payer: WEA Trust Commercial |
$3,698.55
|
| Rate for Payer: WPS Commercial |
$4,980.76
|
|
|
CV Aortogram Abdominal w/ Serialography
|
Facility
|
OP
|
$6,466.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
1412920
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$6,052.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,783.19
|
| 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 |
$3,564.06
|
| 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 |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$6,186.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,763.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$5,984.93
|
| Rate for Payer: HFN Commercial |
$6,186.67
|
| 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 |
$5,379.71
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,186.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,295.07
|
| Rate for Payer: Quartz Commercial |
$4,371.02
|
| 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 |
$3,698.55
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$4,980.76
|
|
|
CV Aortogram Abdominal w/ Serialography
|
Professional
|
Both
|
$6,466.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
1412920
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$121.87 |
| Max. Negotiated Rate |
$6,388.41 |
| Rate for Payer: Aetna Commercial |
$6,388.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,783.19
|
| Rate for Payer: Aetna Managed Medicare |
$121.87
|
| Rate for Payer: Anthem Medicare Advantage |
$121.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.87
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cash Price |
$1,939.80
|
| Rate for Payer: Cigna Commercial |
$6,388.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,362.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.87
|
| Rate for Payer: Health EOS Commercial |
$6,119.42
|
| Rate for Payer: HFN Commercial |
$6,388.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$468.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.87
|
| Rate for Payer: Multiplan Commercial |
$5,379.71
|
| Rate for Payer: NAPHCARE Commercial |
$182.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,388.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,958.84
|
| Rate for Payer: Quartz Commercial |
$3,833.04
|
| Rate for Payer: Quartz Medicare Advantage |
$121.87
|
| Rate for Payer: The Alliance Commercial |
$463.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.87
|
| Rate for Payer: WEA Trust Commercial |
$3,698.55
|
| Rate for Payer: WPS Commercial |
$609.34
|
|
|
CV Arch Aortography
|
Facility
|
IP
|
$9,946.00
|
|
| Hospital Charge Code |
1482835
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$5,068.48 |
| Max. Negotiated Rate |
$9,516.33 |
| Rate for Payer: Aetna Commercial |
$9,309.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,895.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,482.24
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cigna Commercial |
$9,516.33
|
| Rate for Payer: Health EOS Commercial |
$9,206.02
|
| Rate for Payer: HFN Commercial |
$9,516.33
|
| Rate for Payer: Multiplan Commercial |
$8,275.07
|
| Rate for Payer: Preferred Network Access Commercial |
$9,516.33
|
| Rate for Payer: Quartz Beloit One Network |
$5,068.48
|
| Rate for Payer: Quartz Commercial |
$6,206.30
|
| Rate for Payer: WEA Trust Commercial |
$5,689.11
|
| Rate for Payer: WPS Commercial |
$7,661.40
|
|
|
CV Arch Aortography
|
Facility
|
OP
|
$9,946.00
|
|
| Hospital Charge Code |
1482835
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$9,516.33 |
| Rate for Payer: Aetna Commercial |
$9,309.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,895.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,896.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,723.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,171.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,965.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,482.24
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cash Price |
$2,983.80
|
| Rate for Payer: Cigna Commercial |
$9,516.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,788.57
|
| Rate for Payer: Health EOS Commercial |
$9,206.02
|
| Rate for Payer: HFN Commercial |
$9,516.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,757.88
|
| Rate for Payer: Multiplan Commercial |
$8,275.07
|
| Rate for Payer: NAPHCARE Commercial |
$6,206.30
|
| Rate for Payer: Preferred Network Access Commercial |
$9,516.33
|
| Rate for Payer: Quartz Beloit One Network |
$5,068.48
|
| Rate for Payer: Quartz Commercial |
$6,723.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,206.30
|
| Rate for Payer: The Alliance Commercial |
$5,171.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$5,689.11
|
| Rate for Payer: WPS Commercial |
$7,661.40
|
|
