|
VENACAVAL FILTER
|
Facility
|
IP
|
$16,700.00
|
|
| Hospital Charge Code |
2960499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,183.00 |
| Max. Negotiated Rate |
$15,364.00 |
| Rate for Payer: Aetna Commercial |
$15,030.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,362.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,851.00
|
| Rate for Payer: Cash Price |
$5,010.00
|
| Rate for Payer: Cigna Commercial |
$15,364.00
|
| Rate for Payer: Health EOS Commercial |
$14,863.00
|
| Rate for Payer: HFN Commercial |
$15,364.00
|
| Rate for Payer: Multiplan Commercial |
$13,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,020.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,364.00
|
| Rate for Payer: Quartz Beloit One Network |
$8,183.00
|
| Rate for Payer: Quartz Commercial |
$10,020.00
|
| Rate for Payer: WEA Trust Commercial |
$9,185.00
|
| Rate for Payer: WPS Commercial |
$12,369.69
|
|
|
Venofer 1 mg Charge
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
Venofer 1 mg Charge
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.23
|
| Rate for Payer: Health EOS Commercial |
$2.73
|
| Rate for Payer: HFN Commercial |
$2.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2.85
|
| Rate for Payer: Quartz Beloit One Network |
$1.32
|
| Rate for Payer: Quartz Commercial |
$1.71
|
| Rate for Payer: The Alliance Commercial |
$1.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.22
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$0.57
|
|
|
Venofer 1 mg Charge
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.30
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$0.57
|
|
|
Venofer 20mg/ml
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
3005565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
Venofer 20mg/ml
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
3005565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.30
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$0.57
|
|
|
Venofer Supplies
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3005577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Venofer Supplies
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3005577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Venogram Extremity
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
3913412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$574.56 |
| Max. Negotiated Rate |
$8,208.00 |
| Rate for Payer: Aetna Commercial |
$1,846.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,764.72
|
| Rate for Payer: Aetna Managed Medicare |
$574.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,026.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.56
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,887.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,826.28
|
| Rate for Payer: HFN Commercial |
$1,887.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,539.00
|
| Rate for Payer: Multiplan Commercial |
$1,641.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,887.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,005.48
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,231.20
|
| Rate for Payer: The Alliance Commercial |
$8,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,128.60
|
| Rate for Payer: WPS Commercial |
$1,519.92
|
|
|
Venogram Extremity
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
3913412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,005.48 |
| Max. Negotiated Rate |
$1,887.84 |
| Rate for Payer: Aetna Commercial |
$1,846.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,764.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.56
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,887.84
|
| Rate for Payer: Health EOS Commercial |
$1,826.28
|
| Rate for Payer: HFN Commercial |
$1,887.84
|
| Rate for Payer: Multiplan Commercial |
$1,641.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,887.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,005.48
|
| Rate for Payer: Quartz Commercial |
$1,231.20
|
| Rate for Payer: WEA Trust Commercial |
$1,128.60
|
| Rate for Payer: WPS Commercial |
$1,519.92
|
|
|
Venogram Extremity Bilat S&I
|
Facility
|
OP
|
$6,118.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
3052529
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,582.97 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$5,506.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,261.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,976.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,059.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,936.64
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,423.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$5,445.02
|
| Rate for Payer: HFN Commercial |
$5,628.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$4,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,628.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.82
|
| Rate for Payer: Quartz Commercial |
$3,976.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$3,364.90
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$4,531.60
|
|
|
Venogram Extremity Bilat S&I
|
Facility
|
IP
|
$6,118.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
3052529
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,997.82 |
| Max. Negotiated Rate |
$5,628.56 |
| Rate for Payer: Aetna Commercial |
$5,506.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,261.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,242.54
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cigna Commercial |
$5,628.56
|
| Rate for Payer: Health EOS Commercial |
$5,445.02
|
| Rate for Payer: HFN Commercial |
$5,628.56
|
| Rate for Payer: Multiplan Commercial |
$4,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,670.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,628.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,997.82
|
| Rate for Payer: Quartz Commercial |
$3,670.80
|
| Rate for Payer: WEA Trust Commercial |
$3,364.90
|
| Rate for Payer: WPS Commercial |
$4,531.60
|
|
|
Venogram Extremity Uni S&I
|
Facility
|
IP
