|
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: Aetna Gatekeeper/Not Gatekeeper |
$9,673.28
|
| 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
|
|
|
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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| 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
|
|
|
Angioseal 6Fr
|
Professional
|
Both
|
$2,187.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
2550962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$962.28 |
| Max. Negotiated Rate |
$2,077.65 |
| Rate for Payer: Aetna Commercial |
$2,077.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.82
|
| Rate for Payer: Cash Price |
$656.10
|
| Rate for Payer: Cigna Commercial |
$2,077.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,093.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,312.20
|
| Rate for Payer: Health EOS Commercial |
$1,990.17
|
| Rate for Payer: HFN Commercial |
$2,077.65
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,077.65
|
| Rate for Payer: Quartz Beloit One Network |
$962.28
|
| Rate for Payer: Quartz Commercial |
$1,246.59
|
| Rate for Payer: The Alliance Commercial |
$1,093.50
|
| Rate for Payer: WEA Trust Commercial |
$1,202.85
|
| Rate for Payer: WPS Commercial |
$1,619.91
|
|
|
Angioseal 6Fr
|
Facility
|
OP
|
$2,187.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
2550962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.36 |
| Max. Negotiated Rate |
$8,748.00 |
| Rate for Payer: Aetna Commercial |
$1,968.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.82
|
| Rate for Payer: Aetna Managed Medicare |
$612.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,421.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.11
|
| Rate for Payer: Cash Price |
$656.10
|
| Rate for Payer: Cigna Commercial |
$2,012.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.85
|
| Rate for Payer: Health EOS Commercial |
$1,946.43
|
| Rate for Payer: HFN Commercial |
$2,012.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,640.25
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.63
|
| Rate for Payer: Quartz Commercial |
$1,421.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,312.20
|
| Rate for Payer: The Alliance Commercial |
$8,748.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.85
|
| Rate for Payer: WPS Commercial |
$1,619.91
|
|
|
Angioseal 6Fr
|
Facility
|
IP
|
$2,187.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
2550962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,071.63 |
| Max. Negotiated Rate |
$2,012.04 |
| Rate for Payer: Aetna Commercial |
$1,968.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.11
|
| Rate for Payer: Cash Price |
$656.10
|
| Rate for Payer: Cigna Commercial |
$2,012.04
|
| Rate for Payer: Health EOS Commercial |
$1,946.43
|
| Rate for Payer: HFN Commercial |
$2,012.04
|
| Rate for Payer: Multiplan Commercial |
$1,749.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.63
|
| Rate for Payer: Quartz Commercial |
$1,312.20
|
| Rate for Payer: WEA Trust Commercial |
$1,202.85
|
| Rate for Payer: WPS Commercial |
$1,619.91
|
|
|
ANGIOSEAL 6fr VIP CLOSURE 610130
|
Facility
|
OP
|
$4,055.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
2973459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.40 |
| Max. Negotiated Rate |
$16,220.00 |
| Rate for Payer: Aetna Commercial |
$3,649.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,487.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,135.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,635.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,027.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,946.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,149.15
|
| Rate for Payer: Cash Price |
$1,216.50
|
| Rate for Payer: Cigna Commercial |
$3,730.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,269.18
|
| Rate for Payer: Health EOS Commercial |
$3,608.95
|
| Rate for Payer: HFN Commercial |
$3,730.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,041.25
|
| Rate for Payer: Multiplan Commercial |
$3,244.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,433.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,730.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,986.95
|
| Rate for Payer: Quartz Commercial |
$2,635.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,433.00
|
| Rate for Payer: The Alliance Commercial |
$16,220.00
|
| Rate for Payer: WEA Trust Commercial |
$2,230.25
|
| Rate for Payer: WPS Commercial |
$3,003.54
|
|
|
ANGIOSEAL 6fr VIP CLOSURE 610130
|
Facility
|
IP
|
$4,055.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
2973459
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,986.95 |
| Max. Negotiated Rate |
$3,730.60 |
| Rate for Payer: Aetna Commercial |
$3,649.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,487.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,149.15
|
| Rate for Payer: Cash Price |
$1,216.50
|
| Rate for Payer: Cigna Commercial |
$3,730.60
|
| Rate for Payer: Health EOS Commercial |
$3,608.95
|
| Rate for Payer: HFN Commercial |
$3,730.60
|
| Rate for Payer: Multiplan Commercial |
$3,244.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,433.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,730.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,986.95
|
| Rate for Payer: Quartz Commercial |
$2,433.00
|
| Rate for Payer: WEA Trust Commercial |
$2,230.25
|
| Rate for Payer: WPS Commercial |
$3,003.54
|
|
|
Angiotensin Converting Enzyme
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
977869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$175.80
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
Angiotensin Converting Enzyme
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
977869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna Commercial |
$278.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$278.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.80
|
| Rate for Payer: Health EOS Commercial |
$266.63
|
| Rate for Payer: HFN Commercial |
$278.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.54
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$278.35
|
| Rate for Payer: Quartz Beloit One Network |
$128.92
|
| Rate for Payer: Quartz Commercial |
$167.01
|
| Rate for Payer: The Alliance Commercial |
$146.50
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
Angiotensin Converting Enzyme
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
977869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Aetna Managed Medicare |
$14.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.24
