|
Angiocath #18
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
3040300
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Angiocath #18
|
Facility
IP
|
$4.00
|
|
| Hospital Charge Code |
3040300
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
ANGIOCATH 18Gx1.88IN
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
ANGIOCATH 18Gx1.88IN
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Angio Cerebral Uni w/wo Arch
|
Facility
IP
|
$10,036.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
3052420
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,917.64 |
| Max. Negotiated Rate |
$9,233.12 |
| Rate for Payer: Aetna Commercial |
$9,032.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,319.08
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,233.12
|
| Rate for Payer: Health EOS Commercial |
$8,932.04
|
| Rate for Payer: HFN Commercial |
$9,233.12
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,021.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,233.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,917.64
|
| Rate for Payer: Quartz Commercial |
$6,021.60
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
Angio Cerebral Uni w/wo Arch
|
Facility
OP
|
$10,036.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
3052420
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$26,084.76 |
| Rate for Payer: Aetna Commercial |
$9,032.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,630.96
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,319.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,233.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$8,932.04
|
| Rate for Payer: HFN Commercial |
$9,233.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$8,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$9,233.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,917.64
|
| Rate for Payer: Quartz Commercial |
$6,523.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$26,084.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$5,519.80
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$7,433.67
|
|
|
Angio Ea Add Selective S&I +
|
Facility
IP
|
$7,756.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
3052544
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,800.44 |
| Max. Negotiated Rate |
$7,135.52 |
| Rate for Payer: Aetna Commercial |
$6,980.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.68
|
| Rate for Payer: Cash Price |
$2,326.80
|
| Rate for Payer: Cigna Commercial |
$7,135.52
|
| Rate for Payer: Health EOS Commercial |
$6,902.84
|
| Rate for Payer: HFN Commercial |
$7,135.52
|
| Rate for Payer: Multiplan Commercial |
$6,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,135.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.44
|
| Rate for Payer: Quartz Commercial |
$4,653.60
|
| Rate for Payer: WEA Trust Commercial |
$4,265.80
|
| Rate for Payer: WPS Commercial |
$5,744.87
|
|
|
Angio Ea Add Selective S&I +
|
Facility
OP
|
$7,756.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
3052544
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$7,135.52 |
| Rate for Payer: Aetna Commercial |
$6,980.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,670.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,041.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,722.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.68
|
| Rate for Payer: Cash Price |
$2,326.80
|
| Rate for Payer: Cash Price |
$2,326.80
|
| Rate for Payer: Cigna Commercial |
$7,135.52
|
| Rate for Payer: Health EOS Commercial |
$6,902.84
|
| Rate for Payer: HFN Commercial |
$7,135.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,817.00
|
| Rate for Payer: Multiplan Commercial |
$6,204.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,135.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.44
|
| Rate for Payer: Quartz Commercial |
$5,041.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,653.60
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: WEA Trust Commercial |
$4,265.80
|
| Rate for Payer: WPS Commercial |
$5,744.87
|
|
|
ANGIOGRAM, DIALYSIS
|
Facility
IP
|
$1,664.00
|
|
| Hospital Charge Code |
6209795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$815.36 |
| Max. Negotiated Rate |
$1,530.88 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$998.40
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
ANGIOGRAM, DIALYSIS
|
Facility
OP
|
$1,664.00
|
|
| Hospital Charge Code |
6209795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$6,656.00 |
| Rate for Payer: Aetna Commercial |
$1,497.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,431.04
|
| Rate for Payer: Aetna Managed Medicare |
$465.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,081.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$832.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$798.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$881.92
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$931.17
|
| Rate for Payer: Health EOS Commercial |
$1,480.96
|
| Rate for Payer: HFN Commercial |
$1,530.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,248.00
|
| Rate for Payer: Multiplan Commercial |
$1,331.20
|
| Rate for Payer: NAPHCARE Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,530.88
|
| Rate for Payer: Quartz Beloit One Network |
$815.36
|
| Rate for Payer: Quartz Commercial |
$1,081.60
|
| Rate for Payer: Quartz Medicare Advantage |
$998.40
|
| Rate for Payer: The Alliance Commercial |
$6,656.00
|
| Rate for Payer: WEA Trust Commercial |
$915.20
|
| Rate for Payer: WPS Commercial |
$1,232.52
|
|
|
ANGIOGRAPH
|
Facility
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2959803
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,620.12 |
| Max. Negotiated Rate |
$6,796.96 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,432.80
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
ANGIOGRAPH
|
Facility
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2959803
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,068.64 |
| Max. Negotiated Rate |
$29,552.00 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,802.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,546.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,134.32