|
$4,449.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
3052528
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,180.01 |
| Max. Negotiated Rate |
$4,093.08 |
| Rate for Payer: Aetna Commercial |
$4,004.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,826.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,357.97
|
| Rate for Payer: Cash Price |
$1,334.70
|
| Rate for Payer: Cigna Commercial |
$4,093.08
|
| Rate for Payer: Health EOS Commercial |
$3,959.61
|
| Rate for Payer: HFN Commercial |
$4,093.08
|
| Rate for Payer: Multiplan Commercial |
$3,559.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,669.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,093.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,180.01
|
| Rate for Payer: Quartz Commercial |
$2,669.40
|
| Rate for Payer: WEA Trust Commercial |
$2,446.95
|
| Rate for Payer: WPS Commercial |
$3,295.37
|
|
|
Venogram Extremity Uni S&I
|
Facility
|
OP
|
$4,449.00
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
3052528
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,582.97 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$4,004.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,826.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,891.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,224.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,135.52
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,357.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$1,334.70
|
| Rate for Payer: Cash Price |
$1,334.70
|
| Rate for Payer: Cigna Commercial |
$4,093.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,489.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$3,959.61
|
| Rate for Payer: HFN Commercial |
$4,093.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$3,559.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,093.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,180.01
|
| Rate for Payer: Quartz Commercial |
$2,891.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$2,446.95
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$3,295.37
|
|
|
Venogram IVC S&I
|
Facility
|
IP
|
$10,717.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
4378733
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,251.33 |
| Max. Negotiated Rate |
$9,859.64 |
| Rate for Payer: Aetna Commercial |
$9,645.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,216.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,680.01
|
| Rate for Payer: Cash Price |
$3,215.10
|
| Rate for Payer: Cigna Commercial |
$9,859.64
|
| Rate for Payer: Health EOS Commercial |
$9,538.13
|
| Rate for Payer: HFN Commercial |
$9,859.64
|
| Rate for Payer: Multiplan Commercial |
$8,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,430.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,859.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,251.33
|
| Rate for Payer: Quartz Commercial |
$6,430.20
|
| Rate for Payer: WEA Trust Commercial |
$5,894.35
|
| Rate for Payer: WPS Commercial |
$7,938.08
|
|
|
Venogram IVC S&I
|
Facility
|
OP
|
$10,717.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
4378733
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$9,645.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,216.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,966.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,358.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,144.16
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,680.01
|
| 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 |
$3,215.10
|
| Rate for Payer: Cash Price |
$3,215.10
|
| Rate for Payer: Cigna Commercial |
$9,859.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,997.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$9,538.13
|
| Rate for Payer: HFN Commercial |
$9,859.64
|
| 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 |
$8,573.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$9,859.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,251.33
|
| Rate for Payer: Quartz Commercial |
$6,966.05
|
| 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 |
$5,894.35
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$7,938.08
|
|
|
Venogram SVC S&I
|
Facility
|
IP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
4378738
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,431.56 |
| Max. Negotiated Rate |
$8,320.48 |
| Rate for Payer: Aetna Commercial |
$8,139.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,777.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,793.32
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,320.48
|
| Rate for Payer: Health EOS Commercial |
$8,049.16
|
| Rate for Payer: HFN Commercial |
$8,320.48
|
| Rate for Payer: Multiplan Commercial |
$7,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,426.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,320.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,431.56
|
| Rate for Payer: Quartz Commercial |
$5,426.40
|
| Rate for Payer: WEA Trust Commercial |
$4,974.20
|
| Rate for Payer: WPS Commercial |
$6,698.89
|
|
|
Venogram SVC S&I
|
Facility
|
OP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
4378738
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,582.97 |
| Max. Negotiated Rate |
$8,320.48 |
| Rate for Payer: Aetna Commercial |
$8,139.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,777.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,878.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,522.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,341.12
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,793.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,320.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,061.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$8,049.16
|
| Rate for Payer: HFN Commercial |
$8,320.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$7,235.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,320.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,431.56
|
| Rate for Payer: Quartz Commercial |