|
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Anthem Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.60
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.96
|
| Rate for Payer: Dean Health Medicaid |
$15.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.60
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.60
|
| Rate for Payer: Managed Health Services Medicaid |
$15.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.60
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.90
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.09
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$190.45
|
| Rate for Payer: Quartz Medicare Advantage |
$14.60
|
| Rate for Payer: The Alliance Commercial |
$58.40
|
| Rate for Payer: United Healthcare Medicaid |
$15.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.60
|
| Rate for Payer: United Healthcare PPO |
$219.75
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: Wellcare Medicare |
$14.60
|
| Rate for Payer: WMAP Medicaid |
$15.09
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
Angiotensin Converting Enzyme, CSF
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3965999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$58.40 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$14.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.24
|
| Rate for Payer: Anthem Medicaid |
$15.09
|
| Rate for Payer: Anthem Medicare Advantage |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.60
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.98
|
| Rate for Payer: Dean Health Medicaid |
$15.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.60
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.60
|
| Rate for Payer: Managed Health Services Medicaid |
$15.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.60
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.90
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.09
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$14.60
|
| Rate for Payer: The Alliance Commercial |
$58.40
|
| Rate for Payer: United Healthcare Medicaid |
$15.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.60
|
| Rate for Payer: United Healthcare PPO |
$37.50
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: Wellcare Medicare |
$14.60
|
| Rate for Payer: WMAP Medicaid |
$15.09
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Angiotensin Converting Enzyme, CSF
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3965999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$51.54 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.00
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: HFN Commercial |
$47.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.54
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Angiotensin Converting Enzyme, CSF
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
3965999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
Angio Thoracic S&I
|
Facility
|
IP
|
$6,575.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
3052525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,221.75 |
| Max. Negotiated Rate |
$6,049.00 |
| Rate for Payer: Aetna Commercial |
$5,917.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,654.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,484.75
|
| Rate for Payer: Cash Price |
$1,972.50
|
| Rate for Payer: Cigna Commercial |
$6,049.00
|
| Rate for Payer: Health EOS Commercial |
$5,851.75
|
| Rate for Payer: HFN Commercial |
$6,049.00
|
| Rate for Payer: Multiplan Commercial |
$5,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,945.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,049.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,221.75
|
| Rate for Payer: Quartz Commercial |
$3,945.00
|
| Rate for Payer: WEA Trust Commercial |
$3,616.25
|
| Rate for Payer: WPS Commercial |
$4,870.10
|
|
|
Angio Thoracic S&I
|
Facility
|
OP
|
$6,575.00
|
|
|
Service Code
|
CPT 75605
|
| Hospital Charge Code |
3052525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,156.00 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$5,917.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,654.50
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,273.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,156.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,484.75
|
| 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 |
$1,972.50
|
| Rate for Payer: Cash Price |
$1,972.50
|
| Rate for Payer: Cigna Commercial |
$6,049.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,679.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$5,851.75
|
| Rate for Payer: HFN Commercial |
$6,049.00
|
| 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 |
$5,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,049.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,221.75
|
| Rate for Payer: Quartz Commercial |
$4,273.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: WEA Trust Commercial |
$3,616.25
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$4,870.10
|
|
|
Angio UE/LE Bilateral S&I
|
Facility
|
OP
|
$5,082.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
3052527
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,439.36 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$4,573.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,370.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,303.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,541.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,439.36
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,693.46
|
| 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 |
$1,524.60
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cigna Commercial |
$4,675.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,843.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$4,522.98
|
| Rate for Payer: HFN Commercial |
$4,675.44
|
| 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 |
$4,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,675.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,490.18
|
| Rate for Payer: Quartz Commercial |
$3,303.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: WEA Trust Commercial |
$2,795.10
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$3,764.24
|
|
|
Angio UE/LE Bilateral S&I
|
Facility
|
IP
|
$5,082.00
|
|
|
Service Code
|
CPT 75716
|
| Hospital Charge Code |
3052527
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,490.18 |
| Max. Negotiated Rate |
$4,675.44 |
| Rate for Payer: Aetna Commercial |
$4,573.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,370.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,693.46