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,541.00
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,802.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,432.80
|
| Rate for Payer: The Alliance Commercial |
$29,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
ANGIOGRAPHY INTERNAL MAMMARY RS&I 7575626
|
Professional
|
$627.00
|
|
|
Service Code
|
CPT 75756 26
|
| Hospital Charge Code |
5381661
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$595.65 |
| Rate for Payer: Aetna Commercial |
$595.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$539.22
|
| Rate for Payer: Aetna Managed Medicare |
$51.82
|
| Rate for Payer: Anthem Medicare Advantage |
$51.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.82
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna Commercial |
$595.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.82
|
| Rate for Payer: Health EOS Commercial |
$570.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.82
|
| Rate for Payer: Multiplan Commercial |
$501.60
|
| Rate for Payer: Preferred Network Access Commercial |
$595.65
|
| Rate for Payer: Quartz Beloit One Network |
$275.88
|
| Rate for Payer: Quartz Commercial |
$357.39
|
| Rate for Payer: Quartz Medicare Advantage |
$51.82
|
| Rate for Payer: The Alliance Commercial |
$196.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.82
|
| Rate for Payer: WEA Trust Commercial |
$344.85
|
| Rate for Payer: WPS Commercial |
$259.10
|
|
|
ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV 75736
|
Professional
|
$795.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
5104621
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.70 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Aetna Managed Medicare |
$136.70
|
| Rate for Payer: Anthem Medicare Advantage |
$136.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.70
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$755.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$397.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.70
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.70
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.25
|
| Rate for Payer: Quartz Beloit One Network |
$349.80
|
| Rate for Payer: Quartz Commercial |
$453.15
|
| Rate for Payer: Quartz Medicare Advantage |
$136.70
|
| Rate for Payer: The Alliance Commercial |
$519.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.70
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$683.50
|
|
|
ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV 7573626
|
Professional
|
$795.00
|
|
|
Service Code
|
CPT 75736 26
|
| Hospital Charge Code |
5104622
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.68 |
| Max. Negotiated Rate |
$755.25 |
| Rate for Payer: Aetna Commercial |
$755.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Aetna Managed Medicare |
$49.68
|
| Rate for Payer: Anthem Medicare Advantage |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.68
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$755.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$397.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$723.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.25
|
| Rate for Payer: Quartz Beloit One Network |
$349.80
|
| Rate for Payer: Quartz Commercial |
$453.15
|
| Rate for Payer: Quartz Medicare Advantage |
$49.68
|
| Rate for Payer: The Alliance Commercial |
$188.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.68
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$248.40
|
|
|
Angio Non Select Vert Uni w/wo Arch
|
Facility
IP
|
$2,836.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
3052422
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,389.64 |
| Max. Negotiated Rate |
$2,609.12 |
| Rate for Payer: Aetna Commercial |
$2,552.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,503.08
|
| Rate for Payer: Cash Price |
$850.80
|
| Rate for Payer: Cigna Commercial |
$2,609.12
|
| Rate for Payer: Health EOS Commercial |
$2,524.04
|
| Rate for Payer: HFN Commercial |
$2,609.12
|
| Rate for Payer: Multiplan Commercial |
$2,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,701.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,609.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,389.64
|
| Rate for Payer: Quartz Commercial |
$1,701.60
|
| Rate for Payer: WEA Trust Commercial |
$1,559.80
|
| Rate for Payer: WPS Commercial |
$2,100.63
|
|
|
Angio Non Select Vert Uni w/wo Arch
|
Facility
OP
|
$2,836.00
|
|
|
Service Code
|
CPT 36225
|
| Hospital Charge Code |
3052422
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,389.64 |
| Max. Negotiated Rate |
$14,272.20 |
| Rate for Payer: Aetna Commercial |
$2,552.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,438.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,503.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$850.80
|
| Rate for Payer: Cash Price |
$850.80
|
| Rate for Payer: Cash Price |
$850.80
|
| Rate for Payer: Cigna Commercial |
$2,609.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$2,524.04
|
| Rate for Payer: HFN Commercial |
$2,609.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$2,268.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,609.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,389.64
|
| Rate for Payer: Quartz Commercial |
$1,843.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$14,272.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,559.80
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$2,100.63
|
|
|
Angio Pelvic Select S & I
|
Facility
OP
|
$2,888.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
3052540
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$20,205.70 |
| Rate for Payer: Aetna Commercial |
$2,599.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,483.68
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,877.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,444.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,386.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cigna Commercial |
$2,656.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$2,570.32
|