$5,878.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$4,974.20
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$6,698.89
|
|
|
Venography caval inferior serialography RS&I 7582526
|
Professional
|
Both
|
$996.00
|
|
|
Service Code
|
CPT 75825 26
|
| Hospital Charge Code |
5372742
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.31 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Aetna Commercial |
$946.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.56
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$498.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$597.60
|
| Rate for Payer: Health EOS Commercial |
$906.36
|
| Rate for Payer: HFN Commercial |
$946.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.31
|
| Rate for Payer: Multiplan Commercial |
$796.80
|
| Rate for Payer: Preferred Network Access Commercial |
$946.20
|
| Rate for Payer: Quartz Beloit One Network |
$438.24
|
| Rate for Payer: Quartz Commercial |
$567.72
|
| Rate for Payer: The Alliance Commercial |
$498.00
|
| Rate for Payer: WEA Trust Commercial |
$547.80
|
| Rate for Payer: WPS Commercial |
$737.74
|
|
|
VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I 7582726
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
CPT 75827 26
|
| Hospital Charge Code |
6182587
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.48 |
| Max. Negotiated Rate |
$1,343.30 |
| Rate for Payer: Aetna Commercial |
$1,343.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,216.04
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$1,343.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$707.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.40
|
| Rate for Payer: Health EOS Commercial |
$1,286.74
|
| Rate for Payer: HFN Commercial |
$1,343.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.48
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,343.30
|
| Rate for Payer: Quartz Beloit One Network |
$622.16
|
| Rate for Payer: Quartz Commercial |
$805.98
|
| Rate for Payer: The Alliance Commercial |
$707.00
|
| Rate for Payer: WEA Trust Commercial |
$777.70
|
| Rate for Payer: WPS Commercial |
$1,047.35
|
|
|
Venography Extremity Billateral RS&I 75822
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
5192610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.08 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna Commercial |
$552.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$552.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$529.62
|
| Rate for Payer: HFN Commercial |
$552.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.63
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.90
|
| Rate for Payer: Quartz Beloit One Network |
$256.08
|
| Rate for Payer: Quartz Commercial |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
Venography Extremity Billateral RS&I 7582226
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 75822 26
|
| Hospital Charge Code |
5192611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna Commercial |
$552.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$552.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$529.62
|
| Rate for Payer: HFN Commercial |
$552.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.93
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.90
|
| Rate for Payer: Quartz Beloit One Network |
$256.08
|
| Rate for Payer: Quartz Commercial |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
Venography Venous Sinus/Jugular Cath RS&I 75860
|
Professional
|
Both
|
$5,590.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
5190608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$453.85 |
| Max. Negotiated Rate |
$5,310.50 |
| Rate for Payer: Aetna Commercial |
$5,310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,807.40
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cigna Commercial |
$5,310.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,795.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,354.00
|
| Rate for Payer: Health EOS Commercial |
$5,086.90
|
| Rate for Payer: HFN Commercial |
$5,310.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$453.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$453.85
|
| Rate for Payer: Multiplan Commercial |
$4,472.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,310.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,459.60
|
| Rate for Payer: Quartz Commercial |
$3,186.30
|
| Rate for Payer: The Alliance Commercial |
$2,795.00
|
| Rate for Payer: WEA Trust Commercial |
$3,074.50
|
| Rate for Payer: WPS Commercial |
$4,140.51
|
|
|
Venography Venous Sinus/Jugular Cath RS&I 7586026
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 75860 26
|
| Hospital Charge Code |
5190609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.47 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Aetna Commercial |
$584.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$584.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.00
|
| Rate for Payer: Health EOS Commercial |
$559.65
|
| Rate for Payer: HFN Commercial |
$584.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.47
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Preferred Network Access Commercial |
$584.25
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$350.55
|
| Rate for Payer: The Alliance Commercial |
$307.50
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Venous Access Fluoro Guidance S&I +
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
4253580
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$448.84 |
| Max. Negotiated Rate |
$842.72 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.48
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$842.72
|
| Rate for Payer: Health EOS Commercial |
$815.24
|
| Rate for Payer: HFN Commercial |
$842.72
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: NAPHCARE Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$842.72
|
| Rate for Payer: Quartz Beloit One Network |
$448.84
|
| Rate for Payer: Quartz Commercial |
$549.60
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