|
| Rate for Payer: Cash Price |
$1,524.60
|
| Rate for Payer: Cigna Commercial |
$4,675.44
|
| Rate for Payer: Health EOS Commercial |
$4,522.98
|
| Rate for Payer: HFN Commercial |
$4,675.44
|
| Rate for Payer: Multiplan Commercial |
$4,065.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,049.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,675.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,490.18
|
| Rate for Payer: Quartz Commercial |
$3,049.20
|
| Rate for Payer: WEA Trust Commercial |
$2,795.10
|
| Rate for Payer: WPS Commercial |
$3,764.24
|
|
|
Angio UE/LE Uni S&/I
|
Facility
|
IP
|
$4,410.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
3052526
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,160.90 |
| Max. Negotiated Rate |
$4,057.20 |
| Rate for Payer: Aetna Commercial |
$3,969.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,792.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.30
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,057.20
|
| Rate for Payer: Health EOS Commercial |
$3,924.90
|
| Rate for Payer: HFN Commercial |
$4,057.20
|
| Rate for Payer: Multiplan Commercial |
$3,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,646.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,057.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.90
|
| Rate for Payer: Quartz Commercial |
$2,646.00
|
| Rate for Payer: WEA Trust Commercial |
$2,425.50
|
| Rate for Payer: WPS Commercial |
$3,266.49
|
|
|
Angio UE/LE Uni S&/I
|
Facility
|
OP
|
$4,410.00
|
|
|
Service Code
|
CPT 75710
|
| Hospital Charge Code |
3052526
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,116.80 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$3,969.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,792.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,866.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,205.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,116.80
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,337.30
|
| 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 |
$1,323.00
|
| Rate for Payer: Cash Price |
$1,323.00
|
| Rate for Payer: Cigna Commercial |
$4,057.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,467.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$3,924.90
|
| Rate for Payer: HFN Commercial |
$4,057.20
|
| 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 |
$3,528.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,057.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.90
|
| Rate for Payer: Quartz Commercial |
$2,866.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: WEA Trust Commercial |
$2,425.50
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$3,266.49
|
|
|
Angio Vertebral UNI w/wo Arch
|
Facility
|
IP
|
$4,592.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
3052423
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,250.08 |
| Max. Negotiated Rate |
$4,224.64 |
| Rate for Payer: Aetna Commercial |
$4,132.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,949.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,433.76
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$4,224.64
|
| Rate for Payer: Health EOS Commercial |
$4,086.88
|
| Rate for Payer: HFN Commercial |
$4,224.64
|
| Rate for Payer: Multiplan Commercial |
$3,673.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,755.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,224.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.08
|
| Rate for Payer: Quartz Commercial |
$2,755.20
|
| Rate for Payer: WEA Trust Commercial |
$2,525.60
|
| Rate for Payer: WPS Commercial |
$3,401.29
|
|
|
Angio Vertebral UNI w/wo Arch
|
Facility
|
OP
|
$4,592.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
3052423
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,250.08 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$4,132.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,949.12
|
| 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 |
$2,433.76
|
| 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 |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cigna Commercial |
$4,224.64
|
| 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 |
$4,086.88
|
| Rate for Payer: HFN Commercial |
$4,224.64
|
| 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 |
$3,673.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,224.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.08
|
| Rate for Payer: Quartz Commercial |
$2,984.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| 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 |
$2,525.60
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$3,401.29
|
|
|
Angio Visceral Select W/WO AO S&I
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
3052539
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,160.16 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$2,175.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.16
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.01
|
| 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 |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,223.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,352.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$2,151.13
|
| Rate for Payer: HFN Commercial |
$2,223.64
|
| 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 |
$1,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.33
|
| Rate for Payer: Quartz Commercial |
$1,571.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
Angio Visceral Select W/WO AO S&I
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 75726
|
| Hospital Charge Code |
3052539
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,184.33 |
| Max. Negotiated Rate |
$2,223.64 |
| Rate for Payer: Aetna Commercial |
$2,175.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.01
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,223.64
|
| Rate for Payer: Health EOS Commercial |
$2,151.13
|
| Rate for Payer: HFN Commercial |
$2,223.64
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.33
|
| Rate for Payer: Quartz Commercial |
$1,450.20
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
A niger / 34938
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
977781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.43 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.20
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: HFN Commercial |
$77.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: The Alliance Commercial |
$41.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