| Rate for Payer: HFN Commercial |
$2,656.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$2,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,656.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,415.12
|
| Rate for Payer: Quartz Commercial |
$1,877.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$10.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: WEA Trust Commercial |
$1,588.40
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$2,139.14
|
|
|
Angio Pelvic Select S & I
|
Facility
IP
|
$2,888.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
3052540
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,415.12 |
| Max. Negotiated Rate |
$2,656.96 |
| Rate for Payer: Aetna Commercial |
$2,599.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.64
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cigna Commercial |
$2,656.96
|
| Rate for Payer: Health EOS Commercial |
$2,570.32
|
| Rate for Payer: HFN Commercial |
$2,656.96
|
| Rate for Payer: Multiplan Commercial |
$2,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,732.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,656.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,415.12
|
| Rate for Payer: Quartz Commercial |
$1,732.80
|
| Rate for Payer: WEA Trust Commercial |
$1,588.40
|
| Rate for Payer: WPS Commercial |
$2,139.14
|
|
|
ANGIOPLASTY, DIALYSIS
|
Facility
IP
|
$1,872.00
|
|
| Hospital Charge Code |
5260619
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$917.28 |
| Max. Negotiated Rate |
$1,722.24 |
| Rate for Payer: Aetna Commercial |
$1,684.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.16
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,722.24
|
| Rate for Payer: Health EOS Commercial |
$1,666.08
|
| Rate for Payer: HFN Commercial |
$1,722.24
|
| Rate for Payer: Multiplan Commercial |
$1,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.24
|
| Rate for Payer: Quartz Beloit One Network |
$917.28
|
| Rate for Payer: Quartz Commercial |
$1,123.20
|
| Rate for Payer: WEA Trust Commercial |
$1,029.60
|
| Rate for Payer: WPS Commercial |
$1,386.59
|
|
|
ANGIOPLASTY, DIALYSIS
|
Facility
OP
|
$1,872.00
|
|
| Hospital Charge Code |
5260619
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$7,488.00 |
| Rate for Payer: Aetna Commercial |
$1,684.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,609.92
|
| Rate for Payer: Aetna Managed Medicare |
$524.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,216.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$936.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$898.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.16
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cigna Commercial |
$1,722.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,047.57
|
| Rate for Payer: Health EOS Commercial |
$1,666.08
|
| Rate for Payer: HFN Commercial |
$1,722.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,404.00
|
| Rate for Payer: Multiplan Commercial |
$1,497.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.24
|
| Rate for Payer: Quartz Beloit One Network |
$917.28
|
| Rate for Payer: Quartz Commercial |
$1,216.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,123.20
|
| Rate for Payer: The Alliance Commercial |
$7,488.00
|
| Rate for Payer: WEA Trust Commercial |
$1,029.60
|
| Rate for Payer: WPS Commercial |
$1,386.59
|
|
|
Angio Renal Uni w/wo Aorta
|
Facility
IP
|
$11,248.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
3052426
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,511.52 |
| Max. Negotiated Rate |
$10,348.16 |
| Rate for Payer: Aetna Commercial |
$10,123.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,961.44
|
| Rate for Payer: Cash Price |
$3,374.40
|
| Rate for Payer: Cigna Commercial |
$10,348.16
|
| Rate for Payer: Health EOS Commercial |
$10,010.72
|
| Rate for Payer: HFN Commercial |
$10,348.16
|
| Rate for Payer: Multiplan Commercial |
$8,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,348.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,511.52
|
| Rate for Payer: Quartz Commercial |
$6,748.80
|
| Rate for Payer: WEA Trust Commercial |
$6,186.40
|
| Rate for Payer: WPS Commercial |
$8,331.39
|
|
|
Angio Renal Uni w/wo Aorta
|
Facility
OP
|
$11,248.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
3052426
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$26,084.76 |
| Rate for Payer: Aetna Commercial |
$10,123.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,673.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,961.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$3,374.40
|
| Rate for Payer: Cash Price |
$3,374.40
|
| Rate for Payer: Cash Price |
$3,374.40
|
| Rate for Payer: Cigna Commercial |
$10,348.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$10,010.72
|
| Rate for Payer: HFN Commercial |
$10,348.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$8,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,348.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,511.52
|
| Rate for Payer: Quartz Commercial |
$7,311.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$26,084.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$6,186.40
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$8,331.39
|
|
|
ANGIOSCOPY
|
Facility
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2959804
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,620.12 |
| Max. Negotiated Rate |
$6,796.96 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,432.80
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
ANGIOSCOPY
|
Facility
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2959804
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,068.64 |
| Max. Negotiated Rate |
$29,552.00 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,802.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,546.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,134.32
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,541.00
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,802.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,432.80
|
| Rate for Payer: The Alliance Commercial |
$29,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
