|
Velban 1 mg Charge
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Velban 1 mg Charge
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$2,102.52 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.65
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$2,102.52
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$12.56
|
|
|
Velcade 0.1 mg Charge
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$7,802.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Anthem Medicare Advantage |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.96
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.96
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.94
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1.96
|
| Rate for Payer: The Alliance Commercial |
$7,802.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: Wellcare Medicare |
$1.96
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Velcade 0.1 mg Charge
|
Professional
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$3.03
|
| Rate for Payer: Anthem Medicare Advantage |
$3.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.03
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$117.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.07
|
| Rate for Payer: Health EOS Commercial |
$112.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Preferred Network Access Commercial |
$117.80
|
| Rate for Payer: Quartz Beloit One Network |
$54.56
|
| Rate for Payer: Quartz Commercial |
$70.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3.03
|
| Rate for Payer: The Alliance Commercial |
$8.34
|
| Rate for Payer: United Healthcare Medicaid |
$1.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.03
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Velcade 0.1 mg Charge
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Vena Cava Filter Insertion
|
Facility
IP
|
$8,784.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
3529588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
Vena Cava Filter Insertion
|
Facility
OP
|
$8,784.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
3529588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$20,205.70 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| 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 |
$4,655.52
|
| 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 |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| 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 |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| 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 |
$4,831.20
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
Vena Cava Filter Removal
|
Facility
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3052432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,594.08 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| 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 |
$3,601.35
|
| 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 |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| 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 |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,416.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$2,594.08
|
| 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 |
$3,737.25
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
Vena Cava Filter Removal
|
Facility
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3052432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,329.55 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,077.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,077.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
Vena Cava Filter Reposition
|
Facility
OP
|
$5,685.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
3052431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,785.65 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$5,116.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,889.10
|
| 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 |
$3,013.05
|
| 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 |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna Commercial |
$5,230.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$5,059.65
|
| Rate for Payer: HFN Commercial |
$5,230.20
|
| 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 |
$4,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,230.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,785.65
|
| Rate for Payer: Quartz Commercial |
$3,695.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| 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 |
$3,126.75
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,210.88
|
|
|
Vena Cava Filter Reposition
|
Facility
IP
|
$5,685.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
3052431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,785.65 |
| Max. Negotiated Rate |
$5,230.20 |
| Rate for Payer: Aetna Commercial |
$5,116.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,013.05
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna Commercial |
$5,230.20
|
| Rate for Payer: Health EOS Commercial |
$5,059.65
|
| Rate for Payer: HFN Commercial |
$5,230.20
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,411.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,230.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,785.65
|
| Rate for Payer: Quartz Commercial |
$3,411.00
|
| Rate for Payer: WEA Trust Commercial |
$3,126.75
|
| Rate for Payer: WPS Commercial |
$4,210.88
|
|
|
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: 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
|
|
|
VENACAVAL FILTER
|
Facility
OP
|
$16,700.00
|
|
| Hospital Charge Code |
2960499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,676.00 |
| Max. Negotiated Rate |
$66,800.00 |
| Rate for Payer: Aetna Commercial |
$15,030.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,362.00
|
| Rate for Payer: Aetna Managed Medicare |
$4,676.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,855.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,350.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,016.00
|
| 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: Dean Health DHI/DHP/ASO |
$9,345.32
|
| Rate for Payer: Health EOS Commercial |
$14,863.00
|
| Rate for Payer: HFN Commercial |
$15,364.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,525.00
|
| 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 |
$10,855.00
|
| Rate for Payer: Quartz Medicare Advantage |
$10,020.00
|
| Rate for Payer: The Alliance Commercial |
$66,800.00
|
| Rate for Payer: WEA Trust Commercial |
$9,185.00
|
| Rate for Payer: WPS Commercial |
$12,369.69
|
|
|
Venofer 1 mg Charge
|
Professional
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.21
|
| Rate for Payer: Anthem Medicare Advantage |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.21
|
| 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 |
$1.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.23
|
| Rate for Payer: Health EOS Commercial |
$2.73
|
| 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: Independent Care Health Plan Medicare |
$0.21
|
| 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: Quartz Medicare Advantage |
$0.21
|
| Rate for Payer: The Alliance Commercial |
$0.57
|
| Rate for Payer: United Healthcare Medicaid |
$0.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.21
|
| 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 |
$3,402.00 |
| 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 |
$3,402.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$0.57
|
|
|
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: 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 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 |
$3,402.00 |
| 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 |
$3,402.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| 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: 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 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: 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 |
$5,812.20 |
| 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 |
$5,812.20
|
| 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: 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
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: 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 Bilat S&I
|
Facility
OP
|
$6,118.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
3052529
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,471.36 |
| Max. Negotiated Rate |
$5,888.65 |
| 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 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 |
$1,471.36
|
| 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 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: 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
|
|
