|
Velban 1 mg Charge
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.91
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$13.06
|
|
|
Velcade 0.1 mg Charge
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$122.51 |
| Rate for Payer: Aetna Commercial |
$122.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$2.79
|
| Rate for Payer: Anthem Medicare Advantage |
$2.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.79
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$122.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.15
|
| Rate for Payer: Health EOS Commercial |
$117.35
|
| Rate for Payer: HFN Commercial |
$122.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$4.18
|
| Rate for Payer: Preferred Network Access Commercial |
$122.51
|
| Rate for Payer: Quartz Beloit One Network |
$56.74
|
| Rate for Payer: Quartz Commercial |
$73.51
|
| Rate for Payer: Quartz Medicare Advantage |
$2.79
|
| Rate for Payer: The Alliance Commercial |
$7.66
|
| Rate for Payer: United Healthcare Medicaid |
$2.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.79
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$5.38
|
|
|
Velcade 0.1 mg Charge
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
Velcade 0.1 mg Charge
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.85
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$11.15
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$5.38
|
|
|
Vena Cava Filter Insertion
|
Facility
|
OP
|
$8,784.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
3529588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| 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 |
$8,404.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
Vena Cava Filter Insertion
|
Facility
|
IP
|
$8,784.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
3529588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
Vena Cava Filter Removal
|
Facility
|
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3052432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,462.73 |
| Max. Negotiated Rate |
$6,501.46 |
| Rate for Payer: Aetna Commercial |
$6,360.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,077.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,745.40
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,501.46
|
| Rate for Payer: Health EOS Commercial |
$6,289.45
|
| Rate for Payer: HFN Commercial |
$6,501.46
|
| Rate for Payer: Multiplan Commercial |
$5,653.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,501.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,462.73
|
| Rate for Payer: Quartz Commercial |
$4,240.08
|
| Rate for Payer: WEA Trust Commercial |
$3,886.74
|
| Rate for Payer: WPS Commercial |
$5,234.19
|
|
|
Vena Cava Filter Removal
|
Facility
|
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3052432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$12,361.20 |
| Rate for Payer: Aetna Commercial |
$6,360.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,077.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,745.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,501.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$6,289.45
|
| Rate for Payer: HFN Commercial |
$6,501.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$5,653.44
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,501.46
|
| Rate for Payer: Quartz Beloit One Network |
$3,462.73
|
| Rate for Payer: Quartz Commercial |
$4,593.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$5,648.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$3,886.74
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$5,234.19
|
|
|
Vena Cava Filter Reposition
|
Facility
|
OP
|
$5,685.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
3052431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,897.08 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$5,321.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,084.66
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna Commercial |
$5,439.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$5,262.04
|
| Rate for Payer: HFN Commercial |
$5,439.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$4,729.92
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,439.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,897.08
|
| Rate for Payer: Quartz Commercial |
$3,843.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$3,251.82
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$4,379.16
|
|
|
Vena Cava Filter Reposition
|
Facility
|
IP
|
$5,685.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
3052431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,897.08 |
| Max. Negotiated Rate |
$5,439.41 |
| Rate for Payer: Aetna Commercial |
$5,321.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,084.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,133.57
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna Commercial |
$5,439.41
|
| Rate for Payer: Health EOS Commercial |
$5,262.04
|
| Rate for Payer: HFN Commercial |
$5,439.41
|
| Rate for Payer: Multiplan Commercial |
$4,729.92
|
| Rate for Payer: Preferred Network Access Commercial |
$5,439.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,897.08
|
| Rate for Payer: Quartz Commercial |
$3,547.44
|
| Rate for Payer: WEA Trust Commercial |
$3,251.82
|
| Rate for Payer: WPS Commercial |
$4,379.16
|
|
|
VENACAVAL FILTER
|
Facility
|
IP
|
$16,700.00
|
|
| Hospital Charge Code |
2960499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,510.32 |
| Max. Negotiated Rate |
$15,978.56 |
| Rate for Payer: Aetna Commercial |
$15,631.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,936.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,205.04
|
| Rate for Payer: Cash Price |
$5,010.00
|
| Rate for Payer: Cigna Commercial |
$15,978.56
|
| Rate for Payer: Health EOS Commercial |
$15,457.52
|
| Rate for Payer: HFN Commercial |
$15,978.56
|
| Rate for Payer: Multiplan Commercial |
$13,894.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,978.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,510.32
|
| Rate for Payer: Quartz Commercial |
$10,420.80
|
| Rate for Payer: WEA Trust Commercial |
$9,552.40
|
| Rate for Payer: WPS Commercial |
$12,864.01
|
|
|
VENACAVAL FILTER
|
Facility
|
OP
|
$16,700.00
|
|
| Hospital Charge Code |
2960499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,863.04 |
| Max. Negotiated Rate |
$15,978.56 |
| Rate for Payer: Aetna Commercial |
$15,631.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,936.48
|
| Rate for Payer: Aetna Managed Medicare |
$4,863.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,289.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,684.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,336.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,205.04
|
| Rate for Payer: Cash Price |
$5,010.00
|
| Rate for Payer: Cigna Commercial |
$15,978.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,719.40
|
| Rate for Payer: Health EOS Commercial |
$15,457.52
|
| Rate for Payer: HFN Commercial |
$15,978.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,026.00
|
| Rate for Payer: Multiplan Commercial |
$13,894.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15,978.56
|
| Rate for Payer: Quartz Beloit One Network |
$8,510.32
|
| Rate for Payer: Quartz Commercial |
$11,289.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,420.80
|
| Rate for Payer: The Alliance Commercial |
$8,684.00
|
| Rate for Payer: WEA Trust Commercial |
$9,552.40
|
| Rate for Payer: WPS Commercial |
$12,864.01
|
|
|
Venofer 1 mg Charge
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.25
|
| Rate for Payer: Anthem Medicare Advantage |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.25
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.24
|
| Rate for Payer: Health EOS Commercial |
$2.84
|
| Rate for Payer: HFN Commercial |
$2.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.25
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$0.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2.96
|
| Rate for Payer: Quartz Beloit One Network |
$1.37
|
| Rate for Payer: Quartz Commercial |
$1.78
|
| Rate for Payer: Quartz Medicare Advantage |
$0.25
|
| Rate for Payer: The Alliance Commercial |
$0.69
|
| Rate for Payer: United Healthcare Medicaid |
$0.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.25
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.60
|
|
|
Venofer 1 mg Charge
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.32
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.00
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.60
|
|
|
Venofer 1 mg Charge
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
2958932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Venofer 20mg/ml
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
3005565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$341.94 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$418.70
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
Venofer 20mg/ml
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
HCPCS J1756
|
| Hospital Charge Code |
3005565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Aetna Managed Medicare |
$195.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.32
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.38
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$453.60
|
| Rate for Payer: Quartz Medicare Advantage |
$418.70
|
| Rate for Payer: The Alliance Commercial |
$1.00
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$0.60
|
|
|
Venofer Supplies
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3005577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Venofer Supplies
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3005577
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Venogram Extremity
|
Facility
|
IP
|
$2,052.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
3913412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,045.70 |
| Max. Negotiated Rate |
$1,963.35 |
| Rate for Payer: Aetna Commercial |
$1,920.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,835.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.06
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,963.35
|
| Rate for Payer: Health EOS Commercial |
$1,899.33
|
| Rate for Payer: HFN Commercial |
$1,963.35
|
| Rate for Payer: Multiplan Commercial |
$1,707.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,963.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.70
|
| Rate for Payer: Quartz Commercial |
$1,280.45
|
| Rate for Payer: WEA Trust Commercial |
$1,173.74
|
| Rate for Payer: WPS Commercial |
$1,580.66
|
|
|
Venogram Extremity
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
CPT 36005
|
| Hospital Charge Code |
3913412
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$157.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,920.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,835.31
|
| Rate for Payer: Aetna Managed Medicare |
$597.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,387.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,067.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,024.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,131.06
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,963.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,899.33
|
| Rate for Payer: HFN Commercial |
$1,963.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,600.56
|
| Rate for Payer: Multiplan Commercial |
$1,707.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,963.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.70
|
| Rate for Payer: Quartz Commercial |
$1,387.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,280.45
|
| Rate for Payer: The Alliance Commercial |
$157.37
|
| Rate for Payer: WEA Trust Commercial |
$1,173.74
|
| Rate for Payer: WPS Commercial |
$1,580.66
|
|
|
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 |
$3,117.73 |
| Max. Negotiated Rate |
$5,853.70 |
| Rate for Payer: Aetna Commercial |
$5,726.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,471.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,372.24
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cigna Commercial |
$5,853.70
|
| Rate for Payer: Health EOS Commercial |
$5,662.82
|
| Rate for Payer: HFN Commercial |
$5,853.70
|
| Rate for Payer: Multiplan Commercial |
$5,090.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,853.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,117.73
|
| Rate for Payer: Quartz Commercial |
$3,817.63
|
| Rate for Payer: WEA Trust Commercial |
$3,499.50
|
| Rate for Payer: WPS Commercial |
$4,712.70
|
|
|
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 |
$1,656.63 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$5,726.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,471.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,135.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,181.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,054.11
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,372.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cash Price |
$1,835.40
|
| Rate for Payer: Cigna Commercial |
$5,853.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,560.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$5,662.82
|
| Rate for Payer: HFN Commercial |
$5,853.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$5,090.18
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,853.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,117.73
|
| Rate for Payer: Quartz Commercial |
$4,135.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: WEA Trust Commercial |
$3,499.50
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$4,712.70
|
|
|
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 |
$2,267.21 |
| Max. Negotiated Rate |
$4,256.80 |
| Rate for Payer: Aetna Commercial |
$4,164.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.29
|
| Rate for Payer: Cash Price |
$1,334.70
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: Health EOS Commercial |
$4,117.99
|
| Rate for Payer: HFN Commercial |
$4,256.80
|
| Rate for Payer: Multiplan Commercial |
$3,701.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.21
|
| Rate for Payer: Quartz Commercial |
$2,776.18
|
| Rate for Payer: WEA Trust Commercial |
$2,544.83
|
| Rate for Payer: WPS Commercial |
$3,427.06
|
|
|
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 |
$1,656.63 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$4,164.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,007.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,313.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.94
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$1,334.70
|
| Rate for Payer: Cash Price |
$1,334.70
|
| Rate for Payer: Cigna Commercial |
$4,256.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,589.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$4,117.99
|
| Rate for Payer: HFN Commercial |
$4,256.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$3,701.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.21
|
| Rate for Payer: Quartz Commercial |
$3,007.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: WEA Trust Commercial |
$2,544.83
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$3,427.06
|
|
